30 Control of Fertility: Contraception Besinque Flashcards
What are some Combination Estrogen and Progestin contraceptives?
Oral. Patch. Vaginal Ring. Injection (+/- Lunelle)
What are some Progestin only contraceptives?
Injection (DepoProvera). Implants. Pills. IUD/IUS (Mirena)
What are the three top contraception uses?
Sterilization > OC > Male condom
What are considered “Tier 1” contraceptives?
Long acting reversible contraceptives (LARCs: implants, IUDs). Female sterilization. Vasectomy
What are considered “Tier 2” contraceptives?
Injectables. LAM (lactation). Pills. Patch. Vaginal ring
What are considered “Tier 3” contraceptives?
Male condoms. Diaphragm. Female condom. Fertility awareness methods
What are considered “Tier 4” contraceptives?
Withdrawal. Spermicides
What are considered “Tier 5” contraceptives?
Morning after pills
Which Tiers are the most effective?
Tier 1 > Tier 2 > Tier 3 > Tier 4 > Tier 5
What is considered “perfect use” for contraceptives?
The probability of pregnancy during the first year of perfect use of the method; i.e., among those who use the method consistently and according to instructions
What is considered “typical use” for contraception?
The probability of pregnancy during the first year of typical use; i.e. effectiveness for the average person who does not always use the method correctly or consistently
What is the discontinuation rate for women using hormonal contraception?
28% discontinue by 6 months. 33-50% discontinue use by 1 year
What are the menstrual-related health benefits of combined hormonal contraception?
Decreased dysmenorrhea. Decreased menstrual blood loss and anemia. May reduce PMS symptoms
What is there a decreased risk of with combined hormonal contraception?
Ectopic pregnancies. Endometrial and ovarian cancer. Benign breast conditions. PID
What are the Progestin-Related side effects of hormonal contraception?
Bloating. Anxiety. Irritability. Depression. Menstrual irregularities. Reduced libido
What are the Estrogen-Related side effects of hormonal contraception?
Breast tenderness. Nausea. Vomiting. HA. Elevated blood pressure (rare)
What are the contraindications for combined hormonal contraception?
Clotting disorders. History of DVT or pulmonary embolism. Migraine with aura or focal neurological deficit. Uncontrolled hypertension
What are the ADRs from combined oral contraceptives that should cause the patient to stop using the product and contact provider?
ACHES. Abdominal pain. Chest pain. Headaches. Eye problems. Severe leg pain
What is the relationship between blood clots and hormonal contraception?
COCs are CONTRAINDICATED in women who have a personal for family history of idiopathic venous thromboembolism. Smoking is an independent risk factor. Pregnancy and Post-Partum period have a higher risk of blood clots than hormonal contraception (2-5 times the risk)
What are the risk factors for VTE?
Increasing age. Increasing weight (obesity). Family or personal history of VTE. Genetic mutations affecting coagulation. Immobilization or surgery. Long-haul travel. Estrogen containing contraceptives and HRT
In the study, what were the combined hormonal contraceptives (CHCs) and the risks of cardiovascular disease endpoints?
Positive finding to the increasing body of evidence linking drospirenone to increased risk of VTE relative to standard low-dose CHCs
What is the relationship between breast cancer and oral contraception?
There may be an increased risk of breast cancer associated with long-term oral contraceptive pill use in women under the age of 35. However, because the incidence of breast cancer is so low in this population, the attributable risk of breast cancer from birth control pill use is small
When should CHCs be used for women during the postpartum period?
< 21 days is not recommended. 21-42 days, benefits seem to outweigh risks for women without other risk factors for VTE. > 42 days is fine to use
What are the three different ways to start hormonal contraception?
Sunday start. First day of bleeding start. “Any time” start (Quick Start)
What is the “Sunday Start” for hormonal contraception?
Protection after 7 days of active pills/patch/ring. Cycle begins on Sunday always
What is the “First Day of Bleeding Start” for hormonal contraception?
Protection immediate (no back up required). Cycle begins on same day each month (i.e. Wednesday)
What is the “Any Time Start (Quick Start)” for hormonal contraception?
Start pills today (or tomorrow if EC used today). Protection requires 7 days of active pills/patch/ring
What are the 4 classes of hormonal contraceptives used?
Estrogens. Progestins. Drospirenone (17-alpha spironolactone). Ulipristal
What are the three sub-classes of Progestins?
Estranes (Norethindrone, Norethidrone Acetate, Norethynodrel, Ethynodiol Diacetate). Gonanes (Levonorgestrel, Norgestrel, Desogestrel, Norgestimate). Dienogest
What are the pharmacological actions of Progestin?
Ovarian and pituitary inhibition. Thickening of cervical mucus. Endometrial atrophy/transformation. Cycle control