Hormonal contraceptives

Question 1

List indications for oral contraceptives

Answer 1

pregnancy prevention
PCOS
hypothalamic amenorrhea
endometriosis
uterine fibroids
menstrual related migraines
PMDD

Question 2

Contrast the role of progestins vs estrogens in hormonal contraceptives

Answer 2

Progestins
- Suppress the frequency of the GnRH/LH pulses. Proper LH pulse frequency is
necessary for ovulation.
- Inhibits the estrogen-induced LH surge at mid-cycle.

Estrogens
- Suppress FSH release during the follicular phase of the menstrual cycle- follicular development and steroidogenesis are suppressed

Question 3

Describe the direct effects of hormonal contraceptives on the female reproductive structures

Answer 3

mostly related to progestins

thicker cervical mucus, decreased motility in fallopian tubes, endometrial glandular atrophy

Question 4

How do hormonal contraceptives help treat PCOS

Answer 4

• progestin component decreases GnRH pulse frequency, prevents preferential secretion of LH, thus suppressing ovarian androgen production.
• estrogen component suppresses FSH, leading to decreased ovarian follicular development and decreased ovarian steroid production.
  Also increases SHBG levels, decreasing free
  testosterone.

Question 5

How is hormonal contraception helpful in treating functional hypothalamic amenorrhea?

Answer 5

replaces deficient estrogen

can induce regular withdrawal bleeding

Question 6

How is hormonal contraception helpful in treating endometriosis?

Answer 6

• progestin only: causes endometrial glandular atrophy and less buildup of ectopic endometrium
• combined forms also cause less endometrial build up than normal

Question 7

How is hormonal contraception helpful in treating fibroids

Answer 7

Limiting endometrial build-up and frequency of menses decreases menorrhagia and metromenorrhagia

Question 8

How does hormonal contraception help treat acne

Answer 8

estrogen induced increase in SHBG decreases free testosterone

Question 9

List contraindications for combined hormonal contraception

Answer 9

• over 35 and smoker or HTN

- personal history of thromboembolic event

Question 10

Many synthetic progestins activate both the progesterone receptor, as well as the ______

Answer 10

androgen receptor

*** All combined HC is ANTI androgenic

Question 11

A novel progesterone,_________, activates the progesterone receptor, but is a blocker of the mineralocorticoid receptor and the androgen receptor.

Answer 11

drospirenone

Question 12

List some factors a clinician may consider in helping a patient chose a form of contraception.

Answer 12

• patients with estrogen sensitivity symptoms like heavy menses, cramps, breast tenderness may prefer agents with low estrogen activity
• patients with progestin sensitivity symptoms like depression, bloating, headache, edema may prefer low progesterone agents
• patients with androgen sensitivity symptoms like acne and hirsutism may prefer agents with low androgenic activity

Question 13

Describe some formulations of hormonal contraception

Answer 13

• pills: monophasic, biphasic, triphasic, minipills
• patch
• ring
• injection
• IUD

Question 14

How can hormonal contraception cause hypertension?

Answer 14

estrogen induced RAAS activation

Question 15

List some specific side effects seen with progestin only injectable HC

Answer 15

weight gain
menstrual irregularities
decreased bone density