Contraceptives/HRT/Testosterone

Question 1

Main groups of hormonal contraceptives (2 groups)

Answer 1

Estrogen-progestin contraceptives Progestin-only contraceptive

Question 2

Estrogen-progestin contraceptives - MOA

Answer 2

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

Question 3

Estrogen-progestin contraceptives - indications

Answer 3

Abnormal bleeding (menorrhagia/ metrorrhagia/ amenorrhea) – assuming other causes have been excluded Dysmenorrhea Endometriosis PCOS Acne PMS/PMDD

Question 4

Estrogen-progestin contraceptives - cautions

Answer 4

breastfeeding - may decrease milk supply HLD DM with complications prolonged immobility/long leg cast migraine without aura over the age of 35

Question 5

Estrogen-progestin contraceptives - contraindications

Answer 5

Thromboembolic disease CAD Active liver disease Breast cancer Smoker over 35 y Migraine with aura Uncontrolled HTN Undiagnosed vaginal bleeding

Question 6

Estrogen adverse effects

Answer 6

Question 7

High doses of estrogen-progestin contraceptives increases the risk of

Answer 7

Breast cancer, stroke, MI, DVT

Question 8

Progestin adverse effects

Answer 8

Question 9

Androgenic adverse effects

Answer 9

Acne

Weight gain

Hirsutism

Fatigue

Depression

Question 10

Progestin only contraceptive options

Answer 10

Nexplanon implant DMPA injection IUD - Mirena, Skyla, Lilletta

Question 11

Continuous dosing of estrogen-progestin ocps is possible with which formulation?

Answer 11

monophasic

Question 12

Transdermal contraceptive patch - adverse effects

Answer 12

Greater incidence of venous throboembolism Not indicated for weight > 198lbs

Question 13

Depo Provera risks/side effects

Answer 13

Bleeding irregularities Delayed return of fertility Weight gain Decrease in bone mineral density

Question 14

Progestin-only contraceptives - MOA

Answer 14

Inhibition of ovulation- suppression of midcycle peaks of LH & FSH Thickened, decreased cervical mucous Thinner, atrophic endometrium

Question 15

Progestin-only contraceptives - adverse effects

Answer 15

Spotting Amenorrhea Irregular menstruation Ectopic pregnancy - increased risks

Question 16

Paragard IUD MOA

Answer 16

MOA: copper toxic to sperm, prevents implantation

Question 17

Paragard benefits/side effects

Answer 17

Benefits: nonhormonal Side effects: increased menstrual flow and dysmenorrhea

Question 18

Emergency Contraception Options

Answer 18

Plan B Ella Paragard

Question 19

Emergency Contraception MOA

Answer 19

Suppresses Ovulation (if taken prior to LH surge) Prevent fertilization of an ovulated egg Copper IUD: may also prevent implantation No impact if already pregnant

Question 20

Hormone Replacement Therapy (HRT) Indications

Answer 20

Menopausal vasomotor symptoms Vaginal atrphy - vaginal preparations Added benefits: –increased bone density however decreased bone density is not an indication to start HRT –decreases risk of colon cancer

Question 21

Prescribing HRT

Answer 21

Use lowest dose for shortest duration possible Less risky in younger women Vaginal preparation less risky than oral/transdermal In people with an intact uterus both estrogen and progesterone must be used - unopposed estrogen in those with a uterus increases risk for endometrial cancer

Question 22

HRT contraindications

Answer 22

Breast cancer, CHD, VTE hx or high risk, liver disease, unexplained vaginal bleeding

Question 23

Estrogen/progestin contraceptive counseling

Answer 23

How/when to start Whether or not a back up method is needed Common side effects and how to avoid Dangerous side effects No protection against STIs Follow-up visit For pills: strategies to remember to take and what to do if a dose is missed ACHES

Question 24

Contraindications to IUD placement

Answer 24

Current PID/cervicitis or PID within the last 3 months Nulliparity or remote hx of PID (>3 mos) is not a contraindication

Question 25

Testosterone replacement indications

Answer 25

Primary – disorders of the testes Low serum testosterone and elevated LH/FSH Congenital: Klinefelter syndrome, cryptorchidism Acquired: mumps, radiation, chemo, medications, trauma, testicular torsion Secondary – disorders of the hypothalamus/pituitary Low serum testosterone and normal or low LH/FSH Congenital syndromes causing GnRH deficiency Acquired: Tumors, eating disorders, post-androgen abuse, DM, Infiltrative diseases, head trauma, Drug use (marijuana, anabolic steroids, opioids)

Question 26

Testosterone Replacement Adverse Effects

Answer 26

Acne Gynecomastia Edema Increased risk of CV disease Increased risk of prostate cancer Lower HDL, elevated triglycerides Increased homocysteine Male pattern baldness Mood changes Increased risk of sleep apnea

Question 27

Men on testosterone replacement should be screened for

Answer 27

prostate cancer

Question 28

Non-estrogen medications used in treatment of menopausal vasomotor symptoms

Answer 28

Antidepressants Black Cohosh Soy