COCPs Flashcards
6 things to consider when starting COCPs
(1) generic vs brand (2) monophasic vs multiphasic (3) cyclic vs extended cycle vs continuous use (4) EE dose (5) progestin type (6) 21/7 vs 24/4
MOA
ovulation suppression (which improves with higher doses, shorter pill free intervals, continuous dose
Additional progestin effects
Endometrial decidualization and atrophy; thickening of cervical mucus; impairment of normal tubal motility and peristalsis
Contraindications (Category 4)
(1) Age 35+ and smoke 15+ cigs; (2) multiple RFs for CV disease; (3) HTN; (4) VTE (unless on anticoagulation); (5) known ischemic heart disease; (6) hx of stroke; (7) complicated valvular heart disease; (8) current BCA; (9) severe cirrhosis; (10) hepatocellular adenoma or malignant hepatoma; (11) migraine with aura; (12) DM > 20 years or with nephropathy, retinopathy, or neuropathy
Efficacy
perfect-use failure rate is 0.3 percent, the typical-use failure rate is ~ 7 %; not effected by progestin type, estrogen dose, or brand
Non-contraceptive benefits: R/T menses
(1) reduction in dysmenorrhea (2) reduction in pelvic pain r/t endometriosis (3) reduction of menorrhagia (4) reduction of PMS/PMDD symptoms, menstrual migraines, PCOS, AUB (5) regular menstrual cycles
Non-contraceptive benefits: R/T cancer reduction
(1) OCA including some hereditary forms; (2) endometrial cancer; (3) colorectal cancer
Non-contraceptive benefits: other
(1) reduction in risk of ectopic pregnancy; () reduction in risk of benign breast disease (3) reduction in development of new ovarian cysts (higher doses only) (4) reduction in moderate acne (5) reduction in hirsutism
Non-contraceptive benefits: R/T menopause
Reduced hot flashes and improved bone density, AUB
Side effects
VTE, VCV risk, cancer (cervical)
Estrogens
(1) Ethyinal estradiol (2) estradiol valerate (3) 17-beta estradiol (4) estetrol. Those other than EE appear to have less effect on hemostasis, fibrinolysis markers & lipids
Starting COCPs
(1) Can start day 1 of menses (2) If > first 5 days of LMP, BUC is needed for 7 days
Continuous
May use any monophasic 21/7 combination (eg, Amethyst [levonorgestrel 0.09 mcg-ethinyl estradiol 20 mcg]) by taking active hormone pills for 28 or more days continuously. Any progestin may be used, and higher doses of ethinyl estradiol may be used in some women.