February 23, 2015 NURS 330 Human Reproductive Health

Agenda Review In-Class Assignment Quiz Group Project Review & Preparation Contraception Lecture No In-Class Assignment

Quiz

Group Project Project and presentation due on 3/2/15 Assign order of presentation Q &A

CONTRACEPTION

Methods of Contraception and Birth Control _ Birth control _ any means of preventing a birth from taking place; includes contraception and abortion _ Contraception _ The prevention of conception _ Technique designed to either prevent the release of an ovum, prevent the fertilization of an ovum, or prevent a fertilized ovum from implanting in the uterine wall

Alternatives to Intercourse _Abstinence-refraining from sexual intercourse (vaginal, oral, & anal) _Celibacy-not engaging in any kind of sexual activity _Outercourse-a method of birth control using all avenues of sexual intimacy except sexual intercourse

Choosing a Method _Best method is the one you will use consistently _Theoretical effectiveness _User/Typical effectiveness

Failure Rates Typical use failure rate – Percentage of typical users of a contraceptive method who will get pregnant within one year Theoretical use failure rate – Percentage of users of a contraceptive method who will get pregnant within one year while using the method perfectly each time

Chance Not a “method” at all Withdrawal (aka: Coitus interruptus) Douching Assumption: cleanses the vaginal canal by squirting a liquid into the vagina Actuality: Not recommended for any use; no good purpose and can promote infections Urination after intercourse

METHODS BARRIERHORMONALLONG-TERMNATURAL FAMILY PLANNING Cervical CapDepo-Provera Lunelle Female Sterilization Basal Body Temperature DiaphragmEmergency Contraception IUDCervical Mucus/ Ovulation Method Female CondomImplantsMale Sterilization Rhythm Method Male CondomPatch The SpongePill Ring

Hormonal Methods work by.. Preventing the release of an ovum Can also cause the cervical mucus to thicken which prevents sperm from entering the uterus The ingestion or injection of estrogen or progestin or a combination of the two.

Emergency Contraception _ Emergency contraceptive pill (EC) _ Also known as Plan B _ Estrogen and progesterone or just progestin. _ For use within 72 hours of unprotected sex. No later than 5 days. _ “morning after pill” is not an appropriate name _ Must be taken well BEFORE implantation.

_ Two forms of pills _ Estrogen & Progestin (the combination pill) _ Most women choose this method _ Side effects from estrogen include severe headaches and high blood pressure _ Progestin (the mini pill) _ Mostly selected due to side effects experienced from estrogen in the combo pill Oral Contraceptives (OC)– The Pill

Combo pill is best for: Any woman (including those over 35) with no risk factors that preclude OCs. Women with mild headaches or migraines Women who have diabetes without any blood vessel related complications Women with a history of abnormal, precancerous Papsmears (displasia).

Implants Works by inserting progestin rods under the skin and continuously release tiny amounts of progestin into the bloodstream – Norplant (used five rods and lasted five years) is no longer available in the United States – Replaced by implanon Uses one rod Provides protection against pregnancy for up to three years – Can be removed at anytime – After removal, can resume menstruation in one month

Injectibles under a clinician's supervision Depo-Provera – Progestin – Administered four times a year Lunelle – Estrogen + Progestin – Administered every 4 weeks

Ortho Evra Patch Estrogen and Progestin A once-a-week birth control option that's as effective as the Pill. It is the first weekly, non-invasive form of reversible contraception How does it work? What are advantages and disadvantages?

Nuva Ring NuvaRing® delivers steady low-dose contraceptive hormones around the clock. – Progestin and Estrogen One ring is used each month. The ring stays in for 3 weeks and then is removed for one week. Then you insert a new NuvaRing®.

