Contraception Flashcards
What do ovulation kits test for?
LH and are positive if LH is present
What happens pre-ovulation (before day 14)?
FSH is dominant
What happens post-ovulation (after day 14)?
Theres a LH surge from day 14
What indicates a positive pregnancy test?
If hCG (human chorionic gonadotropin) is present in urine
What supplement should all women of child-bearing age be on?
Folic acid supplement 400-800 mcg/day
What’s the purpose of taking Folic acid supplement (400-800 mcg/day)?
To help prevent birth defects of the brain and spinal cord (neural tube defects)
At least how long should a woman be on Folic acid before she conceives? Why?
At least 1 month before pregnancy
Bcuz it takes time to build up adequate body stores
Name the main types of hormonal contraceptive
Progestins-only pills (POPs) - pill or injectable
Estrogen and progestin combinations oral contraceptives (COCs) - pills or patch or ring
Which contraceptive is recommended for breast-feeding mothers? Why?
POPs
Estrogen reduces milk production
List the various indications of COCs
Pregnancy prevention
Dysmenorrhea
PMS
Perimenopausal sx (hot flashes, night sweat)
Anemia due to excessive period-related blood loss
Acne (in females)
Premenstrual migraine
In what type of migraine is POPs preferred over COCs? Why?
In migraines with aura
Estrogen increases the risk of stroke, t4 POPs is preferred
SEs due to estrogen (COCs issue only)?
Nausea
Breast tenderness/fullness
Bloating
Weight gain
Elevated BP
Which SE due to estrogen is most bothersome? What can be done to alleviate it?
Nausea
They may take pill in the evening or at bedtime
Severe SEs of estrogen?
Thrombogenic disorders, including heart attack, stroke, DVT/PE
What other factors, other than estrogen increases a woman’s risk for clotting disorders?
Age
Smoking
Diabetes / HTN
Prolonged bed rest
Overweight
What should be avoided in at-risk women?
Progestin drospirenone (present in YAZ YASMIN Gianvi Ocellated Safyral Syeda Zarah Beyaz as well as Ortho Evra patch)
List the conditions that u should not use any form of estrogen in?
Hx of blood clot disorder (DVT/PE)
Hx of stroke or heart attack
Heart valve dx with complications
Severe HTN
Diabetes that causes blood vessel problems
Poorly controlled diabetes
Severe headaches
Recent major surgery with prolonged bed rest
Breast cancer
Liver cancer or dx
Uterine cancer /other known /suspected estrogen-dependent cancers
Unexplained abnormal bleeding from the uterus
Jaundice during pregnancy or jaundice with prior hormonal contra use
Known or possible pregnancy
If older than 35 yrs + smoke > 15 cigarette/day
SEs of POPs?
Breast tenderness
Fatigue
Changes in mood
What other factors do u consider for clotting risk?
Higher estrogen dose, higher clotting risk
Drospirenone-containing birth control pills may be ass with a higher risk for blood clots than other progestin-containing pills
Ortho Evra patch: higher systemic estrogen exposure than most COC pills
If a woman is breastfeeding, what type of hormonal contraceptive would u recommend? (Formulation considerations)
POPs
If a woman has elevated clotting risk, what type of hormonal contraceptive would u recommend? (Formulation considerations)
Lower dose estrogen content
Progestin-only pill
If a woman has estrogen CI, include clotting risk, what type of hormonal contraceptive would u recommend? (Formulation considerations)
POPs
If a woman experiences Estrogenic side effects, what type of hormonal contraceptive would u recommend? (Formulation considerations)
Low estrogen formulation
If a woman is Spotting/Breakthrough Bleeding, what type of hormonal contraceptive would u recommend? (Formulation considerations)
Wait 3 cycles before switching (bleeding more common with Seasonale, Seasonique and Lybrel)
Use higher estrogen and progestin if mid-cycle bleeding persist
If a woman is Avoiding Monthly Cycle, what type of hormonal contraceptive would u recommend? (Formulation considerations)
Longer formulation - Seasonale or Seasonique (Q3 months)
Continuous - Lybrel
If a woman has fluid retention/bloating, what type of hormonal contraceptive would u recommend? (Formulation considerations)
Product containing Drospirenone (if low clotting risk)
Progestine is a mild diuretic (retains K)
If a woman has Premenstrual Dysphoric Disorder, what type of hormonal contraceptive would u recommend? (Formulation considerations)
YAZ
Sertraline
Fluoxetine (Sarafem)
If a woman has acne, what type of hormonal contraceptive would u recommend? (Formulation considerations)
Ortho Tri-Cyclen
Estrostep
Yaz
If a woman has Heavy Mentsrual Bleeding, what type of hormonal contraceptive would u recommend? (Formulation considerations)
Any OCP would do
Mirena - preferred
Natazia - is indicated for menorrhagia
Tranexamic acid (Lysteda)
List drugs that reduce efficacy of hormonal contraceptive (use back-up while on these meds)
Antibiotics especially, Rifampin. Others are rifapentine, Rifabutin
Anticonvulsants - barbiturates, CBZ, oxcarbazepine, phenytoin, topiramate and felbamate
St. John’s wort
Protease Inhibitors (PIs) and non-nucleoside reverse transcriptase inh (NNRTIs) - increase or decrease OCPs
Bosentan (Tracleer), Mycophenolate (CellCept)
Smoking
How do u make changes to OCPs while on Rifampin?
