Contraception: CHC products

Question 1

CHC tablet benefits

Answer 1

Regulates blood loss, good for anemia, endometriosis, fibroids, decreased cramps
Increased spontaneity, sexual enjoyment, easy to use
Decreased chance of ovarian, endometrial, colorectal cancers, benign breast mass
Improved acne and hirsutism, effective, increased BMD which protects against OP

Question 2

CHC ring benefits

Answer 2

Less spotting than with CHC tablets, low risk of irregular bleeding
Good for forgetful patients
Protects against same cancers as CHC tabs
Non-latex, Nuvaring has a grace period of 35 days, less ADEs due to less hormone present, can remove during intercourse for up to 3 hours, have to remember to replace and wash, can use with tampon, privacy, partner awareness

Question 3

CHC patch benefits

Answer 3

Menstrual, sexual/psychological, and cancers are the same as the pills and ring

Have a grace period of up to 9 days, okay if you forget to change the patch after 7 days, can bathe/swim/etc. in it, readily reversible and effective

Question 4

CHC tablet disadvantages

Answer 4

Spotting (but goes away in 3 months), post-pill amenorrhea
Mood changes, daily administration, can be expensive, adherence issues, decreased libido and anorgasmia
May increase risk for cervical and possibly breast cancer
No STD protection, drug interactions

Question 5

CHC ring disadvantages

Answer 5

Menstrual disadvantages the same as CHC tablets
Insertion and removal, discomfort during intercourse since you technically shouldn’t be removing it
Nuvaring requires refrigeration (Annovera doesn’t)
Systemic absorption

Question 6

CHC patch disadvantages

Answer 6

Menstrual, sexual/psychological, cancers are the same as the CHC tablets

Clot risk, skin irritation, need to rotate site (back, butt, upper arm, abdomen) which means it may show and patients may not like the appearance of it/less privacy, patch detachment

Question 7

CHC patch is CI’ed in…

Answer 7

obese women

90kg for Xulane, BMI >30 kg/m^2 for Twirla

Question 8

CHC tabs ADEs

Answer 8

Nausea, bloating, breakthrough bleeding (but goes away in 2-3 months so patients should hold out until then to switch to a different method)

ACHES:

Abdominal pain
Chest pain
Headache
Eye problems
Severe leg pain

Question 9

CHC ring ADEs

Answer 9

ACHES, device-related events

Question 10

CHC patch ADEs

Answer 10

Higher incidence of blood clots, irritation at patch site, ACHES

Question 11

When do you decrease estrogen content?

Answer 11

Nausea, breast tenderness, headaches, cyclic weight gain, dysmenorrhea, menorrhagia, uterine fibroid growth

Question 12

When do you increase estrogen content

Answer 12

Breakthrough bleeding on days 1-9 of the cycle, vasomotor symptoms, nervousness, decreased libido

Question 13

When do you decrease progestin content?

Answer 13

Increased appetite, weight gain, bloating, constipation, acne, oily skin, hirsutism, depression, fatigue, irritability

Question 14

When do you increase progestin content?

Answer 14

Dysmenorrhea, menorrhagia, late-cycle breakthrough bleeding (days 10-21)

Question 15

What to do if you miss a dose/insertion/application of a tablet/patch/ring in <48 hours

Answer 15

Do it as soon as you remember, no BUM or EC needed

Question 16

What to do if you miss a dose/insertion/application and it’s been >48 hours

Answer 16

Do it as soon as you remember, use BUM for a week, EC should be considered if the dose/insertion/attachment occurred within the first week and unprotected sex happened in the previous 5 days