1. Contraceptive Management Vanessa Noboa, MD Loyola University Chicago, Stritch School of Medicine, Cook County – Loyola –Provident Family Medicine Residency Program

2. Objectives The learner should be able to..  Recite the definition of Contraceptive Management  Define legal status for minors  List minimum of 3 types of contraceptive management  Match 3 contraceptive managements to three comorbidities

3. Definition  Several techniques and methods used to prevent fertilization or to interrupt pregnancy at various stages

4. History  Earliest documentation of birth control method was in 1850 B.C by Kanhun Gynecologial Papyrus  Earliest form of contraceptive methods:  Acacia gum  spermatocidal  Honey and sodium carbonate  Pessary made from crocodile dung.  Lactation

5. Legal Status  United States  1965: Griswold v. Connecticut  married couples  1972: Eisenstadt v. Baird-> unmarried couples.  Under the Illinois law  >14: Counseling without the consent  <18: Abortions  >12: Treatment for STD or birth control

6. Failure rates for birth control methods when used correctly MethodNumber Male condoms11 OCP1-2 Nuvaring1-2 Patch1-2 DEPOLess than 1 IUDLess than 1

7. Estrogen/Progesterone

8. Hormonal Oral Contraceptive pills Nuvaring Transdermal (patch ) Estrogen/Progesterone

9. Oral Contraceptive Pills  Estrogen/Progesterone  Taken daily, Women over 35 use low does estrogen Side Effects Nausea, HA, Increase BP, Breast Tenderness, Bloating, weight gain Safe Comorbidities Depression, Endometrial Ca, Endometriosis, HA w/o Aura, HIV/AIDS, Seizures, Thyroid Disorder Advantages Dysmenorrhea, menorrhagia, irregular menses, Acne, Hirsutism or polycyctic ovarian syndrome Contraindication Cautious >35 smoking, VTE, Stroke, MI, HTN, DM complicated, Current Breast Ca, Migraines with aura, Cirrhosis, active hepatitis

10. NUVARing Place weekly for 3 weeks, must be placed at least for 7 days in a row Side Effects Vaginal discomfort, increased vaginal discharge Safe Comorbidities Depression, Endometrial Ca, Endometriosis, HA w/o Aura, HIV/AIDS, Seizures, Thyroid Disorder Advantages Obese, compliance Contraindication Cautious >35 smoking, VTE, Stroke, MI, HTN, DM complicated, Current Breast Ca, Migraines with aura, Cirrhosis, active hepatitis

11. Transdermal  Don’t place on breast Side Effects Breast discomfort, skin irritation Safe Comorbidities Depression, Endometrial Ca, Endometriosis, HA w/o Aura, HIV/AIDS, Seizures, Thyroid Disorder Advantages Dysmenorrhea, menorrhagia, irregular menses, Acne, Hirsutism or polycyctic ovarian syndrome Contraindication Cautious >35 smoking, VTE, Stroke, MI, HTN, DM complicated, Current Breast Ca, Migraines with aura, Cirrhosis, active hepatitis

12. Non-Estrogen Progesterone or Copper

13. Non-Estrogen Depo- Provera Dermal Implant IUD Mirena Paraguard

14. Depo-Provera  Administered q 3 months Side Effects Weight gain, decrease bone mineral density Safe Comorbidities Seizures, STD, Smoking, Thyroid Disorder, Uterine Fibroids, valvular heart disease, superficial thrombophlebitis, HTN, HA w/aura, DM, Endometriosis, PID, Ovarian Ca, Ovarian cyst Advantages: Unable to take estrogen, compliance, dysmenorrhea Contraindications Current Breast Ca, Cautious with liver disease, current DVT, Rheumatoid Arthritis

15. Dermal Implant  Minor office procedure, lasting up to 3 yr Side Effects Irregular bleeding or spotting Safe Comorbidities Seizures, STD, Smoking, Thyroid Disorder, Uterine Fibroids, valvular heart disease, superficial thrombophlebitis, HTN, HA w/aura, DM, Endometriosis, PID, Ovarian ca, ovarian cyst, Rheumatoid Arthritis, SLE Advantages Compliance, long term affect Contraindications Current Breast ca, Cautious with liver disease, current DVT

16. IUD Contraindications: Ovarian Ca, Uterine fibroids with distortion of cavity, Cervical Ca awaiting treatment Paraguard-10 yr copperMirena-5 year progesterone Stroke, Breast CA current and h/o, DM, HTN, HA, MI, Liver disease, Smoking, Thyroid disorder, valvular heart disease, varicose veins, current DVT h/o DVT DM, HTN, valvular disease, Thyroid Smoking, ovarian cyst Side Effect: Heavy periodsSide Effect: Spotting

17. Summary  Advantages  Safe Comorbidities  Side effects  Contraindication Estrogen/ Progesterone Progesterone /Copper OCPDermal Implant Nuva RingDepo-Provera Trandermal PatchMirena Paraguard

18. Bibliography  AAFP  Managing Adverse Effects of Hormonal Contraceptives  Initiating Hormonal Contraceptives  Contraceptive Choices in Women with Underlying Medical Condition

19. Thank you