44-45: Contraception Flashcards
Hormonal Contraception forms efficacy
- implant
- IUD
- shot
4-6: pill, ring, patch
Hormones in contraceptives
-estrogen
-progestin
Mech of estrogen as contraceptive
-suppress FSH production = prevent dominant follicle = no ovulation
-inc sex-hormone binding globulin = inc binding of free androgens (dec acne)
Mech of progestin in contraceptives
-prevent LH surge = no ovulation (not most effective mech)
-thicken mucus = inhibit sperm
-change motility of tubes = inhibit sperm/ova transport
-atrophy of endometrium = no implantation
Common estrogens
-ethinyl estradiol
-estradiol valerate
-estetrol
-mestranol
Common progestins
-northindrone (acetate)
-norgestimate
-drospirenone
-norgestrel
-levonorgestrel
-segesterone acetate
-ethynediol diacetate
-desogestrel
-etonogestrel
-dienogest
Side effects from too much estrogen
-bloat
-breast tender
-mood swings
-headache
-nausea
-heavy menses
-fibroid growth
-melasma
-vision changes
-cyclic weight gain
side effects of not enough estrogen
-light menses
-vaginal dryness
-spotting
-no withdrawal bleeding
Estrogen dosing
-very low: <20 mcg EE
-low: 20-35 mcg
-high: 50 mcg
Progestational side effects of progestin
-prevent ovulation
-less bleeding
-desire high selectivity
Progetin activity
-progestational
-androgenic
-antiestrogenic
Androgenic side effects of preogestins
-acne
-hirsutism
-desire lower activity
Antiestrogenic side effects of progestins
-androgenic side effects
-desire lower activity
Progestins with high androgenic activity
-levonorgestrel
-norgestrel
Progestins with low androgenic activity
-drospirenone
-segesterone
Side effects from too much progestin
-acne*
-hirsutism*
-dec sex drive
-depression
-inc appetite
-inc sex drive*
-weight gain
-less energy
-cholestatic jaundice*
-yeast infection
-hair loss*
-arm/leg swelling*
Side effects of not enough progestin
-breakthrough bleeding late in cycle
-no withdrawal bleeding
-heavy menses
Non-contraception uses of hormones
-androgenic conditions
-regulate cycle
-PMS/PMDD
-menorrhagia
-endometriosis
-dysmenorrhea
Potential health benefits of hormonal contraceptives
-dec risk of endometrial and ovarian cancer
-dec risk of pms headaches
-improvement in perimenopausal symptoms
Contraceptive considerations
-efficacy
-hormonal content
-route/dosage form
-freq/duration
-side effects
-return of fertility
-potential health benefits
Summary
slide 18-19 pls look
Implant (Nexplanon) components
-progestin only
-Etonogestrel
-injected in non dominant arm
Implant (Nexplanon) side effects
-painful insertion
-irregular bleeding first 6-12 months
-mood
-headaches
-acne
Potential benefits of Implant (Nexplanon)
-long term
-up to 3 years
-don’t need to remember to take it
Return of fertility after implant (nexplanon) use
-delayed or rapid return
-most likely to be delayed tho
-within 6 weeks
Levonorgestrel IUD side effects
-painful insertion
-spotting first 3-6 months
-periods become lighter and less frequent
-uterine perforation
-infection
-expulsion
Potential benefits of LNG IUD
-lighter periods, amenorrhea
-safe to breast feed
-lower risk of uterine cancer
-long term
Return of fertility of LNG IUD
-immediate
Hormonal IUD brands
-Mirena 8
-Skyla 3
-Liletta 8
-Kyleena 5
Shot (depot medroxyprogesterone acetate) admin
-150 mg IM
-104mg SC
side effects of shot (depot medroxyprogesterone)
-weight gain
-spotting between periods/no period
-change in acne, mood, headaches
-lower bone density (supp w calcium)
-heavy bleeding
Potential benefits of shot (depot medroxyprogesterone)
-low risk of uterine cancer
-safe to breastfeed
-lighter periods/amenorrhea
Return of fertility after shot (depot medroxyprogesterone)
-possible delayed return
Pill COC side effects
-nausea, spotting, breast discomfort
-changed mood/headaches
-blood clots (estrogen)
-stroke
Potential benefits of the pill
-improve acne
-lower risk of ovarian/uterine cancer
-regular, lighter, less painful periods
