Contraception

Question 1

Both estrogen and progestin are known to cause:

Answer 1

Both estrogen and progestin are known to cause blood pressure elevations, so changing formulations of COC or using progestin-only pills may not lead to problem resolution. Once COCs are discontinued, blood pressure usually returns to normal within 3 months.

Question 2

The use of COC pills is associated with a threefold risk of:

Answer 2

The use of COC pills is associated with a threefold risk of venous thromboembolism. COCs have a protective effect against ovarian cancer and endometrial cancer. The risk of hemorrhagic stroke is not increased by the use of COCs, and they have not been shown in studies to impact carbohydrate metabolism in a statistically significant way.

Question 3

Progestin-only pills

Answer 3

Progestin-only pills prevent conception through suppression of ovulation, thickening of cervical mucus, alteration of the endometrium, and inhibition of tubal transport. The effectiveness of this method is dependent on consistency of use. In fact, if a pill is taken even after 3 hours, an alternative form of contraception should be used for 48 hours. There is no hormone-free period with these pills, and they should be taken every day. The pills do not carry an increased risk for thromboembolism, and the World Health Organization has reported this form of contraception to be safe for women with a history of venous thrombosis, pulmonary embolism, diabetes, obesity, or hypertension. Nursing women can use this pill, but there is FDA approval for use in others as well. In general, progestin-only pills protect against ectopic pregnancy by lowering the chance of conception. However, if progestin-only pill users get pregnant, the chance of ectopic pregnancy is 6% to 10% higher than the rate found in women not using contraception. Therefore, users should be aware of the symptoms for ectopic pregnancy.

Question 4

Emergency contraception

Answer 4

Emergency contraception is appropriate when no contraception was used (including cases of sexual assault), or when there is contraceptive failure. They should be used within 72 hours of intercourse, well before implantation (implantation occurs 5-7 days after intercourse). ECPs involve limited hormonal exposure, and therefore have not been shown to increase the risk of venous thromboembolism, stroke, or MI. In fact, there are no medical contraindications to the use of emergency contraception pills. They do not disrupt an already implanted pregnancy and do not cause birth defects. Progestin ECPs prevent 85% of expected pregnancies when used correctly, and combined ECPs prevent 75% of expected pregnancies. They are not 100% effective in pregnancy prevention. There is no need to perform a pregnancy test when prescribing.