Hormonal Methods of Birth Control

Question 1

Oral Contraception (combination Birth Control Pill)

Answer 1

aka “the Pill”; FDA approved in 1960; contains estrogen (ethinyl estradiol) and 1 of 8 progestins (synthetic progesterone); most widely used form of reversible contraceptive in US;

Question 2

Combination Birth Control Pill (How it Works)

Answer 2

suppresses ovulation; thickens cervical mucus; thins lining of the uterus; slows the rate of ovum transport; one pill is taken every day for 21 days; no pill is taken for 7 days (if preferred, a placebo or sugar pill can be taken)

Question 3

Pill advantages

Answer 3

high effectiveness rate; can help to regulate irregular menstrual cycles; convenient and easy to use; does not interrupt love making; lowers risk of endometrial and ovarian cancers

Question 4

Pill disadvantages

Answer 4

nausea; weight gain; breast enlargement and tenderness; headaches; hypertension; spotty darkening of facial skin; fatigue; depression; no protection against STIs; More Serious= blood clots, stroke, and heart attack; If you are a smoke, do not use pill. Can use mini pill, but don’t use any birth control with estrogen.

Question 5

Early Danger Signals of the Pill– ACHE

Answer 5

1. severe (A)bdominal pain 2. severe (C)hest pain, shortness of breath or difficulty breathing 3. severe (H)eadaches 4. (E)ye problems (blurred vision, double vision, loss of vision) 5. (S)evere leg pain in the calf or thing

Question 6

Who should not take the Pill *

Answer 6

over 35; smokes; breastfeeding; history of cancer; history of liver or heart disease; has a blood-clotting disorder; has high blood pressure; (always ask doctor b/c some of the above refer only to the combo pill)

Question 7

Drug Interactions

Answer 7

Acetaminophen- decreases pain relief; alcohol- increases the effect of alcohol; Depletes body of: B2, B6, B12, folic acid, vitamin C, Zinc

Question 8

Drospirenone

Answer 8

4th generation progestin; became available in 2001; manufacturer claimed it would protect against pregnancy, but would also decrease acne, bloating, premenstrual depression

Question 9

Drospirenone (Health Risks)

Answer 9

can increase levels of potassium in the blood, which can cause hyperkalemia, a condition that can eventually lead to cardiac arrest; has been linked to increased risk of blood clots, deep vain thrombosis (presence of a blood clot), stroke, Gall bladder disease

Question 10

Birth Control Pills Containing Drospirenone

Answer 10

Yasmin, Yaz, Ocella; in first half of 2008, more than 10 million prescriptions were dispensed for Yaz, Yasmin, and Ocella; Yaz and Yamin alone accounted for nearly 30% of all birth control pills prescribed in US in 2008; FDA ordered Yaz, Yasmin, + Ocella to carry a black box warning

Question 11

Yaz*

Answer 11

approved in 2006; *20mcg of estrogen and 3mg of drospirenone; most popular oral contraceptive in US; monophasic; 24 days of hormone pill, 4 days of Placebo; only pill that’s also approved by FDA to treat symptoms of premenstrual dysphoric disorder (PMDD); effectiveness for PMDD when used for more than 3 months has not been evaluated; hasn’t been evaluated for treatment of PMS; indicated for the treatment of moderate acne in women at least 14 years of age

Question 12

Yasmin

Answer 12

approved in 2001

Question 13

Ocella

Answer 13

generic version of Yaz approved in 2008; advertised as the “one Pill that goes beyond the rest”

Question 14

*Black Box Warning

Answer 14

*the strongest warning that the FDA requires, and signifies that medical studies indicate that the drug carries significant risk of serious or even life-threatening adverse effects

Question 15

Types of Birth Control Pills

Answer 15

Monophasic and Multiphasic

Question 16

Monophasic *

Answer 16

• 1. Oral contraceptives that have the same amount of estrogen and progestin in each active pill pack; *2. Due to the consistent hormone level in each pill, they are less likely to cause side effects that can result from fluctuating hormones levels

Question 17

Multiphasic *

Answer 17

*1. Varied amounts of hormones are designed to be taken at specific times throughout the course of each pill pack; *2. developed to help lessen the side effects of monophasic birth control pills; 3. reduce the total hormone dosage a women receives; thought to be better match to the body’s natural menstrual cycle

Question 18

Seasonale*

Answer 18

contains estrogen; contains levonorgestrel (2nd generation progestin); monophasic; take 1 pill every day for 12 weeks (84 day active pill cycle; then one week of placebos (bleeding occurs); yearly total of 4 menstrual periods; taking pills continuously have the advantage of minimizing or eliminating cyclic symptoms such as headaches, bleeding, cramps, and pain

Question 19

Seasonique *

Answer 19

contains estrogen; contains levonorgestrel (2nd generation progestin); monophasic; has continuous active pill cycle- one active pill each day of the year–there’s no placebo arrival; take 1 pill every day for 12 weeks (84 day active pill cycle); followed by a low dose of estrogen pill for 7 days; yearly total of 4 menstrual periods

Question 20

Lybrel *

Answer 20

continuous use oral contraceptive; contains estrogen; contains levonorgestrel (2nd generation progestin); monophasic; birth control pill that is also designed to eliminate women’s monthly periods; the lining of the uterus doesn’t go through the changes needed for menstruation;

