Ch 43: Contraception & Infertility

Question 1

ovulation

Answer 1

luteinizing hormone surges midcycle d/t signalingof the estrogen to dictate the end of bleeding. LH surge releases the oocyte from ovary into fallopian tube. some ovulation kits check for LH in the urine.

Question 2

combination oral contraceptives (COCs)

Answer 2

inhibit FSH and LH to prevent ovulation. contains ethinyl estradiol (ee) and progestin (norethidrone, levonorgesrel, norgestimate, drospirenone). first line for regulating menses in polycstic ovary syndrome and endometriosis.

Question 3

progestin-only pills (POPs)

Answer 3

mini pill. rec for lactating and contraindication for estrogen like migraine with aura, clot risk, etc. need to be taken <3 h of the same time daily.

Question 4

POP examples

Answer 4

camila, errin, ortho-micronor, nora-BE, heather, jolivette

Question 5

products of combination contraceptives

Answer 5

patch - xulane, nuvaring, extended cycle, biphasic, triphasic, quadriphasic (natazia), many monophasic. lo means low dose estrogen. fe means iron.

Question 6

breakthru bleeding

Answer 6

if early to mid cycle, inc estrogen. if late cycle, inc progestin. wait 3-6 monthly cycles to see if spotting dissipates.

Question 7

BBW for estrogen, xulane, and depo provera

Answer 7

estrogen: avoid use in women >35 YO who smoke. xulane: inc risk of VTE/PE d/t higher AUC than pills. depo: loss of BMD with long term use.

Question 8

serious ADRs to remember

Answer 8

ACHES: abd pain that is severe, chest pain, headaches (sudden and severe with vomiting or weakness on 1 side), eye problems (blurry vision, flashing lights, or partial/complete vision loss for blood clot in eye. swelling or sudden pain in legs.

Question 9

DDIs with contraception

Answer 9

rifampin, rifapentine, rifabutin. anticonvulsants. st. johns wort. PIs. smoking tobacco. avoid hep c agents d/t liver tox.

Question 10

drospirenone

Answer 10

risk of inc K d/t low potency k sparing diuretic. avoid with kidney, liver, or adrenal gland disease. review K level

Question 11

POP missed dose

Answer 11

take as soon as you remember. take the next one as scheduled, even if it means doubling up. 48 h backup contraception.

Question 12

COC missed dose

Answer 12

take as soon as you remember. take the next one as scheduled, even if it means doubling up. if 1 missed pill, no backup required. if 2 missed pills, 7 day back up contraception.