Contraception & Infertility Flashcards

1
Q

Follicular phase

A

GnRH releases FSH to secrete estrogen & stimulate follicle to develop. LH increases androgens

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2
Q

Ovulation

A

Mature follicle ruptures. LH surge just before ovulation

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3
Q

Luteal phase

A

Progesterone more dominate

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4
Q

COCs FDA approved for acne

A

estrostep fe
ortho tri-cyclen
yaz
beyaz

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5
Q

COCs FDA approved for PMDD

A

yaz
beyaz

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6
Q

Purpose of estrogen in COC

A

-Inhibits FSH & ovulation
-Increases aldosterone = increased sodium/water retention
-Increases sex hormone binding globulin = clears up hormone-related acne & unwanted facial hair

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7
Q

Estrogen ADR in COC

A

N/V
Bloating, edema
Irritability
Cyclic weight gain, headache
HTN
Breast fullness/tenderness

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8
Q

Progestational progestins

A

prevent ovulation & lessen bleeding

high activity: desogestrel, etonogestrel, levonorgestrel

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9
Q

Androgenic progestins

A

Contributes to acne, hirsutism

high activity: levonorgesterl, norgestrel

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10
Q

Antiestogenic progestins

A

Contributes to androgenic side effects (hair loss, hirsutism, acne, oily skin)

High activity: norethindrone, ethynodiol diacetate

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11
Q

Progestin action in COCs

A

Thicken cervical mucus - prevent sperm
Endometrial atrophy (thins uterus linig)
prevent ovulation

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12
Q

Progestin ADRs in COCs

A

HA
Increased appetite, weight gain
Depression, fatigue
Change in libido
Androgenic: hair loss, hirsutism, acne, oily skin

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13
Q

Management of breakthrough bleeding

A

Try x 3 months
Late in cycle = choose higher progestin activity

Otherwise choose higher estrogen/progestin activity

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14
Q

Acne management from COC

A

Choose lower androgenic activity progestin

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15
Q

Serious adverse effects from COC

A

ACHES

A: abdominal pain = liver, gallbladder issue
C: chest pain, SOB, coughing up blood = MI, PE
H: headache = stroke, blood clot
E: eye problems = optic neuritis, stroke, clots
S: severe leg pain = DVT

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16
Q

Drugs that may decrease effectiveness of COC

A

-HIV drugs (NRTIs, maraviroc, INSTI, NNRTI, PI)
-Antiepileptics
-Rifampin/rifabutin
-Tetracycline, minocycline, erythromycin, pcn, cephalosporins = back up for abx therapy + 7 days after

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17
Q

Dosing of estrogen (high, low, very low) in COC

A

High: >35 mcg
Low-dose: <35 mcg
Very low-dose: <=10 mcg

18
Q

Back up method needed when starting COC

A

Sunday start or quick start (first day of prescription) = back up for 7 days - 1 month

19
Q

1 COC pill missed or late

A

Take ASAP & continue pack as normal

NO additional contraception needed

Emergency contraception not needed but can be considered

20
Q

> =2 COC pills missed

A

Take most recent missed pill ASAP

Back up or abstinence for 7 days

If missed in last week of hormonal pills, then skip placebos and start new pack

Emergency contraception considered if missed during 1st week & unprotected sex or other times

21
Q

Drosperienone progestin containing COC

A

yaz, beyaz
Analog of spironolactone (so may inc. potassium)

No diuretic effect but decreases bloating from estrogen

Best for acne, hirsutism, or male pattern balding in women

Increased risk of DVT

22
Q

Birth control patch

A

Place on dry hairless area of upper arm, shoulder, abdomen, buttocks (NOT breast)

Possibly less effective if > 90 kg

Higher rate of blood clots

23
Q

Birth control patch missed dose <48 hours

A

apply ASAP

Keep same change patch day

No additional contraceptive or EC needed

24
Q

Birth control patch missed dose >= 48 hours

A

Apply ASAP & keep same change patch day

Back up or abstinence for 7 days

If occurred during 3rd week, omit patch free week

Consider EC (especially if occurred in 1st week)

25
Vaginal ring contraceptive
Has etonogestrel (active form of desogestrel) May be used during intercourse & with tampon If removed <3 hours, rinse with water and reinsert If removed >3 hours, reinsert and use back up x 7days
26
Annovera
Vaginal ring for contraception - same ring used for 13 cycles (1 year) If out <2 hours, rinse and reinsert If out >2 hours, back up needed x7 days Avoid oil-based suppositories, like miconazole 1-3 day treatments, due to increased exposure to hormones.
27
Progestin only pill
Norethindrone: Must take at the same time each day. If > 3 hours late, use back up for 48 hours No hormone-free days. Drospirenone: not as time sensitive. same missed dose guidelines as cocs
28
Medroxyprogesterone acetate depot
IM injection q 11-13 weeks >13 weeks, pregnancy test then readminister ADE: progressive significant weight gain. BBW: loss of bone, especially > 5 years. Reversible. Exercise & get adequate calcium/vit D Delayed return to fertility for up to 18 months
29
Copper IUD duration
10 years Readily reversible
30
Levonorgesterl IUD duration
Kyleena: 5 years Liletta: 8 years Mirena: 8 years (also indicated for menorrhagia) Skyla: 3 years Readily reversible
31
IUD ADEs
PAINS P: period late, abnormal bleeding/spotting A: abdominal pain, pain w/ intercourse I: STI N: not feeling well, fever, chills S: string missing, shorter, longer
32
Nexplanon
3 years prevention of pregnancy Return to fertility in 1-3 months
33
Emergency contraception timing
within 120 hours
34
EC options
Levonorgestrel 1.5mg Ulipristal 30mg (Rx only)*# Copper IUD*^ > levonorgestrel IUD Yuzpe method (high dose estrogen + progestin using COCs) *=preferred if BMI >25 #= pump and dump x24 hours if breastfeeding ^=recommended if BMI >35
35
Clomiphene
SERM- blocks estrogen receptors. Body perceives hypoestrogenic state and releases GnRH, which stimulates FSH and LH Stimulates ovulation or off-label to increase sperm production in men First line agent ADE: hot flash, abdominal/breast tenderness, mood swings, visual alterations May add on metformin if PCOS
36
Letrozole, anastrozole
Off label for anovulatory women Less risk of multiple births ADE: HA, GI, joint/bone pain, edema, sweating, flushing
37
Human menopausal gonadotropin (hMG)
Injection Derived from urine of post-menopausal women Given on day 2-3 of cycle x7-10 days - use ultrasound to monitor follicle development ADE: flu-like symptoms, muscle aches, malaise, HA, dizziness, pain @ injection site
38
FSH for infertility
Injection given in first half of cycle to stimulate development of follicles in ovary Naturally occurring (urine): Bravelle urofollitropin Recombinant: follitropin alpha, follitropin beta ADE: mood swings, depression, breast tenderness, swelling, pain at injection site
39
Human chorionic gonadotropin (hCG)
Injection, similar to LH, given 36 hours before insemination or harvest to help stimulate release of egg
40
GnRH analogs
Used to prevent LH surge that occurs before ovulation to help with timing of ovulation -- optimizes effectiveness of hMG or FSH GnRH agonists: leuprolide, naferlin GnRH antagonists: ganirelix, cetrorelix (more recently used for infertility protocols)
41
Ovarian Hyperstimulation Syndrome
Complication of fertility treatment that is life-threatening Watch for rapid weight gain Will need thrombosis ppx if inpatient