Question 21

Progestin-Only Pill

Answer 21

aka the Mini-Pill; FDA approved in 1973; may help to prevent ovulation; thins the endometrial lining to help prevent implantation; thickens the cervical mucous; 1 pill taken every day of the month; can be used by females: over 35, who smoke, with medical history of headaches and/or hypertension( 1st consult with physician), who are breast feeding

Question 22

Progestin only Pill-Disadvantages

Answer 22

spotting between periods, irregular periods, edema (fluid retention), acne, irritability, depression

Question 23

Intrauterine Devices (IUDs) *

Answer 23

currently available in the US: ParaGard (Copper T), Mirena, Skyla; 1. changes the endometrial lining thus preventing implantation; 2. may interfere with sperm passage; 3. Progestin thickens cervical mucus

Question 24

ParaGard (Copper T)*

Answer 24

*A T-shaped device that sits inside the uterus and continually releases a diminishing amount of copper; has a fine nylon string attached to the end; *can be used for up to 12 years; hormone free

Question 25

Mirena*

Answer 25

A T-shaped device that sits inside the uterus and continually releases a diminishing dosage of levonorgestrel (a progestin); has a fine nylon string attached to the end; *can be used for up to 5 years

Question 26

Skyla*

Answer 26

FDA approved in January 2013; a T shaped device that sits inside the uterus and continually releases a diminishing dosage of levonorgestrel; has a fine nylon string attached to the end; *can be used for up to 3 years

Question 27

IUDs (Comparison of Skyla to Mirena)*

Answer 27

1. Skyla’s slightly smaller frame and narrower placement tube are intended to make it more comfortable to insert and use 2. Skyla and Mirena decrease menstrual cramps and pain for most women 3. Skyla and Mirena cause more spotting at first and then lighter and shorter periods after the first six months *4. Skyla was tested and FDA approved for women who have no children

Question 28

IUDs- Disadvantages

Answer 28

1. costs several hundred dollars for insertion and removal (cost may be covered by insurance) 2. Briefly painful and uncomfortable when inserted 3. Only a healthcare professional can insert and remove it 4. there’s a small risk of infection at the time of insertion 5. there’s a small risk of uterine perforation during insertion

Question 29

IUDs- Disadvantages Cont.

Answer 29

6. the device may be expelled from the uterus 7. doesn’t provide protection from STIs 8. After the ParaGard is inserted, periods may be heavier and more painful 9. the hormonal IUD may cause headaches, acne, breast tenderness in the first few months of use 10. the hormonal IUD shouldn’t be used if you have had breast cancer in the last five years; Progestin helps reduce some of the bleeding

Question 30

Contraceptive Patch*

Answer 30

Xulane (FDA approved as a generic alternative for the Ortho Evra patch); FDA approved in April 2014; Oct. 2014-sale of Ortho Evra was discontinued in the US; contains estrogen and Progestin; *an adhesive patch that can be worn on the stomach, upper outer arm, buttocks, or back; Transdermal delivery

Question 31

Contraceptive Patch-How it works

Answer 31

each week a new patch is worn (3 weeks); each week, apply the patch to a different location than the previous week; 4th week is patch free; patch free week will produce bleeding; never have patch off for more than 7 days in a row (this is your patch free week)

Question 32

Contraceptive Patch- How it works Cont.

Answer 32

if want to move your “patch change day” to a different day of the week, choose a new day during the “patch free” week; if patch falls off and doesn’t completely re-adhere to the skin, apply a replacement patch; a non-sticky patch shouldn’t be taped or wrapped for it to remain in place; when first applied, use a back-up method of birth control for the 1st week

Question 33

Vaginal Ring

Answer 33

aka NuvaRing; FDA approved in 2002; soft, flexible ring about 2 inches in diameter; contains estrogen and progestin; inserted high up in the vagina; worn for 3 weeks; 4th week is ring free; not a barrier method; can increase vaginal discharge, irritation or infection;

Question 34

Injectable Contraceptive

Answer 34

Depo-Provera: contains only progestin (medroxyprogesterone acetate- first-generation progestin), Long-acting, injected intramuscularly every 3 months; Possible side effects= irregular bleeding, weight gain, may temporarily stop having periods

Question 35

Hormonal Implant (Nexplanon)

Answer 35

replaced Implanon as of January 2012- new design of the applicator is to increase the ease of insertion and to decrease the chance of an incorrect insertion, the addition of barium sulfate so it can be seen on an X-ray, a single-rod sub dermal contraceptive implant (size of a match stick) that is inserted underneath the skin of the inner side of the upper, rod is made of synthetic material that is commonly used in artificial joints, local anesthetic is used to numb the area, insertion takes about a couple of minutes, won’t be able to see the rod unless the female is very thin, but the female can feel it with her fingers, tissue forms around the rod to make sure that it doesn’t move

Question 36

Hormonal Implant (cont.)

Answer 36

Releases a progestogenic hormone over the course of 3 years, it can be inserted at any time, recommendation is between the 1st and 5th days of menses or the day after a female takes the last birth control pill for the month, if inserted at any other time, another form of contraception should be used for the next seven days

Question 37

Hormonal Implant*

Answer 37

works in two ways: *thickens cervical mucus, *2. changes the lining of the endometrial wall; removal of the rod takes a few minutes; fertility should return to normal within 1 month

Question 38

Hormonal Implant (possible side effects)

Answer 38

Irregular or missed periods, mood changes, weight gain, breast tenderness, increase in blood pressure, acne, headaches