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OB > 2.2 Hormonal Contraception's > Flashcards

2.2 Hormonal Contraception's Flashcards

1
Q

Hormonal Methods

A
  • Includes estrogen/progestin medications and pregestational agents.
  • Oral
  • Transdermal
  • Vaginal
  • Implantation
  • Injection
  • Intrauterine Insertion
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2
Q

Oral Contraceptives (COC)

A
  • 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
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3
Q

Advantages of Oral Contraceptives

A
  • 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
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4
Q

Disadvantages of Oral Contraceptives

A
  • Hormones can have adverse effects

- The amounts of estrogen and progestin have been reduced since birth control came out.

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5
Q

COC Contraindications (Medical History)

A
  • Thromboembolic Disorders
  • Cerebrovascular or Coronary Artery Disease
  • History of Breast Cancer
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6
Q

COC Contraindications (Diseases)

A
  • 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
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7
Q

COC Contraindications (Obstetrical Factors)

A
  • Lactation/Non-Lactation less than 6 weeks post-partum

- Pregnancy

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8
Q

COC General Contraindications

A
  • Smoking if older than 35
  • Surgery with prolonged immobilization in the legs
  • Hypertension (140/90)
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9
Q

COC Serious Adverse Effects

A
  • Stroke
  • MI
  • Thromboembolism
  • Hypertension
  • Gallbladder Disease
  • Liver Tumor
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10
Q

Estrogen Excess Side Effects

A
  • Nausea
  • Breast tenderness
  • Fluid retention
  • Chloasma (darkened skin)
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11
Q

Estrogen Deficiency Side Effects

A
  • Early Spotting (days 1-14)
  • Hypomenorrhea (abnormally low bleeding)
  • Nervousness
  • Dyspareunia (painful sex)
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12
Q

Progestin Excess Side Effects

A
  • Increased appetite
  • Tiredness
  • Depression
  • Breast Tenderness
  • Vaginal Yeast Infection
  • Oily Skin
  • Hirsutism
  • Post-pill Amenorrhea (absence of mensuration)
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13
Q

Progestin Deficiency Side Effects

A
  • Late spotting and bleeding (days 15-21)
  • Heavy flow with clots
  • Decreased breast size
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14
Q

Most Common Side Effects of COC

A
  • Bleeding irregularities

- Return to fertility is quick after discontinuing

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15
Q

COC Adverse Effects

A

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)

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16
Q

91 Day COC Regimen

A
  • Take COC’s in 3 month cycles.

- Have fewer menstrual periods

17
Q

Transdermal Contraceptive

A
  • 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
18
Q

Vaginal Contraceptive Ring

A
  • 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
19
Q

Progestin Only Contraceptive

A
  • Inhibits ovulation and thickening
  • This decreases the amount of cervical mucus present
  • Thinning of endometrium and alters cilia in uterine tubules.
20
Q

Oral Progestin (minipill)

A

Oral Progesterones

21
Q

Implantable Progestin (Nexplanon)

A
  • 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
22
Q

Injectable Progestin

Type of LARC

A

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
23
Q

Advantages of DMPA

A
  • Effectiveness comparable to perfect use of COC
  • Long Lasting
  • Only 4 injections a year
  • Lactation not affected
24
Q

Side Effects of DMPA

A
  • Decreased bone density
  • Weight gain
  • Irregular vaginal spotting
  • No protection from STI’s
  • Return to fertility may be delayed up to 10 months
25
Q

Emergency Contraceptives

A 
- 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
26
Q

Emergency Contraceptives

A
  • Ulipristal Acetate (Ella)

- Prescription

27
Q

Emergency Contraceptives

A
  • High dose of oral estrogen or COC’s

- Insertion of Copper IUD

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