Contraceptives/HRT/Testosterone Flashcards
Main groups of hormonal contraceptives (2 groups)
Estrogen-progestin contraceptives Progestin-only contraceptive
Estrogen-progestin contraceptives - MOA
Estrogens: suppress FSH release stabilize the endometrial lining provide cycle control Progestins: block the LH surge = no ovulation thicken cervical mucus delay sperm transport induce endometrial atrophy/inhibit endometrial proliferation
Estrogen-progestin contraceptives - indications
Abnormal bleeding (menorrhagia/ metrorrhagia/ amenorrhea) – assuming other causes have been excluded Dysmenorrhea Endometriosis PCOS Acne PMS/PMDD
Estrogen-progestin contraceptives - cautions
breastfeeding - may decrease milk supply HLD DM with complications prolonged immobility/long leg cast migraine without aura over the age of 35
Estrogen-progestin contraceptives - contraindications
Thromboembolic disease CAD Active liver disease Breast cancer Smoker over 35 y Migraine with aura Uncontrolled HTN Undiagnosed vaginal bleeding
Estrogen adverse effects
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High doses of estrogen-progestin contraceptives increases the risk of
Breast cancer, stroke, MI, DVT
Progestin adverse effects
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Androgenic adverse effects
Acne
Weight gain
Hirsutism
Fatigue
Depression
Progestin only contraceptive options
Nexplanon implant DMPA injection IUD - Mirena, Skyla, Lilletta
Continuous dosing of estrogen-progestin ocps is possible with which formulation?
monophasic
Transdermal contraceptive patch - adverse effects
Greater incidence of venous throboembolism Not indicated for weight > 198lbs
Depo Provera risks/side effects
Bleeding irregularities Delayed return of fertility Weight gain Decrease in bone mineral density
Progestin-only contraceptives - MOA
Inhibition of ovulation- suppression of midcycle peaks of LH & FSH Thickened, decreased cervical mucous Thinner, atrophic endometrium
Progestin-only contraceptives - adverse effects
Spotting Amenorrhea Irregular menstruation Ectopic pregnancy - increased risks