Contraception Flashcards
What are the additional benefits of contraception treatment?
- Prevention of STIs (condoms)
- Prevention of ovarian and endometrial cancer (contraception/HT)
- Treatment of acne and hirsutism (HC)
- Treatment of menstruation-related problems (HC)
- Management of perimenopausal symptoms (HC)
What are the Non-Hormonal Contraceptive Methods?
- Periodic Abstinence
- Condoms
- Diaphragms
- Cervical Caps
- Sponges
- Spermicides
What are the Hormonal Contraceptive Methods?
- Oral
- Transdermal
- Vaginal Ring
- Injectable/Implantable Progestin
- IUDs
How does the pill work?
STOPS OVULATION, thins uterine lining, thickens cervical mucus
Does the pill stop the ability to get pregnant?
No, just decreases the ability
How does Estrogen control the cycle?
- Stabilizes endometrial lining
- Provides cycle control
- Suppresses FSH release from pituitary
What are the two synthetic forms of estrogen?
Ethinyl Estradiol and Mestranol
How does Progestin provide Contraceptive Effect (ANTI-Ovulary)?
- Thickens cervical mucus
- Slows tubal motility of sperm
- Induces endometrial atrophy
- Blocks LH surge and secretion of FSH
What occurs with ALL testosterone derived progestins?
Bind to the androgen receptor and retain some androgenic activity
What are the qualities of first generation oral HC?
Norethindrone/Ethynodiol Dictate/Norethindrone Acetate
Estrogenic, Progestational, and Androgenic
What are the qualities of second generation oral HC?
Levonorgestrel/Norgestrel
Progestational and Androgenic
How is second gen different from first gen oral HC?
Second is more potent, longer t1/2, and more androgenic
What are the qualities of third generation oral HC?
Norgestimate/Desogestrel
Progestational and Androgenic
How is third gen different from second gen oral HC?
Less androgenic, higher risk of VTE, otherwise same
What are the qualities of fourth generation oral HC?
Drospirenone
Progestational
What is special about Drospirenone?
Have antimineralocorticoid and antialdosterone activity, higher risk of VTE
What are the forms of Non-Oral HC?
Transdermal Patch, Vaginal Ring, Depot Injection, Long Acting Implantable Progestin, and Intrauterine Device
What are things to know about the Transdermal Patch HC?
NONOBESE PATIENTS
>90kg or BMI >30 DO NOT USE
New patch Q3 wks, apply abdomen/butt/upper torso/upper arms
What are the concerns with Transdermal Patch HC?
Increased risk of VTE, 60% more estrogen
What happens if you forget to change the patch after 3 weeks?
Patch releases hormone for 9 days, if you change by the 9th day over, NO backup method needed, if NOT backup for 7 DAYS
What are the things to know about the Vaginal Ring HC?
NuvaRing = 3 week period
Annovera = resusable for 1 yr
Insert before 5th day of menstrual cycle, keep in for 3 wks, then remove for 1 wk
What are the concerns with Vaginal Ring HC?
Increased VTE Risk
No danger with inserting it too far, cervix will prevent it from traveling up
What happens if you the ring falls out for more than 3 hrs?
Use Back-Up contraceptive and insert a new ring
How long does it take to return to fertility for Oral, Transdermal, and Vaginal HC?
2 weeks
What are the things to know about the Depot Injection HC?
Inhibits ovulation for 14 weeks
Must be injected within 5 days of onset of menstrual bleeding, repeat injection every 3 months
What are the concerns with Depot Injection HC?
Breakthrough bleeding
Weight Gain
Decreased bone mineral density by 3-7%
What happens if you miss a dose of depot injection?
Should do pregnancy test before reducing and use back-up method for 7 days
How long does it take to return to fertility for Depot Injection HC?
10-18 months
How long can you take Depot Injection HC?
2 years due to osteoporosis risk
What are the things to know about the Long Acting Implantable Progestin?
Lasts 3 years
100% effective but reduced in women >130% of their IBW
What are the concerns with Long Acting Implantable Progestin?
Bleeding, no impact on BMD
How long does it take to return to fertility for Long Acting Implantable Progestin?
30 days
What are the things to know about Intrauterine Device HC?
Copper Wrapping or Progestin Reservoir
Minimal systemic absorption
What are the concerns with Intrauterine Device HC?
Pelvic Inflammatory Disease PID with Paragard Copper IUD
How long does it take to return to fertility for Intrauterine Device HC?
Immediate upon removal
How long does each IUD Last/
Paraguard (Copper): 10 yrs
Mirena: 8 yrs
Sjyla: 3 yrs
Liletta: 6 yrs
Kyle’s: 5 yrs
What are the Absolute Contraindications to CHC?
- H/O thromboembolism or thrombophilia
- H/O vascular disease
- Diabetes with vascular involvement (nephro/retino/neuro)
- Migraine HA with Focal Aura
- Uncontrolleed HTN >160/90
- Uncontrolled Dyslipidemia
- Breast Cancer
- Acute or Chronic Hepatocelluar Disease
- Age >36 & Smoking >15 cig/day
- Breastfeeding Women <6 wks POSTpartum
What are the Relative Contraindications to CHC?
- Multiple risk factors for CVD
- Migraine HA w/o aura in women >35
- Cirrhosis, mild
- Symptomatic gallbladder disease
- Postpartum <3 wks and NOT breastfeeding
- Breastfeeding <6 months POSTpartum
- Commonly used drugs that induce liver enzymes
What are the commonly used drugs that induce liver enzymes and reduce efficacy of CHC (relative CI)?
- Rifampin
- Phenytoin
- Carbamazepine
- Barbiturates
- Primidone
- Topiramate
What drugs may cause OC Failure?
Anticonvulsants
Antimicrobials
Griseofluvin
NNRTIs
Protease Inhibitors
Rifampin
St. John’s Wort
What drugs may INCREASE OC Activity?
Acetaminophen
Erythromycin
Fluoxetine
Fluconazole
Fluvoxamine
Grapefruit
Nefazadone
Vitamin C
OC can decrease clearance of what drugs?
Amitriptyline
Benzos
Caffeine
Cyclosporine
Imipramine
Phenytoin
Selegiline
Theophylline
Corticosteroids
OC can decrease efficacy of what drugs?
Lamotrigine
What do Anticonvulsants do to CHC and how to fix it?
Decrease contraceptive effect
At least 50 mcg EE, second method of contraception, or IUD
What does Griseofluvin do to CHC and how to fix it?
Decrease effect on contraception
Second method of contraception or IUD
What does NNRTI/Protease Inhibitors do to CHC and how to fix it?
Increase/Decrease contraceptive effect
IUD
What does Rifampin do to CHC and how to fix it?
Decrease effect of contraception
Second method of contraception or IUD
What does Atorvastatin do to CHC and how to fix it?
Increases contraceptive effect
Norgestimate and EE
Is estrogen and progesterone affected by Antibiotics?
Progesterone = No
Estrogen = potential
How long does Post-OC Amenorrhea last?
No longer than 6 months
What should be done if you miss 1 active OC pill LESS than 24 hrs later?
Take 1 active pill ASAP then continue the remaining pills at the usual time
What should be done if you miss 1 or MORE active OC pill MORE than 24 hrs later?
Take 1 active pill ASAP, then take remaining pills at the usual time, skip placebo week and start new pack
Use 7-day backup method
Consider emergency contraception if unprotected in last 5 days