Contraception and Infertility Flashcards
what are the hormone changes in the follicular phase? What days of the cycle is this?
FSH leads to follicle development and an inc in estrogen
estrogen causes inc FSH and LH
day 0-14
what are the hormone changes in the ovulatory phase? Which days of the cycle is this
day 14 x 24-36h
LH increase triggers egg release from ovary
what are the hormone changes in the luteal phase? Which days is this?
progesterone dominates
day 14-28
what are the folic acid, Ca and vit D requirements during preg
600mcg folic acid a day
1000mg/day Ca
600IU (15mcg)/day Vit D
which BCs are highest efficacy
IUD, nexplanon implant, sterilization male or female
second most efficacious BC
depo, pill, patch, ring, diaphragm
third most efficacious BCs
male condom
female condom
pulling out
sponge
lest efficacious BCs
spermicide
cycle tracking
what does “Lo” mean
</= 35mg estrogen per pill!!
what does 24 mean for pills?
24 days active, 4 days placebo
this is shorter, some placebo times are >4 days
what does Tri mean
triphasic, 3 different types of hormone doses (7/7/7)
what are the monophasic BCs
sprintec-28
cryselle-28
yasmin 28
Yaz
microgestin fe 1/20
junel fe 1/20
Apri
what is the only quadriphasic BC
Natazia
what does 1/20 mean
there is a 7 day placebo week
what are the advantages of drosperinone?
what products have drosperinone?
What should we monitor
unique progestin that is also a mild K sparing diuretic that will dec bloating, PMS sx
low androgenic activity (good for acne, hirsutism)
in Yasmin, Yaz, Nextellis
Slynd is drosperinone only!
Monitor potassium!!
which BCs are E and P
ring
pill
patch
which BCs are progesterone only
POPs (Slynd, Errin, Camila, Nora-Be)
depo provera
non-copper IUDs
how do POPs/mini-pills work
suppress ovulation, thicken cervical mucus, thin endometrium
besides drosperinone, what progesterone has the second lowest androgenic activity
norgestimate
what are patients who are good candidates for progesterone only BCs
migraine w aura
estrogen CI (>35 who smoke or have CVD)
breastfeeding
HTN
mood changes
what patients are good candidates for drosperinone
targeting acne or hirsutism
targeting bloating
no concern for hyperkalemia
estrogen CI
adverse effects of depo shot
dec MBD
need to supplement with Ca and Vit D
how should patients take POPs
must take QD within a 3 hour window
who are not good candidates for drosperinone
liver or renal failure
hyperkalemic
clot risk
side effects of estrogen
nausea
breast tenderness
bloating
weight gain
thrombosis
ACHES (abd pain, chest pain, HA, eye issues, swelling)
estrogen is CI in
> 35 who smoke or have CVD
hx DVT, PE, stroke, CVD, thrombosis of heart valve
ovarian cancer
liver cancer
breast cancer
migraine w aura
DM w vascular disease
use with Mavyret for Hep C
estrogen/progesterone patches are CI in
BMI >/=30 2/2 inc clot risk (Xulane, Zafemy) and dec efficacy (Twirla)
which drugs dec BC efficacy
mostly inducers of CYPs
rifampin
AEDs (tegretol, trileptal, phenytoin, primidone, topamax, lamicatal, barbiturates)
SJ wort
tobacoo
ritonavir
colesevelam
when starting a COC, how long should a backup form of contraception be used
7 days
when starting a POP, how long should backup be used
48 hours
if a patient missed their COC last night at 9 pm, what should they do? Are backup and/or EC needed?
has been less than 48 hours/less than 2 missed
take missed pill ASAP, take scheduled one at 9pm as usually regardless if theres two pills in one day
no EC or backup needed
if a patient missed last two COCs at 9pm and it is now 10am next day, what should they do?
take 1 pill ASAP and continue regularly scheduled one that night at 9pm
EC needed if unprotected sex in last 5 days
backup x7d
if a patient missed their Slynd dose by 8 hours, what should they do? Are backup and/or EC needed?
take missed dose ASAP as well as scheduled dose for later that day
EC needed if unprotected sex in last 5d
backup x48h
what are the options for emergency contraception
copper IUD
levonorgestrel (Plan B)
My Way
Ullipristal (Ella)
what time window does a patient have to use Plan B
3 days (72 h)
what time window does a patient have to use Ella (Ullipristal)
5 days
which ECs are RX
Ella
IUD needs office visit
which ECs are OTC
My Way / Plan B
what time window does a patient have to receive a copper IUD as EC
5 days
what is the dose for Plan B/My Way
1.5mg levonorgestrel x1
what is the dose for Ella (Ullipristal)
30mg x1
what are common SE of EC
nausea/vomiting
infertility is defined as
inability to conceive after 1 year of unprotected sex
what drugs are typically used for infertility tx
clomiphene
gonadotropins
aromatase-i (letrozole)
