Contraception/Menopause √ Flashcards
2 forms of emergency contraceptive
Pill
IUD if within 5 days
Can estrogen suppress ovulation
No just helps the bleeding
Estrogen side effects (ACHES)
A - abdominal pain (severe)
C - chest pain, SOB, coughing blood
H - headaches (severe)
E - eye problems, vision loss/blurry
S - Severe leg/calf pain
STOP and contact PPO
Estrogen dose and smoking
how many generations and what are the meds
1st Ethynodiol diacetate
2nd Norgestrel
3rd Norgestimate
anti-androgen Drospirenone
Monophasic
21/7 or 24/4 fixed E + P
multiphasic
21/7 varrying levels of E + P
Nuraring
insert 3wks/1wks
Xulane
patch 3wks/1wks higher risk of VTE
Annovera
reusable ring 21/7 up to 13 cycles
patient educations for initiation of COC
need use backup for 7 days unless period was <5 days ago
DDI of COC
estrogen excess and deficiency
progesterone excess and deficiency
Opill
progesterone only pill
3hr window need to be taken
injection progesterone
Depot medroxyprogesterone acetate
No need to dose for body weight
q3 months
Progesterone implant
Nexplanon
every 3 years
but ammenohhera (loss of period)
what is the weight cut off for EC
BMI > 25 and must give ella (uliprostal acetate)
Biggest issue with EC
nausea
IUD pros
10 year replacement
Can be used if obese, SLE and APS
IUD cons/risks
Heavier flow
X low platelet counts
X in Wilson disease
Insertion pain
Delay if PID/current or STI
When do you need to use back up method when starting new BC
<5 days after menstruation okay to not use back up
> 5 days need to use back up for 7 days
Which are the category 4
focus on the greens
perimenopause
40-50
menopause
(40-58)
Postmenopause
1 year after menopause
vasomotor symptoms of menopause
1.hot flashes
2. night
3. sweats
4. warmth
5.chills
Gastrointestinal symptoms of menopause
- vaginal dryness
- burning
- irritation
- sexual dysfunction
- dysuria
- dyspareunia
- urinary urgency
8.recurrent UTIs
psychological symptoms of menopause
- Mood swings
- Depression
- Anxiety
- Insomnia
- Fatigue
- Poor concentration
- Forgetfulness
What are the triggers of menopause symptoms
alcohol
caffeine
spicy food
smoking
treatment overview
lifestyle modification for menopause
Avoid triggers (caffeine, alcohol, other)
Layered clothing, lower room temperature
Exercises
Weight-bearing exercise
Calcium and vitamin D supplementation
Smoking cessation
Premarin dosing
estrogen
0.3 mg or 0.45 mg
Menest
Estrogen
0.3 mg
Estrace
estrogen
1 mg or 2 mg
when would i use vaginal estrogens
when they mainly have vagianal symtpoms
What are the vaginal estrogens
Vagifem most common
most common side effect for progestrone
weight gain, acne and vaginal bleeding
most common side effect for estrogen
nausea, headache, VTE, Gallbladder diease
when would i use sequential or cyclic combo for menopause
Preferred in late menopausal transition and early
postmenopause (premphase)
when would i use continuous combo for menopause
Best for patients at least 2 years postmenopausal
and less cancer risk (Prempro)
Duavee dosing
SERMS (0.45/20 mg PO QD)
when would i use Duavee
bone, breast and endometrial issues
When would i use OSPEMIFENE
more for vaginal tissue issues
OSPEMIFENE dosing
60 mg po qd
OSPEMIFENE AD
hot flashes, muscle spams and a lot of the same as menopause so not well liked
Why would we use Duavee over ospenifene
bc of the side effect profile. less side effects that are like menopause
Duavee side effects
muscle spams, nausea, diarrhea and sometimes mouth pain
Duavee w/ or w/o food
w/ food
Absolute MHT contraindication
1.Undiagnosed abnormal genital bleeding
2. History of breast cancer
3. Estrogen- or progesterone-dependent neoplasia
4. Active DVT, PE, or history of VTE
5. Active or recent (in past vear) arterial thromboembolic disease (stroke, MI)
6. Liver dysfunction/disease
Condition to consider against for MHT
what are SSRI used for
decrease hot flashes
what 4 SSRI can we use
What do we watch out for if patients want to take citalopram
QTC
what do we use gabapentin or pregabalin for
hot flashes but also takes 4 weeks
what non hormonal medication is last line
clonidine
What medication do I give if the patient complains of sexual dysfunction as their main concern
Androgen therapy
intrarosa or Covaryx
Biggest side effect with Androgen therapy
virilization (becoming more male), hirsutism,
