Contraceptives Flashcards
Oral hormonal contraceptives
Monophasics, Biphasic, Triphasic -> combined oral contraceptives (estrogen and progesterone)
Norethindrone and norgestrel -> progestin only pills
Non oral hormonal
The patch The ring Progestin injection Progestin Implant Intrauterine systems
Emergency post coital contraception hormonal
One or two tablets of levonorgestrel*** taken before 72 hrs and followed 12 hours later -> nausea and vomiting; no prescription needed if over 17yrs
Ulipristal acetate is a selective progesterone receptor modulator-> inhibits or delays ovulation
Other high dose norgestrel or levonorgestrel formulations can be used
Emergency post coital contraception non hormonal
Copper IUD inserted within five days of intercourse
Estrogens
ethinyl estradiol or mestranol (a prodrug of ethinyul estriol)
Non hormonal contraceptive methods
Barriers (least effective) -> condoms, diaphragm, cervical caps, spermicides
IUD
Sterilization
Progestins
Most have some androgenic activity
Levonorgestrel and norgestrel -> highest
Norethindrone (2nd gen) -> low
Desogestrel and norgestimate (3rd gen) -> lowest
Drospirenone-> anti androgenic
Contraceptive use
Prevention of pregnancy
Menstrual cycle regulation
Reduction of premenstrual symptoms and treatment of acne
Inconsistent use may increase failure rate
Monophasic combined oral contraceptive description
Fixed dose in each active pill
Monophasic combined oral Mechanism
Suppress FSH and LH -> prevents ovulation
Progestin thickens the cervical mucus making it more difficult for the sperm; impairs implantation by inducing changes in the endometrium
Low dose reduces adverse effects, but may be less efficacious if missed dose
Decrease risk of endometrial and ovarian CA, regulation of menstruation, relieve benign breast disease, prevent ovarian cysts, decrease risk of PID and improve acne control
Biphasic oral mechanism
Suppress FSH and LH -> prevents ovulation
Progestin thickens the cervical mucus making it more difficult for the sperm; impairs implantation by inducing changes in the endometrium
Low dose reduces adverse effects, but may be less efficacious if missed dose
Decrease risk of endometrial and ovarian CA, regulation of menstruation, relieve benign breast disease, prevent ovarian cysts, decrease risk of PID and improve acne control
Triphasic oral mechanism
Suppress FSH and LH -> prevents ovulation
Progestin thickens the cervical mucus making it more difficult for the sperm; impairs implantation by inducing changes in the endometrium
Low dose reduces adverse effects, but may be less efficacious if missed dose
Decrease risk of endometrial and ovarian CA, regulation of menstruation, relieve benign breast disease, prevent ovarian cysts, decrease risk of PID and improve acne control
Biphasic and Triphasic oral description
Variable proportions of one or both hormones in each pill to mimic the menstraul cycle
Reduces the monthly progestin dose
Monophasic, Biphasic, Triphasic oral PK
21 active + 7 placebo (most common)
Extended cycle: 84 active + 7 placebo -> 4 periods a year
Continuous regimens: 21 active + 4-7 very low dose -> NO periods
Monophasic, Biphasic, Triphasic oral Adverse
Nausea, bloating, breakthrough bleeding (improve by third cycle)
HA
Migraine and CVA
Depression
Insulin resistance
Hirsutism, oily skin, acne (from progestin)
Melasma (dark skin discoloration)
Amenorrhea
Dyslipidemia
CVD -> increase prouction of PF VII, X and fibrinogen
Monophasic, biphasic, triphasic oral contraindications
Thromoboembolic disease Stroke, CAD Breast CA, estrogen dependent neoplasm Hepatic tumors or liver disease Abnormal uterine bleeding Heavy smoking over age 35 yrs
Minor: history of migraine disorder, HTN, diabetes, uterine fibroids, breast feeding, smoking at any age
Rifampin and other CYP450 inducers increase metabolism of estrogen
Broad spectrum antibiotics (especially Rifampin) reduce intestinal flora and interrupt enterohepatic circulation of estrogen and decreasing efficacy of OCP’s
Norethindrone and Norgestrel class
Progestin only pills
Norethindrone and Norgestrel description
Less effective than combined OCP
NO thromboembolism
Decreased dysmenorrhea, menstrual blood loss and PMS symptoms
Norethindrone and Norgestrel mechanism
Blocks ovulation in 60-80% of cycles, but highly efficacious -> thickening of cervical mucus and endometrial alterations that impair implantation
Norethindrone and Norgestrel Adverse
Not widely used in US
Unscheduled bleeding
Spotting
The patch description
Ethinyl estradiol and progestin
The ring description
Transvaginal delivery of ethinyl estradiol and progestin
Progestin injection description
Depo-Provera
Contains depo medroxyprogesterone acetate (DMPA)
Extremely effective
Progestin injection PK
IM injections every three months
Progestin adverse
Menstrual irregularities
Weight gain
Significant loss of bone mineral density (black box)
Progestin implant description
Contains a progestin
Placed under skin in upper arm
Effective for 3 years
Adverse->irregular menstrual bleeding
Intrauterine Systems
Polyethylene body
Levonorgestrel releasing
Effective for five years
