Contraceptives Flashcards
MOA of OCPs
suppress ovulation
reduce sperm transfer to fallopian tuves
change endometrium making implantation less likely
thicken cervical mucus (preventing sperm penetration)
health benefits of OCPS
dec in ovarian cancer and endometrial cancer - benefits inscrease w/ longer duration of use
contraception method reccommended for Current or past history of breast cancer:
•Copper IUD preferred
Disease progression may be less with levonorgestrel-releasing IUDs compared to COCs or higher-dose progestin-only contraceptives because breast cancer is a hormonally sensitive tumor
Smoking and OCPs
•Absolute contraindicated in smokers over 35
•Relative contraindication in younger, heavy smokers (>15 cigarettes per day)
Use lowest dose estrogen (10 or 20 mcg)
•Progestin only methods are options
conditions where you should avoid estrogen containing pills
Si/Sx of Estrogen Sensitivity
- History of Migraine
- Heavy menstrual cramps
- Severe nausea and vomiting during pregnancy
- Pregnancy-induced hypertension
Si/Sx Progestin Sensitivity
History of excessive:
weight gain
appetite
tiredness
varicose veins
toxemia during pregnancy
PMS: excessive edema, bloating, headache, depression
Si/Sx of Androgenic Sensitivity
what ocp should we choose ??
History of irregular, heavy, menses
Physical exam may reveal oily skin, hirsutism and acne
Use pill with high progestational activity and low androgenic activity
OCP ideal for acne
pick HIGH estrogen and LOW androgen
what is the most common reason women dc OCPS
what pills is this most commonly seen w/?
when do we see this?
Breakthrough Bleeding and Spotting
- BTB most common with low-dose OCPs and POPs
- Occurs most often during the 1st cycles of OCP use while the endometrium is adjusting to a lower amount of estrogen and progestin
- Bleeding continues to decrease until it reaches a plateau in the 2nd to 4th cycle
when switching OCPs due to BTB we should choose a pill with ??
Choose pill with greater endometrial activity. Higher progestin doses
- More androgenic progestins
- Multiphasic OCPs
- Higher estrogen doses
- Different ratios of estrogen to progestin
when to start OCPs
Sunday?
day 1?
quick start?
backup methods?
- Sunday – start on first Sunday after period begins
- Day 1 – start on first day of period
- Quick Start – start immediately appointment day
- A backup method, should be used for the 1st seven days of the initial cycles if pills are started later than the 5th cycle day.
what to do if menstration does NOT occur?
occurs at incorrect time?
•If menstruation does not occur at the regular time, a pregnancy test must be performed.
If menstruation does occur, OCs should be restarted
- either five days after the onset of menstruation (as for the 1st cycle of OCs)
- or seven days after the last active tablet, which- ever is earlier
MISSED PILLS: 1
take missed pill immediately and next one at regular time
MISSED PILLS: 2
first 2 weeks
3rd week
first 2 weeks:
take 2 pills daily for next 2 days then resume on regular schedule -
use additional contraception for the rest of the cycle
3rd week:
take 2 pills daily until all active pills are taken - restart with one pill daily within 7 days -
use additional contraception until pills are restarted and for first 7 days of pills
MISSED PILLS: 3 or more
stop pills, restart within 7 days with one pill daily
use contraception through first seven days of next pill cycle
Si/Sx of OCPs
- Encourage patients to wait 3 cycles before requesting to change pill - Spontaneously disappear
- Breakthrough bleeding
- Symptoms associated with pregnancy
- especially nausea
- weight gain, breast tenderness
- Other Side effects: Amenorrhea, acne, headache, depression, rash
Pill Danger Signs
undisputed drug intractions w/ OCPS
controversial drug interactions w/ OCPs
- Ethynyl estradiol is conjugated in the liver, excreted in the bile, hydrolyzed by intestinal bacteria and reabsorbed as active drug
- Antibiotics reduce the population of intestinal bacteria, and therefore interrupt the enterohepatic circulation of estrogen resulting in a decreased concentration of estrogen
Return of Fertility After OCP Use
- Average 2 month delay
- Traditionally recommend 3 normal menstrual cycles before attempting pregnancy
Prenatal vitamins for 3 months prior
estrogen and progestin effect on lactation
•Estrogens Inhibit the action of prolactin in breast tissue
- Decreased milk production (quantity)
- Decreased protein content (quality)
- Decrease duration of lactation
•Progestins
- POPs have lesser effect on lactation
- Injectable progestins have no effect or increase milk production
POP are good choice of contraceptives in what pt population
Nursing mothers
Women with reasons to avoid estrogen
Smokers over 35
Can be used by women who have had thrombophlebitis
Less nausea and vomiting than OCPs
instructions and cautions w/ POPs
Take on the first day of menses
Take at the same time of day – SAME HOUR
Use back-up method for first cycle
If 3 hours late or miss one pill use backup for 48 hours (Manufacturer)
Emergency contraception if indicated
Conservative recommendations: 7 days or remainder of the cycle
less effective & greater risk of ectopic pregnancy
MOA of emergency contraception
•High dose estrogen or progestin
- Delays development of follicles
- Prevents ovulation
- Interferes with fertilization
- Prevents implantation of fertilized egg
- Prevents not terminates pregnancy; considered contraceptive not abortifacient (controversial)
name 2 types of emergency contraception
Levonorgestrel 1.5mg X 1 dose (OTC)
Ella (Ulipristal) - Rx