Contraception & Infertility Flashcards
Follicular phase
GnRH releases FSH to secrete estrogen & stimulate follicle to develop. LH increases androgens
Ovulation
Mature follicle ruptures. LH surge just before ovulation
Luteal phase
Progesterone more dominate
COCs FDA approved for acne
estrostep fe
ortho tri-cyclen
yaz
beyaz
COCs FDA approved for PMDD
yaz
beyaz
Purpose of estrogen in COC
-Inhibits FSH & ovulation
-Increases aldosterone = increased sodium/water retention
-Increases sex hormone binding globulin = clears up hormone-related acne & unwanted facial hair
Estrogen ADR in COC
N/V
Bloating, edema
Irritability
Cyclic weight gain, headache
HTN
Breast fullness/tenderness
Progestational progestins
prevent ovulation & lessen bleeding
high activity: desogestrel, etonogestrel, levonorgestrel
Androgenic progestins
Contributes to acne, hirsutism
high activity: levonorgesterl, norgestrel
Antiestogenic progestins
Contributes to androgenic side effects (hair loss, hirsutism, acne, oily skin)
High activity: norethindrone, ethynodiol diacetate
Progestin action in COCs
Thicken cervical mucus - prevent sperm
Endometrial atrophy (thins uterus linig)
prevent ovulation
Progestin ADRs in COCs
HA
Increased appetite, weight gain
Depression, fatigue
Change in libido
Androgenic: hair loss, hirsutism, acne, oily skin
Management of breakthrough bleeding
Try x 3 months
Late in cycle = choose higher progestin activity
Otherwise choose higher estrogen/progestin activity
Acne management from COC
Choose lower androgenic activity progestin
Serious adverse effects from COC
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
Drugs that may decrease effectiveness of COC
-HIV drugs (NRTIs, maraviroc, INSTI, NNRTI, PI)
-Antiepileptics
-Rifampin/rifabutin
-Tetracycline, minocycline, erythromycin, pcn, cephalosporins = back up for abx therapy + 7 days after
Dosing of estrogen (high, low, very low) in COC
High: >35 mcg
Low-dose: <35 mcg
Very low-dose: <=10 mcg
Back up method needed when starting COC
Sunday start or quick start (first day of prescription) = back up for 7 days - 1 month
1 COC pill missed or late
Take ASAP & continue pack as normal
NO additional contraception needed
Emergency contraception not needed but can be considered
> =2 COC pills missed
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
Drosperienone progestin containing COC
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
Birth control patch
Place on dry hairless area of upper arm, shoulder, abdomen, buttocks (NOT breast)
Possibly less effective if > 90 kg
Higher rate of blood clots
Birth control patch missed dose <48 hours
apply ASAP
Keep same change patch day
No additional contraceptive or EC needed
Birth control patch missed dose >= 48 hours
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)