Contraception Flashcards
Type of estrogen seen in most COCs?
Ethinyl estradiol
Estrogen binds to what 2 binding proteins?
Sex-hormone-binding globulin & Albumin
What type of drug is Ethisterone?
What type of extra, metabolic effects does it have?
Progestin
Androgen-like effects b/c it was formed by a combo of Estrinyl & Testosterone
The main contraceptive effect of COCs is to suppress ___a___ secretion, thereby inhibiting ___b___.
a) gonadotropin
b) ovulation
**Specifically, steady, low, doses of estrogen and progestin inhibit the LH surge in the menstural cycle which inhibits ovulation.
What are the 3 main MOAs of COCs?
- Inhibiting ovulation
- Endometrial atrophy
- Thickens cervical mucus
Difference btwn Mono & Biphasic COC formulations?
Monophasic
– fixed amount of an estrogen and a progestogen in each active tablet
Biphasic/Triphasic
– varying amounts of the two hormones according to the stage of the cycle (usually fixed estrogen w/ increasing progestin according to time in cycle)
Levonorgestrel is a ___a___ that is structurally related to ___b___?
a) Progestin
b) Testosterone
Norethindrone is a ___a___ that is structurally related to ___b___.
a) Progestin
b) Testosterone
Ass’d risks w/ COC use?
- Venous Thromboembolism (VTE)- risk increases w/ age & in those w/ other risk factors
- Cervical ca- small inc after 5 yr use (likely due to ↑unprotected sex)
- Primary liver cancer
- MI- increased 3 fold if hypertension
- CVA/ischemic – increase is 1.5-fold in normotensive non-smoking COC users & 3-fold in those with hypertension
Ass’d benefits of COCs aside from contraception?
Less menorrhagia/ dysmenorrhea
Reduction in – Ovarian / endometrial Ca – functional Ovarian cysts – Benign breast lessions – Symptomatic endometriosis – Risk of Colon ca – Thyroid dx
Improvement of acne (↓endogenous Testosterone via negative feedback)
Are COCs recommended for the prevention of colorectal cancer?
No, however a dec’d risk is ass’d when taking them.
Which is more common - Endometrial or Ovarian cancer?
Which is more deadly?
Endometrial = more common
Ovarian = more deadly
T or F?
When taken correctly, COCs are >99% effective
True
COC’s can interact with several medications, including what classes in general?
Antieleptics, antibiotics, & HIV medications
Most data indicate that the primary contributing factor to venous thromboembolism is _______ and that the various _____ components pose little risk.
Estrogen contributes to VTE.
Progestin is thought to pose little risk.
What type of contraceptive should be given to a woman w/ risk of venous thromboembolism?
Progestin only
Estrogen poses VTE risk
The risk for MI associated with COCs appears to be correlated with what 3 things?
- Number of cigarettes smoked (biggest impact)
- Age
- Dose of estrogen in the formulation
Women smokers should be put on what type of COCs to lower their risk of MI?
COCs w/ low doses of estrogen
MOA of Estrogen in contraceptive pills? (2)
– Decreases FSH
– Increases progesterone receptors
MOA of Progesterone in contraceptive pills? (4)
– ↓ LH
– ↓ tubal motility
– Opposes estrogens action on the endometrium
– Thickens cervical mucous
Combined Estrogen/Progesterone MOA? (4)
- Suppress GnRH midcycle surge
- suppress ovulation
- increase cervical mucus
- impairs sperm motility
Contraindications for Estrogen/Progesterone contraceptives?
- Currently pregnant
- Uncontrolled HTN, renal or liver disease
- Current or <5yr ago breast cancer
- Elevated risk for VTE (h/o VTE, known thrombophilia, CAD, stroke, post op from pelvic or orthopedic surgery)
What is a Nuva ring?
Once a month birth control w/ Etonorgesterol/Ethinyl estradiol
- Estrogen/progesterone transdermal absorption
- Placed in vagina
- May be out for 3 hours or less
- Same advantages/risks as OCPs
What is Ortho-Evra?
Weekly Patch similar to estrogen/progesterone OCPs
Advantages & Disadvantages of combined birth control pills?
Advantages: effective, reversible, lighter and/or less frequent periods, decreased endometrial and ovarian cancer, inexpensive if generic, acne control
Disadvantages: requires daily use, irregular bleeding, initial nausea, effects on mood, decreased libido, VTE risk
How to manage Nausea side effect of E/P contraception?
usually resolves, can try lower dose of estrogen
How to manage Irregular Bleeding side effect of E/P contraception?
taking regularly, wait few months, can switch to higher estrogen
How to manage Mood/Libido side effect of E/P contraception?
can try switching progesterone types
Mirena - what is it? MOA? Length of efficacy?
- Levonorgestrel containing IUD
- MOA = inhibition of sperm transport & fertilization of ova, partial inhibition of ovulation
- Effective at least 5 yrs
Mirena - contraindications?
- irregular uterine cavity
- pregnancy
- irregular bleeding with no work up
(ok for patients w/ inc’d risk of VTE b/c no estrogen)
(ok for nulliparous women, rule out cervicitis prior to placement)
Nexplanon - what is it? MOA? Length of efficacy?
- Etonogesterol subdermal implant
- Effective at least 3 yrs
- Requires providers to be certified
- Increases cervical mucus, blocks ovulation
- Unpredictable bleeding pattern
Nexplanon - advantages? Disadvantages?
Advantages: Low hormone, very effective
Disadvantages: Variable bleeding pattern
Mirena - Advantages & Disadvantages?
Advantages: low hormone, mostly local, very effective, decreased menstrual bleeding- as effective as ablation, 20% amenorrhea, reversible, decreased PID in long run
Disadvantages: irregular bleeding, expensive, rare risk of perforation requiring surgery, ovarian cysts, acne, increased PID at time of insertion x3wks
Depo Provera - what is it? MOA?
IM or SQ injection Q3months depot medroxyprogesterone
MOA: decreases LH, endometrial lining thinning and thickened cervical mucous
Depo Provera - AEs?
Weight gain
- 5lbs 1st yr
- 16.5lbs at 5yrs
- Decreased bone density after 2yrs
- Irregular periods
- 70% amenorrhea at 9 months
Progesterone only pill
MOA: increases cervical mucus, decreases sperm motility via changes in endometrium & tubal lining
- Same amount of hormone daily, no drug free pills
- Needs to be taken at same time daily to be effective
- Less effective than estrogen/progesterone pills; more expensive
What is “Coitus Interruptus”?
The Latin term for the pull-out method
Ortho-Evra - AEs?
- Possibly higher DVT risk than OCPs
- Skin irritation
- Not as effective if >198lbs
Can you use the Progesterone only pill if breastfeeding?
Yes
What can you consider if the patient can’t use estrogen due to increased risk of VTE (ie >35/smoking)?
Progesterone-only pill
Progesterone-only pill - Contraindications?
- Pregnant
- Irregular bleeding not worked up
What is Adiana?
- Catheter placed in tube via hysteroscopy
- Radiofrequency heats tube, place insert
- Wait 3 mo for scarring, needs HSG to confirm
