💊 Contraception & Reproductive Life Planning
Most contraception questions are really contraindication questions. Learn who cannot have estrogen and the rest follows.
🚨 Who must not have estrogen
Estrogen increases clotting. Every contraindication below is either a clot risk or a hormone-sensitive cancer.
- Smoker over 35 - the classic exam stem
- History of DVT, PE or a clotting disorder
- Migraine with aura — stroke risk
- Uncontrolled hypertension
- Known or suspected pregnancy
- Breast cancer; active liver disease
- Under 6 weeks postpartum, or breastfeeding early on
⭐ ACHES — report immediately
Abdominal pain · Chest pain · Headache (severe) · Eye problems · Severe leg pain
Every one of those is a possible clot. This mnemonic is worth more marks than the method list.
📊 The methods, by how well they work
| Method | Typical use | Key teaching |
|---|---|---|
| Implant / IUD | >99% | Most effective; nothing to remember. Copper IUD also works as emergency contraception |
| Sterilization | >99% | Consider permanent; counsel accordingly |
| Injection (Depo) | ~96% | Every 12 weeks; bone density loss — calcium, vitamin D, weight-bearing exercise |
| Combined pill / patch / ring | ~93% | Same time daily; estrogen rules above |
| Condom | ~87% | The ONLY method that prevents STIs |
| Diaphragm | ~83% | Refit after childbirth or big weight change; leave in 6 h after |
| Withdrawal / fertility awareness | ~77–80% | Least reliable |
✅ The teaching point students miss
An IUD or implant is more effective than sterilization on paper — but only condoms protect against infection. A woman with an IUD and a new partner still needs condoms. That is dual protection.
🧠 Missed pill rules
- One pill missed — take it as soon as remembered, even if two in one day. No backup needed
- Two or more missed — take the most recent, continue the pack, and use backup for 7 days
- Vomiting or diarrhea counts as a missed dose
- Antibiotics and anticonvulsants can reduce effectiveness — use backup
🩸 The cycle underneath it all
A 28-day cycle in two halves, with ovulation in the middle.
| Follicular (days 1–14) | Luteal (days 15–28) | |
|---|---|---|
| Hormone | FSH, then estrogen | LH, then progesterone |
| Ovary | Follicle matures | Corpus luteum forms |
| Uterus | Lining rebuilds | Lining becomes secretory, ready to implant |
Ovulation is triggered by the LH surge, about day 14. Menstruation begins about 14 days AFTER ovulation - that half is fixed, and cycle length varies in the first half.
🌡️ Signs of ovulation
- Cervical mucus becomes clear, stretchy and slippery — like raw egg white (spinnbarkeit)
- Basal body temperature dips, then rises about 0.5°F and stays up
- Mittelschmerz — one-sided mid-cycle pain
The temperature rise confirms ovulation after it has happened, so it is poor for avoiding pregnancy but useful for achieving it.
🎯 NCLEX traps
- Smoker over 35 = no estrogen
- ACHES = report immediately
- Only condoms prevent STIs
- Depo = bone density, so calcium and weight-bearing exercise
- Luteal phase is fixed at 14 days; the follicular phase varies
- Breastfeeding is not reliable contraception
STUDY SHEETS
FROM YOUR SAVED SET
Saved study graphics from your own collection. Each one is someone else’s work — check anything clinical against your course materials before you rely on it.
🗺️ The five method families
Start every conversation with one question:
“Would you like to become pregnant in the next year?”
Counselling is person-centred and noncoercive. The client chooses the method — or chooses no method. You make the choice informed, you do not steer it.
| Family | What it is | The hook |
|---|---|---|
| Fertility awareness | Track fertile days; avoid or use a barrier in the window | Needs consistent monitoring and predictable cycles |
| Barrier | Condom, diaphragm, cap, sponge, spermicide | Used at each act |
| Hormonal | Pill, patch, ring, injection, implant | Adherence and safety screening drive the teaching |
| Intrauterine | Copper or levonorgestrel IUD | Long-acting and reversible |
| Permanent | Vasectomy or tubal surgery | Treat as permanent — confirm certainty and consent |
🌿 Natural methods — and the one that is not contraception
🤝 LAM — all three or it does not count
- No return of menses
- Fully or nearly fully breastfeeding, day and night
- Less than 6 months postpartum
Reassess immediately when any one criterion changes. Miss one and the method has stopped working.