Use other form of birth control
If switching back to OCPs after rifampin use, use back up for 11/2 months after stopping rifampin
Advantage of depo-provera inj? Disadvantage of depo-provera inj?
Doesn’t have drug interactions
Lowers bone density (should be avoided in women at risk for osteoporosis)
List oral contraceptive types (representative list)
High dose Monophasic COCs: all active pills contain the same level of hormone throughout the 3 active weeks
Biphasic or Triphasic (multiphasic): the dose of hormones changes over the course of 21 days
Low estrogen COCs
Extended cycle COCs
Progestin only mini-pills (POPs)
Which OCPs is approved for PMDD?
Seasonique
List agents in high dose Monophasic COCs (all active pills contain the same level of the hormones throughout the 3 active weeks)
50mcg Ethinyl estradiol, with various progestins
Ogestrel 0.5/50-28
Ovcon-50
Zovia 1/50-28
List agents in Biphasic or Triphasic (also called Multiphasic): dose of hormones changes over the course of 21 days
Cyclessa Estrostep FE Kariva Mircette Nortrel 7/7/7 Necon 7/7/7 Ortho-Novum 7/7/7, Tri-Cyclen Lo Tri Lo Sprintec
Which multiphasic OCPs has 4 phases?
Natazia
Uses of low estrogen COCs (20-30 mcg estrogen, compared to 35mcg)?
Used to lower withdrawal sx (emotional/physical) and bleeding
Difference btw Seasonique and Seasonale? (Extended Cycle COCs)
Seasonique has shorter placebo periods (7 days of low dose estrogen) than Seasonale (7 days of placebo)
Which OCPs contain Folic acid?
Extended cycle COCs
Beyaz
Safyral
What’s unique about Lybrel?
12 months continuous OCP
What’s unique about Ethinyl estradiol/levonorgestrel (Amethyst)?
Continuous (no placebo or stop)
What’s LoSeasonique?
3 months, with 20mcg EE
List progestin only mini pills agents
Norethindrone 35 mcg (Camila, Errin, Heather, Jolivette, Micronor, Nor-QD, Nora-BE)
Some names include “nor”
POP start day option?
Start any time
Use another method of birth control for first 48 hrs (protection begins after 2 days)
How to use POPs?
Need to take exactly around same time of day everyday
What happens if 3 hrs have elapsed from regular schedule time?
Back up is needed for 48 hrs after taking the late pill
COC start day?
Sunday (menstruate during the week)
OR
1st day of menses (or within 5 days of start of period)
When should u use back up during the start of COC? For how long?
If not starting within 5 days after start of period, use back-up for 1st week of use
How do u deal with a single COC pill missed?
Take single pill when noticed, and take next pill at scheduled time (u may nene to take 2 pills on the same day)
No additional contraceptive is req
How do u deal with a 2+ COC pill missed?
Back up contraception is needed if >= 2 pills are missed
U may need to take 2 pills on the same day
How do u deal if 2 or more pills are missed in the first week of cycle?
Emergency contraception should be used
How do u deal if 2 or more pills are missed in the last week of hormone pills (day 15-21 of a 28-day pack)?
Omit hormone-free week, by finishing the hormone pills in current pack and start a new pack the next day
How long does it take for protection to occur in Seasonale and Seasonique?
7 days
Use back-up for first 7 days
Which OCPs are continuous pills with no monthly cycle?
