Contraception

Question 1

Non-hormonal Contraceptives

Answer 1

• Abstinence
• Behavioral Methods
• Male and Female Condom
• Spermicide
• Contraceptive Sponge
• Diaphragm and Cervical Cap
• Copper IUD
• Tubal Ligation/Implant or Vasectomy

Question 2

Progestins

Answer 2

-Norethindrone
-Drospirenone
-Levonorgestrel
-Medroxyprogesterone

Question 3

Estrogens

Answer 3

-Ethinyl estradiol
-Estradiol valerate
-Estetrol

Question 4

Missed Doses

Answer 4

If one pill is late or missed by < 24 hr or 24-48 hr:
-Take ASAP, continue pills at usual time, emergency contra not needed but can be considered

If two or more pills missed > 48 hrs:
-Take the most recent pill ASAP
-Continue taking pills at usual time
-Use back up contraception
-Days 15-21 then omit hormone-free interval by finishing hormone pills in pack and starting new pack next day

Question 5

For ESTROGEN: DO NOT USE

Answer 5

-Current DVT/PE, or history/higher risk
-DM with nephropathy, neuropathy, retinopathy
-Current breast cancer
-Pregnancy, postpartum < 21 days
-Severe cirrhosis or acute hepatitis
-Benign hepatocellular adenoma or malignant liver tumor
-Migraines with aura, any age
-Uncontrolled HTN (SBP ≥ 160, DBP ≥ 100)
-Hypertension with vascular disease
-Smoking ≥ 15 cigarettes per day and age ≥ 35
-Complicated solid organ transplantation
-History of cerebrovascular accident
-Complicated valvular heart disease, current/history of ischemic heart disease

= STTD PBV CH LIM

Question 6

AGE AND SMOKING

Answer 6

> 35
-15+ cigs: progestin only
-<15: limit estrogen 20 mcg

< 35
-15+: limit estrogen 20 mcg, DC at 35
-<15: lowest effective estrogen dose

Question 7

Serious AEs

Answer 7

ACHES
-abdominal pain
-chest pain, SOB, coughing blood
-headaches, severe
-eye problems, vision loss/blurry
-severe leg/calf pain

Stop pills, refer to clinician immediately

Question 8

Common AEs

Answer 8

-Nausea, bloating, migraine, tenderness
-Spotting, amenorrhea
-Increase appetite, weight gain, fatigue
-Depression, acne, hair loss

Question 9

Drug Interactions

Answer 9

Reduce OCPs
-Rifampin, phenytoin, carb, SJW (CPRS)

ABX
-Amp, pen, tetra, SMX/TMP (TAPS)

P450: ritonavirs

Question 10

For PROGESTIN: DO NOT USE

Answer 10

-Breast cancer only
but caution in…
-Liver cancer, cirrhosis, bariatric surgery, IHD, lupus, anticonvulsant tx
(BILLA)

Question 11

Emergency Contraception

Answer 11

AE: NV, bleeding, HA, AP, cramp, dizzy

-Levo 1.5: take within 72 hr (5d), OTC
-Uli acetate 30: take with 120 hr, needs RX