Contraception

Question 1

Ethinyl estadiol

Answer 1

estrogen in combination pills

Plus “19-nor” progestin

Question 2

Mechanism of action of Ethinyl estradiol

Answer 2

1. Inhibit ovulation, prevent release of gonadotropins
2. Change cervical mucus
3. Endometrial changes, not a good environment
   Abrupt withdrawal of progestin support prompts bleeding

Question 3

Norethindrone, Norgestrel (minipills)

levonorgestrel

Answer 3

ANDROGENIC, anabolic
Minipills = progestin only
Use if patient has bad side effects with estrogens
LESS EFFECTIVE, 5x more likely to be pregnant
Take daily == IUD - avoid 1st pass metabolism, slow release
Do not prevent ovulation, inhibit fertilization and implantation = risk of pregnancy is higher

Question 4

Norgestimate

Answer 4

Not androgenic or estrogenic

Purely Progestin

Question 5

Drospirenone (Yaz)

Answer 5

Anti-androgenic and anti-mineralcorticoid activities
block endogenous androgen
prevent bloating and edema
24 active pills instead of 21

Question 6

Current low dose pill

Answer 6

10-50 ug estrogen, 1mg progestin

Question 7

Estrogen effects

Answer 7

Nausea, irritability
headache/migraine
Fluid retention, weight gain, breast enlargement, tenderness
Menstrual changes

Question 8

Progestin effects

Answer 8

Nausea, bloating, menstrual changes,
Depression, fatigue
ACNE, hirsutism, libido changes
New drugs without androgenic progestins are good for acne

Question 9

Risks w/ combination estrogen pills:

Answer 9

Cardiovascular risks, thromboembolism, MI
LOW IN LOW-dose pills
except women >35 who smoke

Question 10

Progestins associated with blood clot risk

Answer 10

Drosperinone

Etonogesterol

Question 11

Cancer risks

Answer 11

Estrogens increase endometrial cancer

Combo pills: decrease endometrial cancer and endometriosis, decrease ovarian cancer

Question 12

Contraindications of birth control

Answer 12

Absolute: pregnancy, estrogen-responsive tumor
Relative: Thromboembolic disease, HTN, DM, liver disease, >35 smoking women

Question 13

Medroxyprogesterone

Answer 13

Mini-pill progestin

IM injections every 3 months

Question 14

Etonorgestrel

Answer 14

Single subdermal implant look like matchstick
In upper arm, last 3 years
risk of irregular bleeding

Question 15

Next Choice

Answer 15

Levonorgestrel, 2 pills 12 hr apart/72 hours

Question 16

Plan B One step

Answer 16

Levonorgestrel, 1 high dose/72 hours

Question 17

Testosterone

Answer 17

Ineffective orally, many other preparations
Limited parenteral effectiveness due to rapid metabolism
Hormone replacement tx: prepubertal/postpubertal hypogonadism, hypopituitarism and induce secondary sexual characteristics - must use in combo with gonadotropins

Question 18

Testosterone esters

Answer 18

IM injection

Preparation of choice for most

Question 19

Adverse effects of testosterone

Answer 19

Feminization, testicular atrophy, oligospermia in men due to negative feedback
Masculinization in women
Psychosis “androgen rage”

Question 20

Anabolic steroids

Answer 20

Testosterone-like steroid

masculinizing side effects

Question 21

Male contraceptives

Answer 21

Not sufficiently effective or safe

Hard to block millions of sperm vs one egg

Question 22

Anti-androgens

Answer 22

do not use in endocrinology
Used for treating prostate and other cancers
Inhibit testosterone synthesis and action