Lybrel
Amethyst (generic)
How do u deal with a 1 tab of Lybrel/Amethyst pill missed?
Take as soon as remembered and take next pill at regular time (u may need to take 2 pills in a day)
Use back-up for7 days
How do u deal with a 2 tabs of Lybrel/Amethyst pill missed?
Take the. 2 tabs asap. Take next one at regular schedule time.
Use back-up for 7 days
How do u deal with a 3 tabs of Lybrel/Amethyst pill missed?
Continue to take 1 tab daily
Don’t take missed pills
EC may be req
Use back-up for 7 days
List brands that contain Drospirenone
YAZ
Gianvi
Yasmin
Ocella
Syeda
Zarah
Beyaz
Vestura
Safyral
Loryna
Why are Drospirenone-containing pills imp?
They decrease bloating, PMS sx and Wt gain
What’s the caution with Drospirenone-containing pills?
Have a risk of increased K and caution must be used with K-sparing agents including:
Aldosterone antagonist K supplements Salt substitutes (KCl) ACE-I ARBs Heparin Canaglifozin Calcineurin inhibitors
What must be checked b4 starting Drospirenone-formulations?
Check potassium level
Safe range = 3.5-5 mEq/L
In what disease states are Drospirenone-formulations avoided?
Kidney, Liver or Adrenal gland dx
In women with clotting risk (bcuz they have a slightly higher risk of clotting)
Howz Ortho Evra COC patch used?
Once a week for 21 out of 28 days
Apply on clean, dry skin of buttocks, stomach, upper arm or upper torso
Do u need backup when staring Ortho patch?
No backup needed
When should backup be needed for Ortho patch?
If patch falls > 24hrs
Unique SE of Ortho patch?
Higher systemic estrogen exposure (60% more than a 35mcg pill)
Other SE same as PI,,
When is Ortho patch less effective?
In women > 198 pounds
How often is NuvaRing used?
Inserted into the vagina once a month
Kept in place for 3 weeks
What do u do if ring is out > 3 hrs during week 2 or 3?
Rinse and re-insert ring and use backup for 7 days
T/F? NuvaRing has same SE, CI and drug interactions as the pills?
True
Howz NuvaRing stored? Duration?
Up to 4 months at room temperature
What’s the only 100% way to prevent pregnancy?
Abstinence
What’s used to increase birth control effectiveness of condoms?
Nonoxynol-9 spermicide
What do OTC contraceptive methods (and some condoms) all contain?
Nonoxynol-9
List the 3 options made of soft latex or silicone barriers that cover the cervix is and prevent sperm passage
Shield
Cap
Diaphragm
List other forms of contraception
IUD - Mirena, Skyla
Copper-T IUD - Paraguard
Subdermal rod - Implanon, Nexplanon
Injection - Depo-Provera, Depo-subQ Provera
What’s emergency contraception (EC)?
The morning after pill is a form of contraception that prevents pregnancy up to 72hrs (3days) for levonorgestrel EC
120 hrs (5 days) for Ella
What can also be used as EC?
Higher than normal doses of regular OCPs can be used e.g.
5 tabs of Aviane
Alesse x 2 doses, taken 12 hrs apart
If a pt vomits within 2 hrs of taking pills, what should be done?
They should consider repeating the dose
Which EC is OTC?
Levonorgestrel EC (Plan B One-Step) is OTC with no age or other restrictions
MOA of levonorgestrel (primarily)?
Prevent or delay ovulation
What do ovulation kits test for?
Luteinizing hormone (LH)
When is the highest chance for pregnancy when using ovulation kits?
3 days immediately from the positive result
What agent is oral fertility med?
Clomiphene (Clomid, Serophene)
What’s the brand name of Clomiphene?
Clomid
Serophene
MOA of Clomiphene (Clomid, Serophene)?
Selective Estrogen Receptor Modulator (SERM)
SE of Clomiphene (Clomid; Serophene)?
Hot flash
Ovarian enlargement
Abdominal bloating/discomfort
Thrombosis risk
List injectable fertility meds
Human Chorionic Gonadotropin (hCG)
Gonadotropins
Urofollitropin
Follitropin
Gonadotropin Releasing Hormone Agonist (GnRH agonist)
Gonadotropin Releasing Hormone Antagonist (GnRH antagonist)
How long is the normal menstrual cycle?
23 - 35 days (average 28 days)
