Day 1- PCOS and Endometriosis and Oral Contraception Flashcards
When are transdermal patches(ortha-evra) not as effective?
When is ortha-evra and nuvaring dosed?
How long does Mirena last vs the others?
90 kg’s or higher, increased chance of pregnancy.
Weekly for 3 weeks, Nuvaring is every 3 weeks.
5 years and the others are 3 years. Used in parous women
What are some disadvantages to estrogen-progestin?
What are CI’s for estrogen containing OC’s?
What special things to know about drosperinone?
May increase BP, Increased risk of CVA and MI(especially those >35 and smokers), Thromboembolic disorders.
Age >35 and smoker use progestin only pill. Age >40 use low dose estrogen. HTN, Migraines, Cardiac,renal, bladder disease.
Progestin derived from spironolactone, decreases nausea, fluid retention, acne.
If you miss a dose by more than 3 hours do you have to use a backup method for progestin only pills?
How often do people have menses while they are on LoSeasonique/AmethiaLo, Seasonsale/Amethia?
How is seasonal and seasonique different?
Yes! Must use for >48 hours.
91 days!
Seasonique contains 7 days of 10 mcg of estrogen during menses to avoid estrogen withdrawal symptoms.
What BMI do you need to watch out for when using Natazia?
What days of Natazia do not have active pills?
What does estrogen excess cause?
BMI >30. Only OC approved for lightning monthly periods not caused by another condition of the uterus.
Days 27 and 28.
Headaches, MI, progestin excess causes increased libido.
What drug interactions to know with Oral contraceptives?
What is the most common cause of infertility?
Do you have to have ovarian cysts or ovarian dysmorphology to be diagnosed with PCOS?
Rifampin, antibiotics.
PCOS.
NO!
When do abnormalities occur in PCOS?
What androgens are high in PCOS?
What is hirsutism?
IMbalance of LH and FSH production(High amount of LH).
Testosterone, androstenedione, and DHEA-S. Obesity amplifies the degree of both abnormalities(peripheral insulin resistance and hyperinsulinemia.).
Weird male pattern hair in females.
What is NIH diagnostic criteria?
What is AE-PCOS criteria?
What do you use for diagnosis?
NO POLYCYSTIC OVARIES
rotterdam doesn’t have exclusion however AE-PCOS includes everything!
Rotterdam!
What are your 3 goals of therapy?
Which OC do you give for treating hirsutism and pregnancy?
How do you treat hirsutism?
Reduce hirsutism, acne, and hair loss. Prevent pregnancy. Prevent endometrial hyperplasia and carcinoma.
Combination.
After 6 months if patient isn’t happy with OC therapy you can add spironolactone.
How do you treat type 2 diabetes in PCOS?
How do you induce ovulation in PCOS?
What are the classic symptoms of endometreosis?
Metformin.
Clomiphene.
Severe dysmennorhea, deep dyspareunia, chronic pelvic pain. GI, urinary tract, soft tissues, and diaphragm follow.
What are the barriers to diagnosis of endometreosis?
What are your medical therapies of endometreosis?
How can you treat endometreosis?
Delay in diagnosis of 7-12 years and present to 5 physicians on average. Absence of evidence is not absence of disease.
induce ammenorhea and create hypoestrogenic environment.
Letrozole and Anastrozole. Oral contraceptives, Progestins.
What are the serious ADR’s for OC’s?(ACHES)
What is your dosing for progestin for endometreosis?
Does GnRH have infertility improvement in endometreosis?
Abdominal pain, Chest and congestion, Headache, Eye problems, Severe leg pain(thigh or calf).
10mg for 10 days(days 16-25) for 3 months. Mirena intrauterine shown to be effective.
No.
How often are medroxyprogesterone IM doses given and what happens if you miss a week?
How long does fertility return in depoprovera?
11-13 weeks. More than 7 days you need to do a pregnancy test and use back up contraception for 3 days.
2 months.
