15. Oral Contraceptives Flashcards
What are the Oestrogen oral contraceptives?
Etinyloestradiol & Mestranol
What are the old Progestogens oral contraceptives?
Norethisterone &Levonorgestrel
What are the newest Progestogens oral contraceptives?
Cypoterone & Drospirenone
What are the pseudo-new Progestogens oral contraceptives?
Desogestrel and Gestodene
Which of the Oestrogen oral contraceptives are used the most?
Ethinylestradiol
What are some uses of Norethisterone & Levonorgestrel (Old Progestogens)
○ Used for menstrual irregularity
○ Hormone replacement
○ Morning after pill
○ Some side androgenic effects
What are Desogestrel and Gestodene less sold in the market?
- Increased incidence of thromboembolic disorders
- Still on the market but prescription amount is low
Which of the Progestogens OC have the highest increased risk of thromboembolic event?
Cytoterone (Taken off the market in France)
Which of the Progestogens have aldosterone receptor antagonist acivity, progesteronic activity, antimineralcorticoid and anti-adrenergic activity?
Drospirenone, because it is a derivative of spironolactone which is an aldosterone receptor antagonist
What are the uses of new generation Cypoterone & Drospirenone
○ Can relieve heavy and painful bleeding
○ Can treat PCOS
○ Have anti androgenic activity especially Cypoterone
What are some side effects of progesterone?
can cause androgenic effects such as hirustism, acne
What are COC?
- 28 tablets with 21 active containing fixed dose of progesterone and estrogen and 7 placebo tablet.
- The break will cause some bleeding, very important to not go above 7 days, If over 7 days ovulation can occur
What are sequential prep OC?
- Thought to copy the changes during normal menstruation cycle to reduce some side effects of COC
- Different doses, variations in doses of the 21 active tabs
- It is vital that Sequential prep and minipil are taken at the SAME time everyday
What is the minipil?
- Uses older generation progesterone (Norethisterone & Levonorgestrel)
- Used when estrogen are contraindicated and Lactating women
- At this dose the progestogen does not produce enough inhibition to stop prolactin release whereas estrogen does.
- Can get breakthrough bleeding
It is vital that Sequential prep and minipil are taken at the SAME time everyday
How does OC work?
- Estrogen component inhibit FSH
- Progestogen inhibit LH (not much effect on FSH)
- Progestogen changes the property of the endometrium to make it unfavorable for implantation. (Change in mucus type)
- It also interfere with the coordinated contraction that accomodate fertilisation
Which component of the OCE contribute to Venous Thromboembolism (VTE?
Estrogen
Which os the OC are least likelt yo produce VTE?
The older COCs
Why do some women gain weight when taking COCs?
- Fluid retention (Aldosteric effect)
- Anabolic effect
Is there an increase in breast cancer risk when taking COC?
No
Does COC increase risk of cervical cancer?
Yes, encouraged for cervical screening
Does COC increase risk of uterine (endometrial carcinoma) cancer?
Yes, but progesterone will negate any cancer risk induced by Estrogen
What are the other side effects of OC?
Nausea, vomitting, dizziness, flushing, breast discomfort, headache (before period), weight gain, decreased libido, choasma, acne, depression, iritability, fatigue
What are the benefits of OCs?
Decreased risk of endometrial cancer, ovarian cancer, colorectal cancer and ovarian cyst formation.
Protective effect against benign breast cancer
Reduction in risk of bone fractures
Reduction in dymenorrhea and menorrhagia
What is a vaginal ring?
- Etonogestrel and ethylestradiol inserted into the vagina for three weeks and removed for one week. Repeated.
Effective with lower doses as hormones bypasses the portal circualtion
What is Progestogen only contraceptive?
- Medroxyprogesterone - IM injection every 12 weeks
- Etonorgestrel - Subdermal implant effective for three years
- Morning after pill = 72hrs after unprotected intercourse
