Hormonal Contraception Flashcards
define menarche
first menstraul cycle
around 12 years
define menses
sloughing of endometrial cells - period
define menopause
cessation of menstraul cycle
one year with no period
around 50
goals of therapy
prevent fertilization in order to prevent pregnancy
tailor method to individual needs
avoid/minimize adverse effects
ensure adherance by providing clear oral and written instructions
4 mechanisms of action
- estrogen and progesteron provide negative feedback
- creates endometrium that is unreceptive to implantation
- production of viscous cervical mucus
- effect secretion adn peristalisis in fallopian tubes
doses of ethinyl estradiol
low - 10mcg
high - 50mcg
most women dont need over 35mcg
diff types of progestins
1st gen - bind to estrogen, progesterone, androgen
2nd gen - more potent and better tolerated
3rd gen - fewer androgenic effects
newer - antiandrogens
two different categories of progestins
androgenic activity
progestagenic activity
difference between the different phasics
monophasic - fixed amount of estrogen and progestin
biphasic - 2 phases of progestin
triphasic - 3 phases of progestin
how do the extended cycles work
24/26 days only 4 days hormone free
84 day 7 days hormone free (seaonale) or will little estrogen (seasonique)
what is suggested dose for starting a coc
20mcg ethinyl estrodiol and older progestin (levonorgestrel or norethindrone)
which is preferred for doing continuous use with no hormone free period and why
monophasic because biphasic will get that drop in progesterone level and may get spotting
why cant the hormone free interval be more than 7 days
dominant follicle will form and ovulation will occur
what is recommended for starting coc
back up contraception for first 7 days unless its on the first day of your period
to avoid weekend periods start the first sunday after period starts
cautions with COCs
people at increased risk of VTE
migraines with an aura higher risk of stroke
hypertension that is uncontrolled or greater then 160/100
smoke more than 15 cigs a day and over 35
21 days post partum, 30 days if breast feeding
current or previous breast cancer
diabetes for 20 yrs
uncontrolled dyslipidemia- may increase LDL and decrease HDL
obesity decreases serum levels
systemic lupus erythmatosus - high risks associated wiht pregnancy so use contraception
benefits of combined oral hormonal contraception
relief from menstrual issues such as cramps, ovulatory pain, blood loss
menstrual regularity
decreased acne and hair growth due to antiadrogenic effects
reduced risk of ovarian and endometrial cancer
bone density benefits
risks of coc’s
heart attack and stroke due to high doses of estrogen
thromboembolism, but less risk than in pregnancy
who are at high risk of DVT/PE and what should they do
over than 35 adn smoker history of clots obesity prolonged immobilization family history use other contraceptive methods
what are some earyl danger signs (ACHES)
abdominal pain severe (thrombosis, pancreatitis, gallbladder disease)
chest pain, shortness of breath (pulmonary embolus, MI)
headache (stroke, hypertension)
eye problems (stroke, hypertension, vascular insufficiency)
severes leg pain (DVT)
symptoms of too much estrogen
nausea bloating breast tenderness melasma irritable headache weight gain
signs of too little estrogen
early spotting vasomotor symptoms headache depression nervous
signs of too much progestin
breast tenderness headache fatigue cahnges in mood increased appetite weightgain decreased libido
signs of too little progestin
late break through bleeding
dysmenorrhea
heavy flow
signs of too much androgen
increased appetite and weight oily skin and scalp acne hirsutism increased libido rash increased LDL
what do you do if pt experiences break through bleeding
may occur in first month of use but keep using
after 3-6 months doesnt resolve may need to change to increase estrogen or progestin
what to do if pt experiences breast tenderness
if continues after 3 months see doctor
may need less estrogen
should you gain weight on the pill
may have increased appetite in first month but overall not associated with weight gain
what to do if pt experiences nasuea
should resolve in 3 months
take at bedtime or with food
may consider less estrogen
what to do if pt experiences headaches
if related to treatment avoid oco
what to do if pt experiences acne
may worsen initially but general should improve long term
if not change to less androgenic progesterone
drug interactions with coc
carbamazepine oxcarbazepine phenytoin primidone phenobarb topiramate rifampin griseofulvin ritonavir stjohns wort antibiotics?
