A - 11. Contraceptives Flashcards
Combination therapy
Progestin + estrogen
Inhibits pituitary axis (no FSH/LH release -> no ovulation)
Changes secretion
Indications for combination therapy
- not wanting children
- endometriosis
- dysmenorrhea
- acne (estrogen inhibits testosterone)
Combination therapy: Effects on ovaries and breasts
ovarian suppression -> hypotrophy
returns to normal after cessation
breasts grow
Combination therapy: Effect on uterus
Cervical hypertrophy
Polyp formation
Cervical mucous gets thicker
Combination therapy: CNS
Estrogen increases excitability, while progestins decreases excitability (mood and temperature changes)
Combination therapy: Endocrine
LH/FSH inhibition
Estrogen increases corticosteroid binding globulin production (CGB) -> cortisol levels rise
Also increases TBG -> t4 plasma levels rise
(In some: RAAS stimulation -> increased renin and aldosterone levels)
Combination therapy: Liver
Protein synthesis increase (estrogen)
Gall stone risk increase
Increased production of clotting factors
Combination therapy: Blood
Thromboembolism due to increased clotting factors and downregulation of AT III
Blood iron increase
Combination therapy: Lipids and carbohydrates
Estrogen increases
- Serum TG
- Cholesterol
- Phospholipids
- HDL
- lipolysis
Carbohydrates
- Gi absorption decrease
- Insulin resistence (progestins)
Combination therapy: cardiovascular
CO increase (BP and HR up)
Combination therapy: Skin
Pigmentation increases
Sebum increase -> acne (androgenic progestins)
Estrogen decreases testosterone and acne
Side effects: mild
Breakthrough bleeding
Edema
Mastalgia
Nausea
Side effects: moderate
Weight gain Skin pigmentation Hirsutism Acne Bacteruria Vaginal infections Omenorrhea
Side effects: severe
Thromboembolism MI GI - jaundice, ischemic bowel disease Depression Breast cancer
Combination therapy: Contraindications
Thrombogenic diseases
Breast cancer risk
DM
Antibiotics - bacterial flora is needed to increase the bioavailability
