contraception Flashcards
things to consider before start on contraception, ie baseline for what? 5
Pregnancy test
Weight
Blood pressure in women considering combined estrogen-and progestin-containing contraceptives (COCs)
Bimanual examination and cervical inspection for women considering intrauterine devices (copper-IUD or LNG-IUS), cervical cap or diaphragm
STI screening for women considering intrauterine devices
contraindication for contraception
Breast cancer or hormone-dependent cancer
Cerebrovascular disease, history of cerebrovascular accident
Complicated valvular heart disease
Current or past history of venous thromboembolism or pulmonary embolism, known thrombogenic mutations (e.g., factor V
Leiden), prothrombin mutation, protein S, protein C and antithrombin deficiencies or other known coagulation-factor
deficiency
Diabetes with microvascular complications
History of or current MI or ischemic heart disease, vascular disease
<6 weeks postpartum if breastfeeding
Migraines with aura at any age
Hypertension (SBP ≥160 mm Hg or DBP ≥100 mm Hg)
Severe cirrhosis or liver tumour
Smoker >35 years of age (≥15 cigarettes/day)
what is estrogen metabolized by?
where in the body is estrone produced?
liver
adipose tissues
two estrogen out there
name a few progestins, which one is equiv to spirnolactone
ethinyl - estradiol
mestranol
P - drospirenone - spiro - yasmin
norethindrone
levonorgestrel
aldosterone antagonist
fx of estrogen 3
- suppress FSH and thus prevent development of a dominant follicle
- potentiates action of progestin component
- stimulates endometrial proliferation
fx of progestin 4
- suppresses LH surge and thus blocks ovulation
- thickens cervical mucus to inhibit sperm penetration through cervix
- induces atrophy of endometrium
- alters motility of fallopian tubes to interfere with ova transport
what is micronor and how it works? why chose this over estrogen?
how to take?
SE?
norethindrone - progestrin
Prevents pregnancy through changes in cervical mucus- can still ovulate
useful when smoker >35, obesity, migraine; safe in postpartum and breastfeeding
take continuously, take same time every day within 3 hours
SE - spotting, decreased menstral flow, amenorrhea
which combined OC good for acne? why?
SE?
yasmin or yaz - similar to spiro - anthiadrogenic,
antiminerolcorticalcoid - less weight gain, less fluid retention
SE - Hyperkalemia, headaches, menstrual disorders, breast pain, nausea, increased VTE risk
SE of estrogen - think newly preggers have these SE
SE for progestin
E- nausea, breast tenderness, HA, thromboembolic effects (rare)
P- acne, oily skin, hirsutism, voice changes, breakthrough bleeding - has estrogen deficiency
if pt starts to spot, what should you do with dosing?
what to do if nausea?
has estrogen deficiency, increase dose to build the wall hence no bleed
decrease estro to lessen effect
breakthrough bleeding
If bleed occurs in first 10 days & midcycle, do what?
If bleed occurs in last 11 days?
may be due to low E. Need to increase E relative dominancy – best done by decreasing P.
may be due to low P . Need to increase P.
which drug has the most androgenic agent? - acne se
levonorgestrel
7 day rule?
Never let the Pill- free interval exceed 7 days since there is a
risk of ovulation
postpartum - when you start ovulating again?
when can start OC post delivery? which one can use right away?
6 weeks - 24 days
4 weeks if not BF, estrogen inhibit prolactin action on breast
but progestin only can be used immediately and while BF ie mini-pill
RED flags 5
abdo pain
chest pain - PE
HA - stroke, htn, migraine
Eye problems
leg/calf pain - dvt
