contraception & Infertility Flashcards
ovulation summary
- The surge in estrogen causes luteinizing hormone (LH) and FSH (follicular stimulating hormone)
- LH surge triggers ovulation 24 -36 hours
- Luteal the start of ovulations begins and which lasts till 14 days, progesterone is dominant in this phase
ovulation kits
measure LH, first urine, if LH is present, ovulation will occur in 24-36 hers, best time for intercourse to conceive
prego
human chorionic gonadotropin (hCG) positive
generally best to measure w/ prego test first urine when levels would be the highest
folic acid
400mcg DFE to 600mcg DFE (which is equivilant to 360mcg RDA)
return to fertility
most contraceptions you return to fertility immediately, but medroxyprogesterone injection
caya
diaphragm, single size and does not require fitting (some do require prescription for fitting)
oil-based lubricants
never recommend oil-based lubricant for use w/ a latex or non-latex synthetic condom. ONLY recommend water or silicon-based lubricants
Phexxi
prescription-only vaginal gel that maintains an acidic pH (3.5-4.5)
spermicide OTC, but keep in mind, higher risk of STDs, UTIs, not a good option..
hormonal contraceptives
inhibit the production of FSH and LH, which prevents ovulation
They also alter cervical mucus, which inhibits the sperm from penetrating the egg
progestin-only options
pill, injectable, implantation, and IUD
estrogen/progestin products
pill, patch, and vaginal ring
oral products are called COCs- combination oral contractacpetions
progestin is what in most COCs products
norethindrone, levonorgestrol, drospirenone
monophasic COCs
same dose of estrogen and progestin throughout the pill pack
biphasic, triphasic, and quadriphasic COCs
mimic the estrogen and progestin levels during the menstrual cycle
bi, tri, quad- represents the number of times the hormones changes
drospirenone
potassium-sparing diuretics
elagolix
orilissa- is FDA-approved for moderate to severe pain associated w/ endometriosis
heavy menstrual bleeding
menorrhagia
COC Natazia and the levonorgestrel-releasing IUD Mirena are indicated
lysteda
an oral formulation of tranexamic acid (antifibrinolytic) is a non-hormonal tx for menorrhagia
POPs- progestin-only pills
suppress ovulation
and thicken the cervical mucus to inhibit sperm penetration and thinning the endometrium
primarily used in breastfeeding women cause estrogen decrease milk production, and increase thrombosis risk
POPs adherence
must be taken within 3 hours of the scheduled time
migraines w/ aura
estrogen CAN NOT be used, increased risk of stroke, POPs are used
Depo-prevera, prevera
medroxyprogesterone
IM, every 3 months
progesterone only- suppressed ovulation, thickens the cervical mucus and causes thinning of the endometrium
About half of users will be amenorrheic (no menses) after 1 year of use..
extended-cycle COCs
periods every 3 months
“Lo”
means <=35mcg of estrogen
ex: Loestrin
“Fe”
iron supplement included
ex: Loestrin Fe
“24”
shorter placebo time 24 active, 4 placebo= 28 day cycle
monophasic formulations
Junel Fe 1/20 (1mg norethindrone, 20mcg EE)
Microgestin Fe 1/20
Sprintec 28
Loestrin 1/20, Loestrin 24 Fe, Lo Leostrin Fe
Yasmin 28, Yaz
biphasic, triphasic formulation
ortho tri-cyclen lo, tri-sprintec
quadriphasic formulation
Natazia
Extended Cycle Formulation
Seasonique
drospirenone-containing formulation
Yasmin 28, yaz
continuous formulation
amethyst
no inactive pills
patch
xulane, twirla
progestin-only
Errin, Camila, Nora-Be
ACHES
severe & rare AE of estrogen
A-abdominal (stomach) pain that is severe
C- chest pain
H- headaches
E- eye problems
S- swelling or sudden leg pain
box warning
all estrogen-containing products (pills, rings, patch)
do not use in women >35 old who smoke due to risk of serious cardiovascular events
box warning
estrogen + progestin transdermal patch
increased risk of DVT/PE compared to COCs
box warning
depo-Provera
loss of bone mineral density w/long-term use
box warning
do not use estrogen w/ these conditions
history of DVT/PE, stroke, CAD… etc
history of breast, ovarian, or liver cancer
severe headaches or migraines w/ aura
what decreases hormonal contraception efficacy
- antibiotics (inducers- rifampin, rifabutin…)
- aniconvulsants (carbamazepine….)
- st. john’s wort
- smoking tobacco
- ritonavir
- bosentan
- mycophenolate
liver tox
mavyret and viekira pack can not be used w/ any ethinyl estradiol due to the risk of liver tox.
COCs
1 late or missed pill
<48hrs since the last dose
- take the missed pill as soon as possible and take the next dose on schedule even if its 2 pills in 1 day
COCs
2 missed pills (>= 48hrs since last dose)
- take the missed pill as soon as possible and take the next dose on schedule even if its 2 pills in 1 day
—> Consider emergency contraception if unprotected sex in last 5 days
if week 3 - Omit hormone-free week: start the next pack of pills right after finishing current pack
POPs
if >3 hrs past scheduled time
back up contraception required x 48hrs
—> Consider emergency contraception if unprotected sex in last 5 days
IUD
Mirena (FDA approved for heavy menstural bleeding)
Skyla
Kyeena
Liletta
this is progestin levonorgestrel
copper-T
paraguard
EC/ and regular birth control
not hormonal
Copper IUD
- EC
within 5 days
paragard
Ulipristal
Ella
ASAP, within 5 days
prescription needed
chemical causing of mifepristone… so there is a controversy but nothing is proven
Levonorgestrel
Plan B or generic
ASAP, within 3 days
OTC
infertility drugs act like
try to increase LH/FSH –>ovulation
Clomiphene acts as estrogen to increase LH/FSH
Aromatase inhibitors suppress estrogen to increase FSH
gonadotropin drugs acts as LH, FSH, or hCG
