Contraceptive choices

Question 1

Methods of contraception

Answer 1

• Hormonal E+P: COC, transdermal patch, vaginal ring
• Hormonal P only: LNG-IUS, impant, DMPA, POP
• Non-hormonal: copper IUD, barrier methods
• Action: P blocks LH surge and inhibits ovulation, as well as decreases sperm transport by thickening cervical mucus (E is not required)
• E decreases FSH and inhibits follicular growth, while maintaining endometrium to decrease breakthrough bleeding

Question 2

Effectiveness of various forms of contraception

Answer 2

-Highly effective (1% failure): condoms, spermicides, diaphragm, withdrawal

Question 3

Side effects for various contraceptive methods 1

Answer 3

• COC: regular menstrual cycle w/ decreased bleeding/PMS/acne and hirsutism
• Decreased ovarian and endometrial CA risk
• Negative side effects of COC/patch/vaginal ring: no STI protection, increased risk of VTE/gallbladder disease, cholestatic jaundice, hepatic neoplasms, HTN, MI/CVA
• Estrogen containing contraceptives are contraindicated in women who have migraines preceded by an aura

Question 4

Side effects for various contraceptive methods 2

Answer 4

• W/ the patch there can be skin reactions and has a higher failure rate in heavy women
• For the ring there may be increased vaginal discharge, toxic shock syndrome, ring expulsion
• POP: breakthrough bleeding (BTB), highly sensitive to user error
• DMPA: drastically decreases menses (most become amenorrheic)
• Implant: menstrual cycle changes
• LNG-IUS: same as DMPA (drastically reduces bleeding)

Question 5

Non-contraceptive benefits to hormonal contraception

Answer 5

• Cycle regularity
• Decreased dysmenorrhea, blood loss, PMS Sxs
• Decreased risk for ovarian CA and endometrial CA
• Improved acne and hirsutism