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
