Ex 5. L2-3 Preventative Health/Nonhormonal Contraception (44-45) Flashcards
Different types of hormonal contraception
Levonorgestrel (IUD)
Shot
Implant
Pill
Vaginal Ring
Patch
Emergency Contraception
Estrogen hormones in contraceptives
-Suppress FSH production
-Increase sex-hormone binding globulin
-Prevent dominant follicle
-Increase binding of free androgens
Helps with acne
Progestin hormones in contraceptives
Prevent LH surge
-Inhibit ovulation
Thicken cervical mucus
-Inhibit sperm penetration/transport
Change of motility of fallopian tubes
-Impair transport of sperm/ova
Atrophy of endometrium
-Impair implantation
Common estrogens
Ethinyl estradiol (EE)
Estradiol valerate
Estetrol
Mestranol
Common Progestins
Norethindrone
Norethindrone acetate
Norgestimate
Drospirenone
Norgestrel
Levonorgestrel
Segesterone acetate
Ethnediol diacetate
Desogestrel
Etonogestrel
Dienogest
Side effects of too much estrogen
Bloating
Breast tenderness
Mood changes
Headache
Nausea
Heavy menses
Fibroid growth
Melasma
Vision changes
Cyclic weight gain
Side effects of not enough estrogen
Light menses
Vaginal Dryness
Spotting
No withdrawal bleeding
Estrogen dosing
Very low dose = < 20 mcg EE
We should NEVER be using high dose estrogen pills
Low dose = 20-35 mcg EE
Typically people have good experience in low dose range
High dose = 50 mcg EE
Progestin component
Progestational
-Prevent ovulation
-Lessen bleeding
-Desire high selectivity
androgenic
-Acne
-Hirsutism (male pattern hair growth)
-Desire lower activity
Antiestrogenic
-androgenic side effect
-Desire lower activity
Preferred lines of therapy for Progestin
First
Norethindrone
Ethynodiol diacetate
Noregestrel
Norethindrone acetate
second
Levonorgestrel
Third
Norgestimate
Desogestrel/Etonogestrel
Fourth
Drospirenone
Segesterone
Progestin characteristics
Prevent ovulation
Decrease bleeding
We want More selective
Androgenic characteristics
Acne
Hirsutism
Desire lower activity
Side effects of too much progestin
Acne
Hirsutism
Decreases sex drive
Depression
Increased appetite
Increase sex drive
Noncyclical weight gain
Less energy
Cholestatic jaundice
Yeast infections
Hair loss
Swelling in arms/legs
Side effects of not enough progestin
Breakthrough bleeding late in cycle
No withdrawal bleeding
Heavy menses
Potential benefits beyond pregnancy prevention
Decreased risk of endometrial cancer
Decreased risk of menstrual-related headaches
Decreased risk of ovarian cancer
Improvement in perimenopausal symptoms
Specific methods things to consider:
Efficacy
Hormonal content
Route/dosage form
Side effects
Return of fertility
Potential health benefits