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Senior Obstetrics and Gynaecology > Contraceptives > Flashcards

Contraceptives Flashcards

1
Q

Active ingredient in depo- Provera and mesigyna

A

Depo - progesterone only - 150g medeoxypeogesterone acetate

Mesigyna - combined - norethisterone and estradiol

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2
Q

Failure rate of depo

A

Less than 0.1% per year

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3
Q

If a patient comes for injectables after the due time then what do you do?

A

Rule out pregnancy!!!!! It’s a contraindication

If more than 2 weeks Ask her to come back on her menses

Ask to carry a pregnancy

Ask if in first 7 days of period

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4
Q

Quick menstrual cycle breakdown

A

DAY 1 OF CYCLE
Gnrh released by hypothalamus

Goes to anterior pituitary

Causes release of FSH

FSH prompts production of estrogen by the ….cells

Estrogen peaks at approximately day 14 and once this happens LH rises quickly and peaks …at this point ogulation occurs. Estrogen peak also neg feedback on hypothalamus reducing gnrh release

Corpus lutem forms and starts secreting progesterone so progesterone peaks
Also secretes Estrogen and inhibin which negative feedback and prevent Gnrh release and block fsh release respectively

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5
Q

Mode of action of progesterone only / progestin only eg depo

A
  • thicken the cervical mucus thus creating an obstacle to sperm
  • inhibits inhibits LH surge by reducing production of gnrh thus blocking ovulation
  • makes tbe endometrium unsuitable for implantation - thins the endometrial lining
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6
Q

Indications for depo Provera

A
  • Risk factors for estrogen use
  • does not wish to regain fertility soon
  • does not remember to take pill daily
Contraindications (WHO class 3 and 4 - absolutely contraindicated) 
- pregnancy 
- unexplained bleeding 
- breast cancer  (current) 
Also liver pathology
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7
Q

Advantages for depo Provera

A
  • suited for Cardiac patients, sixklers, women with large fibroids, hx of VTE, endometriosis, dysmenorrhea
  • reversible, easy to use,
  • effective
  • can be used in nursing mothers and increases milk production
  • easy patient compliance
  • reduces risk of: endometrial cancer, ectopic pregnancy, vaginal yeast infection, PID, symptoms of endometriosis
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8
Q

Disadvantages of depo

A
  • Risk of reduced bone density (osteoporosis) particularly in adolescents
  • delayed return of menses/fertility (depo 9 months)
  • no protection against STIs
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9
Q

List some progestins

A

Levonorgestrel
Medroxyprpgesterone acetate
Norethinidrone
Drospirenone

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10
Q

What are the side effects of depo.? (Progesterone only contraceptives?)

A
  • irregular bleeding- causes blood vessel fragility in endometrial lining
  • amenorrhea
  • acne and hirsutism - they may also bind to androgen receptors like the
  • bloating- mineralocorticoid and glucocorticoid
  • elevated blood pressure
  • hypoglycemia
  • increased cramping
  • heavy withdrawal bleed
  • fatigue
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11
Q

Combined injectables MOA

A

The estrogen of the injection regulates bleeding patterns and the bleeding Cycles become more regular. It builds up the endometrium to prevent the erratic bleeding that’s usually occurs with progesterone only. Also it combats the negative side effects of progesterone only

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12
Q

Schedule for combined injection

A

Every month once a month

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13
Q

Contraindications of combined injections

A
  • Migraine headaches with focal neurological symptoms
  • Pregnancy
  • breast cancer
  • breastfeeding
  • severe hypertension
  • history of thromboembolic disorders or stroke
  • history of ischemic heart disease
  • diabetes
  • active hepatitis liver tumors
  • major surgery with prolong immobilization
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14
Q

Advantages of combined injectables

A

Quicker return to fertility, easy to use and reversible, milder side effects than progesterone only, patient compliance with usually good

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15
Q

Disadvantages of combined injectables

A

Have to visit the doctor every month, increased DVT risk, no STI protection

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16
Q

Side effects of combined injectables

A

Irregular bleeding, weight changes, headaches, dizziness, oil changes, heavy bleeding, prolonged bleeding, amenorrhea

17
Q

What is the failure rate of oral contraceptive pills

A

Typical use 8.9% perfect use 0.3%

18
Q

When is the oral contraceptive pill started in the cycle

A

Ideally you would want it to start in the first 5 days. If you start after five days of your. You need backup contraceptive for the first 48 hours. Pills must be taken at the same time each day

19
Q

What are the components of oral contraceptive pills

A

Synthetic estrogen and the synthetic progestin or progesterone

Estrogen eg. Ethanol estradiol 20-35 micrograms

Progesterone eg.
Norgestrel
Drospirenone

20
Q

What is the mode of action of oral contraceptive pills

A

Ocps Act centrally as well as peripherally

Inhibit ovulation - centrally by blocking LH FSH

Thicken cervical mucus

Prevents normal buildup of the endometrium

21
Q

What is the difference between the monophasic and multiphasic formulations of combined oral contraceptive pills

A

Monophasic has the same amount of estrogen and progestin in each pill and is less likely to cause SIDE EFFECTS FROM FLUCTUATING HORMONES IN MULTIPHASIC THERE ARE changes during the cycle in terms of the amount of hormones given

MonophASIC eg. YASMIN
Biphasic eg. Necon - progestinenincreased halfway through the cycle
Triphasic -
Extended cycle- 91 day pill - used for endo or pain with periods

22
Q

What is the difference between the monophasic and multiphasic formulations of combined oral contraceptive pills

A

Monophasic has the same amount of estrogen and progestin in each pill and is less likely to cause SIDE EFFECTS FROM FLUCTUATING HORMONES IN MULTIPHASIC THERE ARE changes during the cycle in terms of the amount of hormones given

MonophASIC eg. YASMIN
Biphasic eg. Necon - progestinenincreased halfway through the cycle
Triphasic -
Extended cycle- 91 day pill - used for endo or pain with periods

23
Q

Contraindications for the combined oral contraceptive pill

A

Absolute contraindications include pregnancy, less than six weeks postpartum and breastfeeding, smoker, hypertension, past history of DVT or stroke, ischemic heart disease, valvular heart disease, migraine headaches with focal neurological symptoms, breast cancer, diabetes, severe cirrhosis, liver tumors

24
Q

Advantages of using combined oral contraceptive pills

A

Effective when used correctly, regular monthly periods, lighter. Reduce the pain with periods, can be used at any age, fertility returns when the Police Stopped immediately, can be used as emergency contraception

Non contraceptive benefits
Protects against osteoporosis, improves acne, decrease is benign breast disease and ovarian cyst development, decrease risk of ovarian and endometrial cancel, lower risk of STI (due to increased cervical mucus)

25
Q

What are the side effects of the combined oral contraceptive pill

A

Estrogen related- Nausea and vomiting, breakthrough bleeding, headaches, breast changes, amenorrhea, thromboembolic events DVT or stroke

Senior Obstetrics and Gynaecology (11 decks)

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