Contraception 1 Flashcards
What is the most effective contraceptive method?
Long acting reversible contraceptive
(vasectomy, female sterilization)
What is the MOA of estrogen (ethinyl estradiol) (4)
- inhibits ovulation: stops GnRH release –> less FSH/LH
- Inhibition of implantation
- alters cervical mucous secretions - Accelerated ovum transport
- Induces luteolysis: degrades the corpus luteum (prevents implantation)
What is the MOA of progesterone
- Production of thick cervical mucous: reduces sperm penetration
- Inhibition of capacitation: inhibits the hydrolytic enzymes required for sperm penetration into the ovum
- Slowing of ovum transport: progestin-only pills can increase chance of ectopic pregnancy
- Inhibition of implantation: atrophic endometrium
- Inhibition of ovulation: cancels LH surge
Explain the minipill (progestin-only pills)
When is it the most effective?
HFI/no HFI?
Effectiveness of progestin-only pills is greater when the “normal” bleeding pattern is most disturbed.
- There is no hormone-free interval
Who can use progestin-only pills/ advantages? (4)
- Pt who cannot tolerate COCs
- Pt over 35+ years of age smoking more than 14 cigs/day
- Pt with headaches related to estrogen/migraine + aura
- Pt who are breastfeeding
What are disadvantages of using progestin-only pills
- irregular menses
- increase incidence of breakthrough bleeding
- inc risk of ectopic pregnancy
***ADHERENCE WITHIN A 3 HOUR WINDOW (take
How effective is depot medroxyprogesterone
100% effective at blocking cycles/ovulation
How much estrogen and progesterone are usually in COCs
Estrogen <35ug
Progestin <1mg
What are phasic combinations of COCs designed/attempt to do
Deliver hormones in varying quantities throughout cycle (to minimize the cumulative hormone dose)
- attempt to minimize late-cycle breakthrough bleeding
What are advantages of phasic combinations?
- Less progestin intake
- Less androgen intake
- Less metabolic effects (lipids, BP, CHO, metabolism)
What are disadvantages of phasic combinations
Disadv:
- confusing for patient
- More frequent/heavier spotting
- Less flexible
- May cause side effects related to progestin deficiency
What are counselling points of first cycle of OC?
- Can start anytime
- take pill same time each day
- Takes at least 3 months for a patient’s cycle to stabilize (BTB and ADRs are more common here)
- Use back-up contraception for the first 7 days (preferred for the entire first cycle)
When will prevention of ovulation not occur when taking COCs
Will not occur if first pill is taken after the 5TH DAY of the menstrual cycle (day 1 is when your period begins)
- Other contraceptive actions may occur anytime during the cycle but may take 48-72 hours to become effective
What missed doses should backup contraception be used in COCs?
When to skip the hormonal free interval?
- 1 missed dose in the first week
- 3 missed doses in 2nd/3rd week
** Need 7 days of correct use
Skip HFI when missed 2nd/3rd week of hormones
What happens if you miss less than 3 pills in week 2 or 3 of COCs
Take 1 pill ASAP
Skip HFI
