Contraception Flashcards
Describe the mechanism of action of combination hormonal contraceptives.
overall: inhibits ovulation
Estrogen- inhibits FSH- preventing development of a dominant follicle
Progestin- inhibits LH surge, thickens mucus, alters fallopian tube secretions
Order the progestins below from MOST ANDROGENIC to LEAST ANDROGENIC: Norgestimate, levonorgestrel, drospirenone, norethindrone
MOST:
Northindrone
levonorgestrel
norgestimate
drospirenone
:LEAST
What are the differences between monophasic, biphasic, and triphasic contraceptives?
-Monophasic - contains the same dose of hormone in each active pill
-Biphasic - alter the hormone dose in the middle of the cycle
-Triphasic - alter the estrogen dose, the progesterone dose, or both each week during a 28-day dose pack
For which patient population should the combination hormonal contraceptive patch be avoided? Why?
pts weighing > 90 kg (198 lbs), less effective
A patient is interested in “continuous cycling” with her oral contraceptive. What are some disadvantages to this method? Which oral contraceptive would you prescribe for her?
Frequency of breakthrough bleeding/spotting in 1st 3-6 mos of use has been shown to be higher than pts on cyclical methods
I would prescribe Monophasic or Ring
A patient is interested in “continuous cycling” with her oral contraceptive. What are some advantages to this method?
-Not at an increased risk of developing DVTs -Endometrial bx performed up to a yr after initiation indicate no increased risk of endometrial hyperplasia or CA -Pts should return to baseline fertility w/in 90 days of rx d/c
ADE of too little progestin
Late cycle breakthrough bleeding
ADE for too little estrogen
Early cycle breakthrough bleeding
ADE too much progestin
Hirsutism
ADE for too much estrogen
Melasma
What is the duration of action of the progestin-only pill?
25 hours
What instructions should a patient receive if they are late taking their POP dose?
if late dose taken >3 hours late, must use backup method for 48 hours
What is Slynd and how is it different from the norethindrone-containing progestin only pill?
drospirenone (Slynd) has 4 inactive pills/pack, norethindrone has none
Describe 2 risks associated with the medroxyprogesterone acetate (Depo-Provera) injection.
-development of amenorrhea
-wt gain
-depression
-decreased bone density
According to the CDC guidelines, if a woman is a smoker is it safe for her to use hormonal contraceptives? Which methods are preferred?
Cu-IUD, levonorgestrel-releasing intrauterine device (LNG-IUD), implant, DMPA, POP
Which hormonal contraceptive has the SLOWEST return to baseline fertility?
Depo-provera ~ 10 month after d/c
A 36 year-old female patient suffers from migraine headaches with aura. Which hormonal contraceptive methods would be safe for her to use?
Cu-IUD, levonorgestrel-releasing intrauterine device (LNG-IUD), implant, DMPA, POP
What is in Plan B One Step? How can a woman access this medication (RX only, OTC, etc.)? How long after inadequately protected intercourse can the medication be used?
high dose progestin-only contraceptive; Available OTC, no age restrictions; Indicated for women who present less than or equal to 120 hrs after inadequately protected intercourse
What is ulipristal & when it be prescribed as an emergency contraceptive?
low dose progestin-only contraceptive (PPT) -Not an “abortion pill,” lower dose than mifepristone inhibits ovulation & prevents implantation but will NOT disrupt an implanted pregnancy -Maintains efficacy for up to 5 days vs Plan B which starts to lose efficacy after 3 days
True or False. The copper IUD can be used as a form of emergency contraception.
True
What is the reason estrogen-containing contraceptives should generally be avoided in breastfeeding women?
decreases the quality and quantity of breast milk
