Contraceptives

Question 1

Advantages and disadvantages of combo OCPs

Answer 1

Advantages: decreased cramps, decreased menstrual flow, improvement in facial acne, may provide protection against ovarian and endometrial cancer
Disadvantages: mood changes, blood clots, increased risk of liver tumors, nausea, HA, breakthrough bleeding

Question 2

Absolute contraindications to combo OCPs

Answer 2

History of blood clots/stroke/smoker
Coronary artery disease
Known/suspected breast cancer
Liver tumor impaired liver function
Previous cholelithiasis during pregnancy
Undiagnosed abnormal uterine bleeding

Question 3

Management/Prescription Guidelines of combo OCPs

Answer 3

1. Start with low dose combo or multiphasic pill (35 mcg or less)
2. Progestin only mini pill may be used in women with hx migraines or other contraindication to combo pills
3. Estrogen=pregnancy category X, immediately DC if pregnant
4. Increased risk of hypertension
5. Certain antibiotics and anticonvulsants decrease efficacy; OCPs decrease the efficacy of warfarin, insulin and certain oral hypoglycemics

Question 4

Undesirable hormone effects: High estrogen/Low estrogen

Answer 4

High: dysmenorrhea, nausea, chloasma, CVA/DVT, telangiectasias, liver tumor/cancer, cervical changes, breast tenderness
Low: No withdrawal bleeding, decreased duration of menstrual bleeding, spotting, breakthrough bleeding day 1-9 of cycle, atrophic vaginitis

Question 5

Undesirable hormone effects: High progestin/low progestin

Answer 5

High: breast tenderness, hypertension, depression, fatigue, low libido, decreased duration of menstrual bleeding, increased appetite
Low: delayed menses, breakthrough bleeding days 10-21

Question 6

Undesirable hormone effects: Excessive androgenic effects

Answer 6

Hirsutism, acne, oily skin, edema, increased libido

Question 7

Nuvaring

Answer 7

Estrogen/progestin combo

Leave ring in for 21 days, remove for withdrawal bleeding, then reinsert new ring one week later

Question 8

Ortho Evra (Patch)

Answer 8

estrogen/progestin combo
Change weekly, leave off for week 3 for withdrawal bleeding
Apply anywhere except on the breast
If off >24 hours, new 4-week cycle is necessary (and back-up)
Reduced effectiveness in women >90kg
Increased risk of blood clot versus OCPs

Question 9

Depo Provera

Answer 9

Progestin only
Shots every 3 months, pregnancy test if >2wk late
Delayed return of fertility (up to 1 year)
Can decrease HDL cholesterol, decrease bone density

Question 10

Implanon

Answer 10

progestin only

3 years

Question 11

IUD

Answer 11

ParaGard (copper), up to 10 years
Mirena (progestin), up to 5 years
can prevent Asherman’s syndrome
SE: lost string, PID (first 6 weeks highest rate)
Contraindicated with active, recent, or recurrent pelvic infection
May insert 4-8 weeks postpartum, any time in cycle (expulsion more common during menses)

Question 12

Diaphragm/cervical cap

Answer 12

Refit if weight gain/loss greater than 20lb
Leave in for 6 hours after sex
Instill more spermicide into vaginal without removing for repeat sex
No oil based lubricants

Question 13

Mechanism of action of combo OCPs

Answer 13

Estrogen: ovulation inhibited by suppression of FSH/LH, implantation inhibited by alteration of the endometrium
Progesterone: thick cervical mucous, implantation inhibited by suppression of the endometrium, ovulation inhibited by hypothalamic-pituitary-ovarian disturbances