Contraception Flashcards
Estrogen and progesterone ____ feedback to anterior pituitary to prevent___
negative
ovulation
What is the difference between endogenous estrogen vs what is in the pill
exogenous is more potent
the pill has ethinyl estradiol
What are qualities of the 4 different generations of progesterone
1st: potent, well tolerated
2nd: longer half life, more androgenic
3rd: work on minerocorticoids too, fewer androgenic side effects. risk of thromboembolism
4th: increased thromboembolism, antimineralcorticoid and antiandrogen
What are 1st gen progesterone? 2nd? 3rd? 4th?
1st: morethinddrone, ethylnodiol
2nd: levonorgestrel, norgestrel
3rd: norgestimate, desogestrel
4th: drospirenone, dienogest, segesterone
estrogen suppresses ___ which causes what
FSH-> no follicles grow, no LH surge so no ovulation
Progesterone acts at the ______
cervical mucus and thickens it. less lush endometrium, impaired tubal motility
Endogenous hormones have ___ oral absorption
poor
extensive first pass metabolism with estrogen at _____
CYP3A4
Proposed male contraception is proposed to work to reduce ___
GnRH. need to have androgen as well so body doesn’t rev up (?)
What are the risks of OCP
VTE! (varies by estrogen, age, BMI, smoking)
Stroke: be careful in individuals with HTN, DM, obesity, migraines with aura, cirrhosis
What are the risk profiles with using OCP and cancer
ovarian and endometrial: decreased risk
cervical: maybe increased
breast cancer: mixed
What are side effects of cOCPs
mood changes, libido changes, nausea, breast tender, HA, breakthrough bleeding, amenorrhea
The patch gives you (increased/decreased) systemic exposure to estrogen becasue____
increased, bypass the first pass metabolism
What do you do if the patch falls off
if it falls off >24 hours, or if interval lasts longer than 9 days, use backup method
The patch is not indicated for _____
individuals BMI>30, >200lb
What are the differences between NuvaRing vs Annovera. Similarities?
Nuva-> every 4 weeks insert new ring
Annovera: you can insert same ring after removal for 1 week
keep in for 3 weeks, remove for 1
There is ____ variability in level of hormones for the ring and patch
less. the level of hormone is sustained more.
What are some of the risks for the patch and ring
VTE, CV, cancer risk (maybe)
overall same as OCPs
For the patch there is a relative contraindication for people will
morbid obesity. There is not the same contraindication with the ring
What is lactation amenorrhea?
nursing-> hypothalamus-> decreased GnRH pulse frequency-> hormones disrupted-> no egg, no pregnancy
Estrogen inhibits ___ more than progesterone
lactation
Norethindrone has a _____ half life, so if you miss a dose >/= 3 hrs, you need to ___
short
backup method for 48 hours
Drospirenone is the new progesterone containing tablet and could cause an increased in ___ and if you miss a dose >24 hours, use______
potassium
use backup method for 7 days
What is the risks for drospirenone?
higher increase for VTEs, be VERY careful in individuals who were just pregnant
POPs MOA?
thicken cerical mucus, endometrial decidualization and atrophy, impaired tubal motility
With progesterone only pills, they may not______
prevent ovulation. Not predicable for cycle control
POPs side effects
irregular bleeding, increased acne, no impact on weight gain
POP contraindications
Pregnancy, breast cancer, uterine bleeding, liver disease
Women who have undergone________ or taking ______ are not advised to use POPs
malabsoptive bariatric surgeries, certain anticonvulsants
Even with perfect use, POPs have a __% failure rate
5
What molecule is in depo
medroxyprogesterone
There are two versions of depo. There are:
IM and SQ
How does depo work for 3 months?
acetate group added that keeps the molecule there for longer
Depo should be administered by the ___ day of menses
5th
Depo inhibits ____, produces shallow endometrium, and thickens ___
FSH and LH
cervical mucus
There is erratic absorption of depo when given ___
IM. The SC formula is less eratic
Return to ovulation after depo could take up to
10 months
Are the worries with bone mineral density with depo
Not really. physiologically yes but not seen clinically
Depo is ok in women with history of __
VTE
What are common side effects of depo
irregular periods, no periods, bone density loss, weight gain, delayed return to fertility, injection reactions
Depo contraindications
pregnancy, breast cancer, uterine bleeding, liver disease, long term risk of corticosteroid therapy
nexplanon is a single rod implant of _____ and it releases 60mcg/day for ___ years
etonogestrel
3 years
Implant Nexplanon during days ___ of the cycle
1-5
MOA of Nexplanon
inhibits gonadotropins (FSH, estrogen), produce shallow and atrophic endometrium and produces vertical mucus
Nexplanon return to ovulation within ____ after removal
7-14 days
What are the 4 commonly used progestin-based IUDs
Mirena (7 years)
Liletta (6 years)
Kyleena (5 years)
Skyla (3 years)
MOA of IUDs
low grade intrauterine inflammation, increased prostaglandin formation primarily spermicidal, interfere with implantation
endometrial suppression
Nexplanon risk and side effects
no VTE, CV risk, no impact on breast cancer
irregular bleeding, increased acne, HA, local inflammation or bruising on placement
Hormonal IUD risks and side effects?
no VTE, CV, breast cancer risk. perforation with placement/expulsion. ectopic pregnancy
irregular bleeding, cramping
Hormonal IUD contraindications that are not the standard contraindications
severely distorted uterine cavity
active PID
Copper IUD can be used as _____
emergency contraception
What is the MOA of copper IUD
?????
(intrauterine inflammation-> increased prostaglandin formation -> spermicidal/impaired sperm transport. Also interferes with implantation)
Risks of copper IUD? Side effects?
expulsion/perforation, ectopic pregnancy
continued cyclic bleeding (heavier), cycles may be longer and crampier
What is a contraindication for copper IUD that is different from the usual contraceptives?
Wilson’s disease/copper allergy
(Relative: heavy periods, anticoagulation use, coagulopathy)
And strike liver disease from the typical list