↩️ Withdrawal
Requires correct timing every single time, is less effective with typical use than most alternatives, and gives no STI protection.
🚩 Postcoital douching
This is not contraception.
Sperm reach the cervix within seconds. Douching does not prevent pregnancy and must never replace emergency contraception.
🌡️ Fertility awareness — the four signs
| Sign | How it is measured | What trips students up |
|---|---|---|
| Calendar | Standard Days Method is built for cycles 26–32 days | Irregular cycles make it unreliable |
| Basal body temp | Before rising, same time daily, with a thermometer | The rise happens after ovulation; illness and poor sleep skew it |
| Cervical mucus | Slippery, clear, stretchy — like raw egg white | This is the classic exam answer for “how do I know I am fertile” |
| LH testing | Urine kit detects the pre-ovulatory LH surge | Predicts ovulation; does not confirm it happened |
Fertility awareness = mucus + temperature + calendar. If an answer choice is not one of those three — feeling hot, mood swings, breast sensitivity — it is a distractor.
🛡️ Barrier and hormonal timing
🎈 Condoms
- New condom for every act — never reuse either type
- Water- or silicone-based lubricant only. Oil weakens latex
- The internal condom goes in before any penile contact — pre-ejaculate carries sperm and STIs. It can be placed up to 8 hours ahead
⏱️ The numbers
- Diaphragm — leave in 6 hours after intercourse, out within 24 hours
- Patch — weekly × 3, then a patch-free week
- Ring — monthly: 3 weeks in, 1 week out
- Depo — every 12 weeks IM
- Implant — 3 years, inner upper arm
🦴 Depo deposits leave your bones
Black-box warning for bone mineral density loss → calcium, vitamin D, weight-bearing exercise. Return of fertility can take 9–10 months.
Progestin-only methods all share one headline side effect: irregular bleeding, heaviest early on.
🔩 IUDs — strings, timing, and who cannot have one
| Copper | Levonorgestrel | |
|---|---|---|
| Duration | up to 10 years | 3–8 years by product |
| Hormone | none | progestin |
| Bleeding | heavier or longer at first | irregular early, then often lighter |
| Also | most effective emergency contraception | not used with current breast cancer |
🧵 Teach the strings
Check monthly, after each period. Missing, longer, or shorter strings can mean expulsion or perforation — call the provider and use backup.
Placed more than 7 days after bleeding began? Backup for 7 days.
🚨 Do not insert with
- Known pregnancy
- Current purulent cervicitis
- Current chlamydial or gonococcal infection
Seek care for severe pelvic pain, fever, foul discharge, very heavy bleeding, changed strings, or a positive pregnancy test.
Two myths exams love: IUDs are not restricted to people who have given birth, and fertility returns almost immediately after removal.
✂ Permanent methods
Vasectomy
- Blocks the vas deferens
- Does not reduce testosterone, erection, or desire
- Not immediately effective — backup until semen analysis confirms it
Tubal surgery
- Occludes or removes the fallopian tubes
- Effective immediately
- Pregnancy is rare — if it happens, evaluate for ectopic
Tubal ligation is a roadblock, not a shutdown. Ovulation, hormones, and periods all continue — the egg is simply reabsorbed. Sperm can no longer reach the ovum because the tubes are blocked.
⏰ Emergency contraception
| Option | Window | Key points |
|---|---|---|
| Copper IUD | within 5 days | Most effective. Works immediately and keeps working as ongoing contraception |
| Ulipristal 30 mg | within 5 days | Better than LNG late in the window. Wait 5 days before starting hormonal contraception, then backup 7 days |
| Levonorgestrel 1.5 mg | ASAP, within 5 days | Better the sooner it is taken. Start or resume hormonal contraception immediately, then backup 7 days |
EC does not end an established pregnancy and gives no STI protection. No bleeding within 3 weeks → pregnancy test.