how is ethinyl estradol metabolized
CYP3A4
what is contained in the transdermal contraceptive patch evra
norelgestromin 150mcg
ethinyl estradiol 20 mcg
how do you use the transdermal patch
apply one patch weely for 3 weeks with 1 week patch free
start first day of menses
some of the side effects of transdermal not seen in coc
more spotting and breast tenderness in the first 2 cycles
local skin reaction
what is contained in the vaginal contraceptie ring - nuvaring
120mcg etonorgestrel
15mcg ethinyl estradol - less estrogen so less SE
how do you use nuva ring
insert for 3 weeks then remove for 1 week
start day one of mensus no back up method needed
disadvantages of the nuva ring
requires self insertion and removal
more vaginal symptoms of irritation, discharge, vaginitis
concurrent use of tampons not recommended bc absorb some of the progesterone
who should you use the progestin only pill in
during lactation
contraindication to estrogen
what does the minipill contain
35mcg norethindrone
how do you take the minipill
no pill free interval
have to take tablet within 3 hours everyday
MAO of the minipill
increases cervical mucus viscosity and endometrial atrophy
decreases sperm motility
ovulation still occurs
adverse effects of minipill
irregular bleeding
hormonal side effects
what to do if pill is taken more than 3 hours past
take the pill ASAP and continue taking pack
back up must be used for 48 hrs
emergency contraception should be considered if unprotected intercourse occurred in the past 5 days
how often do you get the medroxyprogesterone acetate injection
every3 months
MAO of progestin injection
inhibits secretion of gonadotropins
inhibits ovulation
increases cervical mucus viscosity and endometrial atrophy
resembles menopause bc no GnRH release
who should use the progestin injection
women who desire 3 month contraception
contraindications to estrogen (over 35 smokers, migraine sufferers, breastfeeding, endometriosis, sickle cell disease, taking anticonvulsants, high risk of stroke)
contraindications for the progestin injection
pregnancy unexplained vaginal bleeding current breast cancer severe liver disorder - caution between 16-18 bc thats when peak bone mass is being laid fown
benefits of progestin injectable
no period
decreased risk of endometrial cancer
decreased symptoms of endometriosis?
adverse effects of progestininjectable
menstraul cycle disturbance
hormonal
weight gain
decrease mood
decreased bone mineral density (increased with greater duration of use)
delayed return of fertility (9-12 months)
who cant use an ius
current pregnancy pelvic inflammatory disease STI undiagnosed abnormal vaginal bleeding uterine abnormalities
what are some of the risks associated with ius
uterine perforation with insertion or expulsion
MAO copper IUD
creates a hostile environment for sperm through an immune response
reduces formation of mature eggs
side effects of copper iud
increase in menstrual bleeding and cramping
maximum time a copper iud is inserted
30 months
dont need back up contraception as soon as its inserted
MAO of levonorgestal ius
creates a hostile environment for sperm trhoguh an immune response
reduces formation of mature eggs
endometrial suppression and thickening of cervical mucus
side effects of levonorgestrel ius
breast tenderness
headache
acne
maybe irregular periods and amenorrhea
benefit of levonorgestrel ius
reduced menstrual bleeding and cramping
does back up contraception have to be used with levonorgestrel ius
use back up for 7 days if it hasnt been inserted within 7 days of onset of menses
duration and strength of mirena ius
levonorgestrel 52mcg (20mcg/day of progestin) 5 years
strength and duration of jaydess
levonorgestrel 13.5mg
3 years
who is jaydess marketted for
adolescent and nulliparous (havent given birth) women
strength and duration of kyleena
levonorgestrel 10.5mg
5 years
which progestins have the most progestagenic activity
desogestrel
levonorgestrel
norgestrel
what does yasmin contain as a progestin
drospirenone
activity of yasmin and what it is good for
progestagenic
antiadrongenic
antimineralcorticoid
polycystci ovary syndrome, acne, premenstrual dysphoric disorder
adverse effects of yasmin
increase potassium
what does diane contain and what is it actually used for
cyptoterine which is an antiandrogenic so used as a temporary treatment of severe acne
