Ch 47: contraception & infertility

Question 1

Monophasic COC

Answer 1

Junel Fe 1/20
Microgestin Fe 1/20
Sprintec 28
Yasmin 28
Loestrin 24 Fe
Yaz

Question 2

Triphasic COC

Answer 2

Tri-Sprintec
- 3 different weeks (7/7/7)

Question 3

Extended cycle COC

Answer 3

Seasonique
- 84 days of EE + LNG followed by 7 days of low dose EE

Question 4

Continuous COC formulation

Answer 4

Amethyst
- no placebo pills

Question 5

Drospirenone containing COCs

Answer 5

Yasmin 28
Yaz

• CI in renal and liver disease
• monitor potassium & kidney functions

Question 6

COC Patches

Answer 6

Xulane
- higher AUC than pills
- once weekly
- 3 weeks on / 1 week off

Question 7

Combined oral contraceptives: Ring

Answer 7

NuvaRing
- lower AUC than pills
- insert monthly
- 3 weeks in / 1 week out

Question 8

Progestin only pills

Answer 8

Norethindrone:
- Errin
- Camila
- Nore-BE

Drospirenone:
- Slynd

Question 9

contraceptive injection

Answer 9

Depo Provera
- depot medroxyprogesterone
- IM or SC once every 3 months

Question 10

Considerations for contraceptive selection:
Acne or hirsutism

Answer 10

COC with a progestin that has little or no adrenergic activity

little: norestigmate (Sprintec 28)

none: drospirenone (Yasmin, Yaz)

Question 11

Considerations for contraceptive selection:
Breastfeeding

Answer 11

POP or nonhormonal method

Question 12

Considerations for contraceptive selection:
Estrogen CI (ex. clotting risk)

Answer 12

POP or nonhormonal

Question 13

Considerations for contraceptive selection:
Migraine

Answer 13

with aura: POP

without aura: any

Question 14

Considerations for contraceptive selection:
Fluid retention / bloating

Answer 14

choose a product with drospirenone

Question 15

Considerations for contraceptive selection:
Heavy menstrual bleeding (menorrhagia)

Answer 15

FDA indicated
- Natiza (COC)
- Mirena (Lev IUD)

Off label:
- COC with only 4 placebo pills rather than 7
- Continuous / Extended COC

Question 16

Considerations for contraceptive selection:
uncontrolled HTN

Answer 16

POP or nonhormonal

Question 17

Considerations for contraceptive selection: Mood changes / disorder

Answer 17

Preferred:
- extended cycle or continuous with drospirenone

Other:
- monophasic COC

Question 18

Considerations for contraceptive selection:
Nausea

Answer 18

• take at night w/ food
• decrease EE dose
• POP / nonhormonal
• vaginal ring

Question 19

Considerations for contraceptive selection:
overweight

Answer 19

any method
- counsel on possibility of reduced effectiveness with patch
- do not use depo

Question 20

Considerations for contraceptive selection:
Postpartum

Answer 20

POP or nonhormonal methods for 3-6 weeks

Question 21

Considerations for contraceptive selection:
PMDD

Answer 21

drospirenone
SSRI

Question 22

Considerations for contraceptive selection:
Spotting

Answer 22

• usually resolves within 3-6 months
• early or mid cycle bleed: inc EE dose
• late cycle bleed: inc progestin dose

Question 23

Estrogen ADE

Answer 23

• Nausea
• breast tenderness
• bloating
• weight gain
• inc BP
• spotting
• thrombosis

Question 24

ACHES

Answer 24

Signs of clot:

Abdominal pain
Chest pain
Headache
Eye problems
Swelling / sudden leg pain

Question 25

Progestin ADE

Answer 25

• breast tenderness
• HA
• fatigue
• depression

Drospirenone:
- higher clot risk
- hyperkalemia

Question 26

Depot medroxyprogesterone acetate ADE

Answer 26

decreased bone mineral density

Question 27

Hormonal Contraceptives Boxed Warnings: All EE containing products

Answer 27

do not use in patients 35yo who smoke

Question 28

Hormonal Contraceptives Boxed Warnings: EE + progestin patch

Answer 28

do not use in patients with a BMI > 30
- increased clot risk (Xulane, Xafemy)
- reduced efficacy (Twirla)

Question 29

Hormonal Contraceptives Boxed Warnings:
Depo-Provera

Answer 29

Loss of BMD with long term use