2.2 Hormonal Contraception's Flashcards
Hormonal Methods
- Includes estrogen/progestin medications and pregestational agents.
- Oral
- Transdermal
- Vaginal
- Implantation
- Injection
- Intrauterine Insertion
Oral Contraceptives (COC)
- Regular ingestion of COC’s suppress action of hypothalamus and anterior pituitary which leads to insufficient secretions of FSH and LH.
- Also effects endometrium (uterine lining) bleeding can occur due to hormonal withdrawal.
- Take at the same time everyday.
- Progestin makes cervical mucus thick
- Monophasic pills provide fixed dosage of estrogen and progestin.
- Multiphasic pills alter progestin and estrogen each cycle
Advantages of Oral Contraceptives
- Acceptability increased because does not relate to sexual act
- Regulates irregular cycles
- Treatment of endometriosis
- Protection against endometrial and ovarian cancer
- Improved hirsutism and acne
- Protection against ovarian cysts
- Increase bone mass
Disadvantages of Oral Contraceptives
- Hormones can have adverse effects
- The amounts of estrogen and progestin have been reduced since birth control came out.
COC Contraindications (Medical History)
- Thromboembolic Disorders
- Cerebrovascular or Coronary Artery Disease
- History of Breast Cancer
COC Contraindications (Diseases)
- Migraine with aura
- Multiple sclerosis with prolonged immobility
- Gallbladder disease
- Hepatitis
- Liver Cancer
- Severe Cirrhosis
- Hepatocellular Tumor
- Complicated Solid Organ Transplant
- Use of anti-convulsant
- Diabetes more than 20 years with vascular disease, nephropathy, neuropathy, retinopathy
COC Contraindications (Obstetrical Factors)
- Lactation/Non-Lactation less than 6 weeks post-partum
- Pregnancy
COC General Contraindications
- Smoking if older than 35
- Surgery with prolonged immobilization in the legs
- Hypertension (140/90)
COC Serious Adverse Effects
- Stroke
- MI
- Thromboembolism
- Hypertension
- Gallbladder Disease
- Liver Tumor
Estrogen Excess Side Effects
- Nausea
- Breast tenderness
- Fluid retention
- Chloasma (darkened skin)
Estrogen Deficiency Side Effects
- Early Spotting (days 1-14)
- Hypomenorrhea (abnormally low bleeding)
- Nervousness
- Dyspareunia (painful sex)
Progestin Excess Side Effects
- Increased appetite
- Tiredness
- Depression
- Breast Tenderness
- Vaginal Yeast Infection
- Oily Skin
- Hirsutism
- Post-pill Amenorrhea (absence of mensuration)
Progestin Deficiency Side Effects
- Late spotting and bleeding (days 15-21)
- Heavy flow with clots
- Decreased breast size
Most Common Side Effects of COC
- Bleeding irregularities
- Return to fertility is quick after discontinuing
COC Adverse Effects
A - Abdominal Pain (Liver/Gallbladder Problem)
C - Chest Pain (Clot problem in heart or lungs)
H - Headaches (Stroke/hypertension)
E - Eye problems (Stroke/hypertension)
S - Severe Leg Pain (Thromboembolism)
91 Day COC Regimen
- Take COC’s in 3 month cycles.
- Have fewer menstrual periods
Transdermal Contraceptive
- Prescription Only
- Transdermal patch that delivers progestin and ethinylestradiol.
- Applied to upper outer arm, upper torso, lower abdomen or butt.
- Applied same day once a week for 3 weeks and then 1 week without a patch
Vaginal Contraceptive Ring
- Prescription Only
- Flexible ring worn in vagina
- Delivers continuous progestin and ethinylestradiol.
- Can remain in vagina for 3 weeks followed by 1 week without.
- Does not need to be fitted
Progestin Only Contraceptive
- Inhibits ovulation and thickening
- This decreases the amount of cervical mucus present
- Thinning of endometrium and alters cilia in uterine tubules.
Oral Progestin (minipill)
Oral Progesterones
Implantable Progestin (Nexplanon)
- Tube/Rod inserted under woman’s arm.
- Last 3 years and must be removed at end of recommended time
- Injected subdermal in non-dominant arm and prevents some ovulatory cycles and thickens cervical mucus
- Reversible and long term.
- Does not affect lactation
- Causes irregular menstrual bleeding and no STI protection
Injectable Progestin
Type of LARC
DMPA or Depo-Provera
- IM injection in Deltoid or Gluteus Maximus
- Can also be given SQ
- Do not massage site after injection because it can hasten absorption or shorten effectiveness
Advantages of DMPA
- Effectiveness comparable to perfect use of COC
- Long Lasting
- Only 4 injections a year
- Lactation not affected
Side Effects of DMPA
- Decreased bone density
- Weight gain
- Irregular vaginal spotting
- No protection from STI’s
- Return to fertility may be delayed up to 10 months
Emergency Contraceptives
- Levonorgestrel-Releasing Intrauterine System (LNG-IUS) - Tablets that are the only EC without prescription - Plan B One-Step - Take Action - Aftera - Next choice One-Dose - My Way
Emergency Contraceptives
- Ulipristal Acetate (Ella)
- Prescription
Emergency Contraceptives
- High dose of oral estrogen or COC’s
- Insertion of Copper IUD