Return of fertility after pill
-immediate
Monophasic pill
-same dose thru cycle
-start patients on this one
bi/tri/four phasic pill
-2/3/4 strengths of EE or progestin thru cycle
Progestin only pill (POP) miniill
-mini-pill (norethindrone)
-norgestrel (OTC)
POP (mini pill) freq
-daily within 3 hours of the same time
-no placebo pills
POP (mini pill) side effects
-spotting and menses changes more so than in the pill
-headaches
-bleeding
-ectopic preg
Potential benefits of POP (mini pill)
-safe to breast feed
-lack of estrogen side effects
return of fertility after POP (mini pill)
-immediate
POP- Drosperinone (Slynd) dosing
-4mg daily
-no placebo
POP (drosperinone) side effects
-spotting and menses changes more than COC
-severe headaches
-hyperkalemia
potential benefits of POP drospirenone
-safe to breast feed
-lack of estrogen effects
Return of fertility after POP (drosperinone)
-immediate
Vaginal Ring (Etonogestrel and EE)
-NuvaRing and Eluryng
-leave in place for 3 weeks
-remove for one week
-new ring after 7 days
Vaginal ring side effects
-nausea, spotting, breast discomfort
-change in mood/headaches
-blood clots
-stroke
potential benefits of vaginal ring
-improved acne
-more regular, lighter periodsr
return of fertility after vaginal ring
-immediate
Annual vaginal ring (segesterone and EE) Annovera
-reused
-no data on continuous use (we dont know how long it is safe to leave in for to skip a period)
Patch (norelgestromin and EE)
-Xulane, Zamefy
-transdermal patch applied to outer arm, ab, butt, back
-new patch every week for 3 weeks
-patch free for 7 days then new patch
Side effects of patch
-nausea, spotting, boob hurt
-skin irritation
-change in mood/headaches
-blood clots (more estrogen than pill)
potential benefits of the patch
-improved acne
-lower risk of ovarian/uterine cancer
-more regular periods
-don’t have to remember daily
return of fertility after the patch
immediate
Patch (Twirla)
-Levonorgestrel and EE
-just a little bit bigger but everything else is the same
patches and weights
-CDC says don’t look at weight
-we dont really have data for ppl over 200lbs but that doesnt mean it wont work
General approaches to starting contraception
-quick start
-next period start
-sunday start
Quick start
-start anytime as long as not pregnant
-if more than 1-6 days after period start, use back up protection for 2-7 days
Next period start
-Start within 1-6 days of period start
-no backup protection needed
Sunday start
-start on sunday after period starts
-if more than 1-6 days after period start, use backup protection for 2-7 days
General approach to starting contraception when changing hormonal methods
-switch method at any time or when due for injection
-no back up needed if no gaps in treatment
Gen approach to starting emergency contraception
-within 5 days of unprotected sex
-levonorgestrel more effective the sooner it is used
-may be less effective if over 165 lbs
Gen approach to restarting contraception after emergency contraception
-levonorgestrel: start/resume immediately, backup method 7 days
-ulipristal acetate: start/resume method 5 days AFTER use, backup method 7 days
If one hormonal pill is late/missed
-take as soon as possible
-no additional contraception needed as long as it’s taken by or with the next dose
Delayed application of patch
-apply new patch asap
-keep the change day the same
patches must stick on as
self adhesive or it doesnt work
Delayed application of over 48 hours
-new patch
-reset the change date
delayed insertion of vaginal ring
-put new one in immediately
-reset the calendar if over 2 days
Missed POP drospirenone pill
-take asap
-same as COC
missed POP minipill
-any number of pills taken over 3 hours late
-take asap
-continue daily pills
-backup method 2 days
progestin only injection missec dose <2weeks
-receive injection
-backup method 7 days and maybe emergency contraception if over 2 weeks late
How to clean ring
-mild soap
