44-45: Contraception Flashcards by Brooke Thornburg

Hormonal Contraception forms efficacy

implant
IUD
shot
4-6: pill, ring, patch

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Hormones in contraceptives

-estrogen
-progestin

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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)

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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

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Common estrogens

-ethinyl estradiol
-estradiol valerate
-estetrol
-mestranol

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Common progestins

-northindrone (acetate)
-norgestimate
-drospirenone
-norgestrel
-levonorgestrel
-segesterone acetate
-ethynediol diacetate
-desogestrel
-etonogestrel
-dienogest

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Side effects from too much estrogen

-bloat
-breast tender
-mood swings
-headache
-nausea
-heavy menses
-fibroid growth
-melasma
-vision changes
-cyclic weight gain

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side effects of not enough estrogen

-light menses
-vaginal dryness
-spotting
-no withdrawal bleeding

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Estrogen dosing

-very low: <20 mcg EE
-low: 20-35 mcg
-high: 50 mcg

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Progestational side effects of progestin

-prevent ovulation
-less bleeding
-desire high selectivity

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Progetin activity

-progestational
-androgenic
-antiestrogenic

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Androgenic side effects of preogestins

-acne
-hirsutism
-desire lower activity

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Antiestrogenic side effects of progestins

-androgenic side effects
-desire lower activity

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Progestins with high androgenic activity

-levonorgestrel
-norgestrel

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Progestins with low androgenic activity

-drospirenone
-segesterone

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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*

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Side effects of not enough progestin

-breakthrough bleeding late in cycle
-no withdrawal bleeding
-heavy menses

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Non-contraception uses of hormones

-androgenic conditions
-regulate cycle
-PMS/PMDD
-menorrhagia
-endometriosis
-dysmenorrhea

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Potential health benefits of hormonal contraceptives

-dec risk of endometrial and ovarian cancer
-dec risk of pms headaches
-improvement in perimenopausal symptoms

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Contraceptive considerations

-efficacy
-hormonal content
-route/dosage form
-freq/duration
-side effects
-return of fertility
-potential health benefits

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Summary

slide 18-19 pls look

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Implant (Nexplanon) components

-progestin only
-Etonogestrel
-injected in non dominant arm

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Implant (Nexplanon) side effects

-painful insertion
-irregular bleeding first 6-12 months

-mood
-headaches
-acne

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Potential benefits of Implant (Nexplanon)

-long term
-up to 3 years
-don’t need to remember to take it

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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