••• Chapter 61^ Family Planning and Sterilization^611
❍ What are advantages of ESSURE?
ESSURE can be done in the physician’s office without the need for conscious/general anesthesia. It is a transcervical
approach with no incision required and may be preferred for obese women, women with abdominal adhesions,
and women with risk factors for general anesthesia.
❍ What is the follow-up post ESSURE?
Hysterosalpingogram must be done 3 months post-procedure to ensure complete tubal blockage. The couple must
use another form of contraception in the interim.
❍ What is the effectiveness of ESSURE?
99.8% effective after 3 years (1 pregnancy in 100 women in 3 years after placement).
NATURAL METHODS
❍ Name fertility awareness-based methods of contraception.
Calendar charting (Standard Days Method, Two Day Method), basal body temperature charting, cervical mucus
charting, sympto-thermal charting, and electronic methods (mini microscopes, hand held computers to evaluate
cervical mucus).
❍ Does pre-ejaculate contain sperm?
No. It is fluid produced by local glands. However, a previous ejaculate may leave sperm hidden within the urethral
lining.
HORMONAL CONTRACEPTION
❍ Are combined oral contraceptives (COC) contraindicated in patients with a history of benign breast disease
or a family history of breast cancer?
No. Only if the woman has current or recent breast cancer.
❍ What positive test prevents women with lupus from taking COC?
Positive antiphospholipid antibodies. This is associated with an increased risk of both arterial and venous thrombosis.
Unless there are other cardiovascular risk factors, women with lupus are good candidates for hormonal contraceptives.
❍ Can women with migraines take COCs?
Women under 35 who have migraines without aura, and without other risk factors for stroke can take COCs.
Women of all ages who have migraines with aura should not take them.
❍ At what age should women stop using COCs?
Women without medical problems who are nonsmokers may continue COCs until menopause.
❍ Should COCs be prescribed to women with diabetes and/or hypertension?
Patients who are compliant with follow-up and management of their hypertension and diabetes may be started on
a trial of COC, provided they have no additional cardiovascular risk factors.