Hormonal Contraceptives

Question 1

MOA of GnRH:
Modifies what surge?
Inhibits ovulation by?

Answer 1

GnRH modifies/inhibits mid‐cycle surge of LH & FSH –>

inhibiting ovulation

Question 2

LH/FSH function (3)

Answer 2

• Diminish ovarian hormone production
• Produce endometrial changes
  unfavorable for ovum implantation
• Thicken cervical mucus to impede sperm transit

Question 3

Name the three Estrogen compounds that can be present in ORAL HCs

Answer 3

(Estr~): Ethinyl Estradiol (EE=most commonly used), Estradiol valerate, Mestranol.

Question 4

The two main families of Progestins in HCs

Answer 4

• 19-Nortestosterone analogs = estranes and gonanes

- Spironolactone-analog = drospirenone

Question 5

The three progestins that have the most progestinic/androgenic effects

Answer 5

Desogestrel = levonorgestrel > norgestrel (all gonane class)

Question 6

Three progestins with the most estrogenic-receptor effects (little to no androgenic activity)

Answer 6

Ethynodiol diacetate > norethindrone = norethindrone acetate (all estrane class)

Question 7

Phasic combinations of HCs

• Monophasic HCs
• Biphasic HCs
• Triphasic HCs
• Quadriphasic HC

Answer 7

• Monophasic HCs - fixed dose of E/P throughout cycle
• Biphasic HCs - fixed dose of E, P increased from 1st to 2nd half of cycle
• Triphasic HCs - increasing E dose 3 times during cycle
• Quadriphasic HC - decreasing dose of E and increasing dose of P 4 times during cycle

Question 8

Non-contraceptive effects of Estrogens!

Answer 8

Decreased - cholesterol, anti-thrombin 3 (DVT/clotting), increase osteoclastic (bone turnoveR), bile acid levels
Increased - TG, Clotting factor (DVT/clotting), Platelet aggregation (DVT/clotting), RAAS, thyroid, iron

Question 9

Common HC AE

**Serious AE of HCs

Answer 9

• Common - irregular bleeding, breast tenderness, fluid retention, mood, HA, GI distress, hyperK (acne/hirsutism/wt gain(progestinic/androgenic))
• ***Serious - systemic thromboembolism - MI/stroke/DVT/intestinal ischemia, HTN, gallbladder disease

Question 10

*****Contraindications of combination HCs

Answer 10

• Hx of vascular-related disease (VTE, CardioVD, CerebroVD, DVT)
• planning/already pregnant
• breast/endometrial/heaptic neoplasm
• Undx vaginal bleeding
• Uncontrolled HTN
• ***Smoking in pts less than 35!

Question 11

Emergency contraception may be admin ___hrs after unprotected intercourse

Answer 11

72-120 hours

Question 12

MOA of Progestin (levonorgestrel) emergency contraception. how many doses

Answer 12

**INHIBITION OF OVULATION - no effects if implantation has already occurred. 1 or 2 doses.

Question 13

P-only, 2-dose emergency contraception - describe the doses

Answer 13

First dose - take 1 tablet within 72 hours

Second dose - take 12 hrs after first dose

Question 14

P-only, 1-dose emergency contraception - describe the dose

Answer 14

Take tablet within 72 hours

Question 15

Non-progestin, 1-dose emergency contraception - name, dose, MOA

Answer 15

Ella: tablet within 120 hours
MOA: Progesterone receptor modulator - inhibits ovulation

Question 16

Yuzpe Method, 2-dose emergency contraception - doses

Answer 16

First dose - EE + levonorgestrel within 72 hours

Second dose - EE + levonorgestrel 12 hrs after 1st dose

Question 17

Daily use HC - admin route and types

Answer 17

Oral tablet - E/P, P-only, Extended cycle

Question 18

Non-Daily use HC - admin route and types

Answer 18

Injectable, implantable, patch, vaginal ring, IUD

Question 19

Emergency Use - admin route and type

Answer 19

Oral tablet - P-only

Question 20

Non-oral Progestin: Patch with EE, 7-day duration

Answer 20

Norelgestromin

P/E

Question 21

Non-oral Progestin: vaginal ring with EE, 3 week duration

Answer 21

Etonogesterel

P/E

Question 22

Non-oral Progestin: rod, 3 year duration

Answer 22

Etonogesterel

P only

Question 23

Non-oral Progestin: injection, 3 months

Answer 23

Medroxyprogesterone

P only

Question 24

Non-oral Progestin: IUD (and oral), 5 years or 3 years

Answer 24

Levonorgestrel

P-only