Barrier Methods work by… Preventing fertilization of an ovum Providing a physical barrier between the semen and the cervix in order to prevent sperm from reaching the egg cell

Condoms Male Female Use either one or the other at one time – Never both at the same time

Today Sponge Back on the US market blocks sperm from entering the uterus and absorbs and kills off the sperm. Intended to be used with spermicide

Diaphragm Cervical cap Work to prevent sperm from entering the uterus – Intended to be used with spermicide Diaphragm – a flexible ring around the top, the diaphragm is inserted into the vagina prior to sexual intercourse. Cervical Cap – smaller and fits more tightly around the cervix when in place – must be fitted by your doctor and then purchased from a local pharmacy – can leave the cervical cap in place for up to 48 hours

Spermicides Spermicide - substance toxic to sperm _ Contraceptive foam _ Contraceptive film _ Creams, jellies & Vaginal suppositories _ Non-oxynol 9??

Long-term Methods IUD Female Sterilization Male Sterilization

Intrauterine Device (IUD) _ Tiny T-shape plastic or copper device inserted into uterus _ Multiple theories on how it works _ Insertion can be painful, heavy cramping and menstrual flow _ Two currently available in the United States: – Progestasert (~ 10 years) – ParaGard (~ 1 year)

Sterilization WOMEN Laparoscopy- closing the tubes by electrocauterization – Minilaparotomy-tubes are tied off or sealed – Culpotomy-tubes tied and cut – Culdoscopy- Same as Culpotomy; however, leaves less visible scars – Hysterectomy-surgical removal of the uterus MEN Vasectomy _ cut or tie off the Vas deferens

Abortion Spontaneous abortion – aka miscarriage – Loss of baby before 20 weeks of pregnancy Induced abortion – Surgical – Drug-based

Surgical Method Vacuum Aspiration – First trimester method Dilation and Extraction (D & X) – Late surgical method

Drug-Based Methods Mifepristone (RU 486) –Injection, 0rally – An anti-progesterone prevents progesterone from making uterine lining hospitable for implantation If fetus is already implanted, causes the uterus to shed its lining and, along with it, the fertilized fetus – Approved by FDA in September 2000 for abortion As an alternative to surgical procedure – Effectiveness is increased if used with another drug, Misoprostol (95-98%) – Most effective within 7 weeks of fertilization

Drug-Based Methods (cont) Methotrexate –Injection; orally (rarely) – Prevents cell division and multiplication – Can be used to induce an abortion Effectiveness is increased if used with another drug, Misoprostol (95%) – Approved by FDA for treatment of cancer, arthritis and psoriasis – Most effective within 7 weeks of fertilization Misoprostol – orally or vaginally – Legal Drug used in conjunction with above drugs – The second drug used to complete the abortion procedure Taken a day or two after administration of the first drug – Causes the uterus to contract and expel its contents – Approved in the US for coating the stomach of people who take stomach- irritating anti-inflammatory drugs.

Abortifacient A method or substance that causes a fertilized egg that has implanted in the uterine wall or fetus to be expelled. Which of the drug-based methods is an abortifacient?

Source: Perspectives on Sexual and Reproductive Health Incidence of Abortions Nearly half of pregnancies among American women are unintended, and four in 10 of these are terminated by abortion. Twenty-two percent of all pregnancies (excluding miscarriages) end in abortion. In 2005, 1.21 million abortions were performed, down from 1.31 million in From 1973 through 2005, more than 45 million legal abortions occurred. Each year, about two percent of women aged have an abortion; 47% of them have had at least one previous abortion.

Source: Guttmacher Institute When women have abortions

Cost Surgical – In 2005, the cost of a non-hospital abortion with local anesthesia at 10 weeks’ gestation ranged from $90 to $1,800; the average amount paid was $413 (Source: Perspectives on Sexual and Reproductive Health) Drug-based – most providers do charge more for this method

Abortion and the Law Roe v. Wade – 1973 Supreme Court decision stating 1st trimester abortions cannot be regulated by states and the decision to abort is between woman and physician 2nd trimester abortions permitted when mental or physical health of mother at risk 3rd trimester abortions allowed when life of mother at risk

Source: Alan Guttmacher Institute California Law California does not have any of the major types of abortion restrictions – such as waiting period, mandated parental involvement or limitations on publicly funded abortions – often found in other states.

The Pro-Life and Pro-Choice Controversy Anti-abortion (Pro-life) position Pro-choice position