Contraception Flashcards
Ethinyl estadiol
estrogen in combination pills
Plus “19-nor” progestin
Mechanism of action of Ethinyl estradiol
- Inhibit ovulation, prevent release of gonadotropins
- Change cervical mucus
- Endometrial changes, not a good environment
Abrupt withdrawal of progestin support prompts bleeding
Norethindrone, Norgestrel (minipills)
levonorgestrel
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
Norgestimate
Not androgenic or estrogenic
Purely Progestin
Drospirenone (Yaz)
Anti-androgenic and anti-mineralcorticoid activities
block endogenous androgen
prevent bloating and edema
24 active pills instead of 21
Current low dose pill
10-50 ug estrogen, 1mg progestin
Estrogen effects
Nausea, irritability
headache/migraine
Fluid retention, weight gain, breast enlargement, tenderness
Menstrual changes
Progestin effects
Nausea, bloating, menstrual changes,
Depression, fatigue
ACNE, hirsutism, libido changes
New drugs without androgenic progestins are good for acne
Risks w/ combination estrogen pills:
Cardiovascular risks, thromboembolism, MI
LOW IN LOW-dose pills
except women >35 who smoke
Progestins associated with blood clot risk
Drosperinone
Etonogesterol
Cancer risks
Estrogens increase endometrial cancer
Combo pills: decrease endometrial cancer and endometriosis, decrease ovarian cancer
Contraindications of birth control
Absolute: pregnancy, estrogen-responsive tumor
Relative: Thromboembolic disease, HTN, DM, liver disease, >35 smoking women
Medroxyprogesterone
Mini-pill progestin
IM injections every 3 months
Etonorgestrel
Single subdermal implant look like matchstick
In upper arm, last 3 years
risk of irregular bleeding
Next Choice
Levonorgestrel, 2 pills 12 hr apart/72 hours
Plan B One step
Levonorgestrel, 1 high dose/72 hours
Testosterone
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
Testosterone esters
IM injection
Preparation of choice for most
Adverse effects of testosterone
Feminization, testicular atrophy, oligospermia in men due to negative feedback
Masculinization in women
Psychosis “androgen rage”
Anabolic steroids
Testosterone-like steroid
masculinizing side effects
Male contraceptives
Not sufficiently effective or safe
Hard to block millions of sperm vs one egg
Anti-androgens
do not use in endocrinology
Used for treating prostate and other cancers
Inhibit testosterone synthesis and action
