Incomplete - 206 - Use of Hormonal Contraception in Women with Coexisting Medical Conditions Flashcards
MEC categories and meaning
1 - no restrictions
2 - benefits > risks
3 - risks > benefits
4 - unnaceptable
Which coagulation factors does estrogen increase?
VII, X and fibrinogen
Risk of estrogen contraception in causing VTE compared to pregnancy
1/2 the risk
What is the MEC for estrogen contraception if previous provoked DVT
3
could also use if risk of recurrence but for example on anticoagulation and getting hemorrhagic cysts
How long does it take to reverse the hypercoaguable state induced by combined contraception?
4-6 weeks.
It is category 4 if there is a major surgery planned with prolonged immobilization
What is the amount of ethinyl estradiol in patch compared to pills?
More total in patch but lower peaks
Factors making COC category 3 or 4
- smoking over 35yo
- <21 PP or 21-42d PP with other RF (>35yo, thrombophilia, prior VTE, immobility, transfusion at delivery, peripartum cardiomyopathy, BMI >30, PPH, post-cesarean, PEC, smoking
- major surgery of prolonged immobilization
- hx DVT/PE
- IBD with active or extensive disease, surgery, immobilization, steroids, vitamin deficiencies, or fluid depletion
- SLE with positive of unknown antiphospholopid antibodies
- superficial venous thrombosis (now or hx)
At what level of ethinyl estradiol does VTE risk decrease?
50mcg
What is the difference between old progestins (levonorgestrel, norethindrone) and new progestins (desogestrel, drospirenone) on VTE risk?
Same
Which progestin only method is category 3 for hx of IHD or stroke and why?
DMPA due to hypoestrogenic effects and increased total cholesterol levels
MEC of progestin only for hx VTE?
2 for initiating
3 for continuing if VTE, ischemic cardiac event, or stroke occur while on them
MEC for COC and P-only contraception with inherited thrombobphilias
COC - 4
P only - 2
For breast-feeding exclusive mothers, how long can lactational amenorrhea be considered a method of contraception?
6 months
How soon after birth can non-breastfeeding mothers ovulate?
3 weeks (usually 6+)
MEC for COC use in SLE by risk factors:
- Antibody positive = 4
- plt <50k or immunosuppression = 2 (unless CV risk factors)