contraception and infertility Flashcards
phases in the menstrual cycle
follicular
ovulatory
luteal
follicular phase is when
FSH causes follicle development creating a surge in estrogen
estrogen–>LH and FSH stimulation
Ovulatory phase is
the LH surge –> ovulation 24-36 hours later, release of egg
luteal phase is
lasts 14 days
progesterone is dominant
when is a good time to get pregnant
when LH is present in urine following 2 days
cervical mucus and body temperature
what indicates pregnancy
human chorionic gonadotropin in the first urine
preconception health
folate 400mcg during pregnancy 600mcg
vit B9
stop smoking and drinking keep vaccines current
avoid toxic drugs
which contraception has a delay in fertility
medroxyprogesterone injection
what is the most effective contaceptive
Implants and intrauterine devices
vasectomy, hysterectomy
lleast effective contraception
male condom, female condom, withdrawal, sponge,
fertility awareness, spermicide
does condoms help against STDs
yes only if latex or synthetic not natural sheepskin
- use with nonoxynol-9 spermicide can cause irritation and increased risk of STD/HIV
- lubricants reduce breakage of condoms (water or silicon based lubricants preffered
should spermicide be used in anal
no
phexxi
vaginal cream that keeps acidic and reduces sperm motility
hormonal contraception MOA
inhibits production of FSH and LH and prevents ovulation
progestin only
estrogen/progestin combination or COCs= combination oral contraceptives
noon oral contraceptives= CHC= combined hormonal contraceptives
*** PPI must be dispensed with oral contraceptives
what are the diff progestins in COCs
norethindrone
levonorgestrel
drospirenone
what is monophasic COCs
equal dose of estrogen and progestin throughout the pack
what are biphasic, triphasic and quadraphasic COCs
mimics the E and P levels of menstrual cycle
advantage of drospirenone
decrease AE such as bloating , PMS and weight gain
less acne (antiandrogenic acitivtiy )
- other progestins include norgestimate, desogestrel and dienogest
what are some other use of COCs
PMS
Acne
dysmenorrhea- menstrual cramps
pCOS- polycystic ovary syndrome- 1st line
endometriosis
elagolix or Orlissa is indicated
for treating pain associated with endometriosis
Natazia / mirena are indicated for
heavy mentrual bleeding
Oriahnn= estradiol, norethindrone and elagolix
indicated for heavy menstrual bleeding with uterine fibroids but not a contraceptive
progestin only pills POPS
28days active pills in each packs
supresses ovulation
thickens mucus and thins endometrium= prevents sperm penetration
needs to be taken within 3 hours of schedule
what are some benefits of POPs over estrogen products
can be used in lactating pts
can be started as early as 3-6 weeks after delivery
doesnot have risk of thrombosis after delivery
migrane prophylaxis= estrogen can cause stroke
notes on contraceptive patchs
should not be used in >35 years old who smokes
is not effective in >198lbs oor BMI >30
injectable depo provera
every 3 months delay in fertility
menstrual period affected by use of contraception
medroxy users= 1 year of use can cause no menses to 50% of pts
extended cycle COCs involve 84 days active and 7 days low estrogen causing menses every 3 months
benefits of taking continuous contraception= less migrane and anemia
what does lo mean in contraception
<35mcg of estrogen
what does Fe indicate in contraception
iron supplement is included
what does 24 indicate in contraception
24 active and 4 placebo
shorter placebo time
which contraception is contraindicated in renal or liver disease
Drospirenone containing
Yasmin 28
what is a conctinuos formuation
Amethyst
no inactive pills
does patches have more AUC than pills
YES
do rings have more AUC than pills
no
every 3 weeks and off for 1 week
how long does Depo provera last
3 months
which ring is yearly
Annovera
what are some AE of hormonal contraceptives
Nausea
breast tenderness
bloating
weight gain
HBP
spotting
what are some serious AE of estrogen
ACHES
Abdominal pain
chestpain
headache
eye problems
swelling or leg pain
what are some effects of progestin
HA, fatigue depression
drospironone can cause clotting risk adn increased potassium
injectable medroxy can cause loss in bone density
spotting cause and how to prevent
check adherence
increase dose if taking <30mcg estrogen
if taking >30 takke a different progestin
if acne what type of contraception
COC with a progestin that has lower or androgenic activity
norgestimate or drospirenone
If breastfeeding
POPs or non hormonal
if estrogen containdication
POPS or nonhormonal
if Migraine
if with auro POPs
if no aura chose any method
If fluid retention/bloating
Drospirenone
heavy menses use
COC- Natazia and IUD Mirena
Hypertension
POPS or non hormonal
mood changes
use mono phasic or extendted cycle/continuous cycle with drospirenone
nausea
take at night consider decreasing estrogen or swithcing to POP
Overweight
chose any method
postpartum
can use POP or non hormonal
premenstrual dysphoric disorder
Yaz or antidepressant
monthly cycles
use extended or continuous fomrulation
drug interaction with hormonal contraceptive
decrease in efficacys-
abx rifampin, rifabutin and rifapentine (use backup)
anticonvulsants- carbamazepine, oxcarbamazepine phenytoin topiramate lamotrigine
st johns wort
tobacco
PI- ritonavir
colesevelam
byetta
drospirenone with ace arbs heparin sglt2 calcineurin
when is a backup method needed with COC inititation
upto 5 days after beginning of menses
COC initiation
start today with backup for 7 days
sunday start after menses backup for 7 days
POPs initiatiton
start anytime use another method for the first 48 hours
all 28 pills are active
long acting contraceptives not dispensed in community pharmacies
IUDs like mirena skyla kyleena liletta = cause lighter bleeds 3-6 years use
copper-T IUD= paragard= emmergency contraceptio and/or regular birth control upto 10 years can cause heavy mense
Nexplanon plastic rod placed in the arm releases etonogestrel for 3 years
emmergency contraceptions
Copper IUDs within 5 days
Ella Ulipristal within 5 days and asap (more effective than plan B and less effective in 195lbs or BMI>30
PLan B levonorgesterel less effective in 165lbs or BMI > 25 asap within 3 days
what is levonorgestrel
1.5mg tab within 3 days the sooner the better
89% efffective
works by thickening cervical mucus
AE- nausea if puked within 2hours retake the dose
What is Ella
ulipristal acetate (relative to mifepristone Mifeprex) abortion pill
30mg - RX
COCS missed 1 pill
take missed pills asap and if it makes it 2 a day take 2
no backup needed
COCs missed 2 pills
take asap take next dose even if it makes 2 at same day
omit hotmone free week- start next pack of pills
back up contraception required for 7 days
POPs missed pill
if >3 hours past schedule
take as soon as remembered and take next dose in schedule
back up contraception 48 hours
key counselling points for diaphram
one teaspoon of spermicide
leave in for 6 hours after intercourse
do not keep wearing for 24 hours
reapply spermicide in intercourse is repeated
can be used for upto 2 years
foams creams suppository jellyies
place deep innto the vagina before intercourse
sponge
leave in for 6 hours after intercourse not more than 24 hours
COCs
risk of clots
nausea weight gain breast tenderness
take pill same time of day
drug interactions
drospirenone
increases potassium
patches
but stomach, upper arm
once a week for 21 days do not apply to breasts
start on day1 or sunday (back up for 7 days )
nuva ring
3 weeks taken out 1 week
injectable medoxyprogesterone
decrease bone density take with calcium or vit D
menstruation cycle may change
infertility
> 1 year unable to get pregnant
clomiphene
letrozole
gonadotropins
hCG
