Lecture 5

Question 1

What are examples of progestin only pills ?

Answer 1

Norethindrone
Drospirenome

Question 2

When can a patient use a POP ?

Answer 2

Avoid estrogen ( migraines with aura, smoking >35 yo)

Postpartum and breastfeeding

Question 3

What are the contraindications for progestin-only medications?

Answer 3

breast cancers, history of cancer, liver diseases and inducers ( CYP3A4: anticonvulsants and rifampin)

Question 4

What are the main counselling point when a pt will take norethindrone ?

Answer 4

TIMING!
Missed dose ( not more than 3 hours)
Take it ALL the TIME ( no break)

Question 5

What is the MOA of norethindrone

Answer 5

Progestin analog
Cervical mucus more thick and can stop ovulation

Question 6

Which contraceptive helps with acne tx ?

Answer 6

Drospirenone with the anti-antiandrogenic abilities

Question 7

What is the MOA of drospirenone ?

Answer 7

Progestin ONLY
Inhibits ovulation + thick mucus

Question 8

If a pt starts drospironone outside of 1st day of menses , what would you counsel ?

Answer 8

recommend a 7 days backup

Question 9

Why is there a longer back up time with drospirenone compared to norethindrone ?

Answer 9

Drospirenone has a longer 1/2 life than norethindrone

Question 10

Which POP has hyperkalemia SE ?

Answer 10

Drospirenone

Question 11

What are the common progestin SE ?

Answer 11

Mood, headache, breast tenderness,

Question 12

Who would best benefit from DMPA ?

Answer 12

pts that are on anticonvulsant , no exposure to estrogen

Question 13

How frequent does a pt is injected for DMPA ?

Answer 13

every 3 months (in week 12-13)

Question 14

What would you counsel a pt that is starting DMPA on day 10 of cycle ?

Answer 14

requires 7 days back up

Question 15

What is a major SE from DMPA to mention to pt ?

Answer 15

weight gain , delay in fertility ( 9 months)

others : progestin SE ( mood, headache, breast tenderness) , menstrual cycle disturbance

Question 16

When would you need backup for DMPA ?

Answer 16

missed dose after 14 weeks
starting after 5 days of normal cycle

7 days back up

Question 17

When is the safe age gap for DMPA in terms of loss of bone mineral density ?

Answer 17

18 - 45 years old

Question 18

What is the MOA of LNG IUS ?

Answer 18

LNG releasing system
Thinning of uterus lining
Stops sperm
Thick mucus

Question 19

What are the additional indications of LNG IUS ?

Answer 19

Dysmenorrhea
Heavy and abnormal bleeding
Protects from estrogens ( endometrial protection)

Question 20

What is the main difference between the Mirena and kylena ?

Answer 20

both LNG IUS
Kyleena releases less LNG doses

Mirena –> “more”

Question 21

What is the bleeding events - menstrual with patients on LNG IUS ?

Answer 21

reduced mens
amenorrhea is also common

Question 22

What are the SE of LNG IUS ?

Answer 22

irregular bleeding
Pain at insertion
Systemic LNG levels ( less than CHC) = mood, breast tenderness, headache

Question 23

What are the contraindications for intrauterine contraceptions ?

Answer 23

Pregnancy
Current PID
Current breast cancer
Undiagnosed abnormal uterine bleeding
Previous risk of breast cancer
Postpartum > 48 hours to 4 weeks

Question 24

What is the MOA of copper IUD ?

Answer 24

Copper ions inhibits sperm movement

Question 25

What are the SE of copper IUD ?

Answer 25

irregular bleeding/ BTB ( more than LNG IUS) more dysmenorrhea, pelvic pain, cramps than LNG IUS

Question 26

Do you need backup with copper IUD ?

Answer 26

No it works right away

Question 27

what are the risks of IUD ?

Answer 27

Expulsion (first ear, heacy mens,. Atypical anatomy ) Perforation PID Vasovagal reaction /fainting with insertion

Question 28

What is within a contraceptive implant ?

Answer 28

Progestin subdermal Etonogestrel - 3rd gen

Question 29

How long can one keep the contraceptive implant inside ? m

Answer 29

for 3 years

Question 30

What is the MAIN MOA of contraceptive implant ?

Answer 30

STOPS OVULATION thicken mucus and atrophic endo

Question 31

What happens to the fertility of contraceptive implants ?

Answer 31

Fertility returns in ONE month after removal

Question 32

What are the SE of contraceptive implants ?

Answer 32

Irregular bleeding or breakthrough bleeding Progestin related Weight Gain

Question 33

What should we do moving from CHC oral patch/ ring to LARC ?

Answer 33

CHC for 7 days after insertion

Question 34

What should we do DMPA to LARC?

Answer 34

No later than 13 weeks after the last injection

Question 35

What can be said about transgender with ova and uterus ?

Answer 35

With ova + uterus → ovarian function is not fully suppressed while on testosterone Needs : NO estrogen → POP, IUD,n copper IUD

Question 36

If a patient is on anticonvulsants what contraceptive would you recommend ?

Answer 36

Try IUD if CHC ( minimum 30-35 ug of EE) , longer ½ lfe progestin ( 2nd gen) Continuous/ external interval dosing + backup

Question 37

What is the recommendations fo pts with migraines + AURA ?

Answer 37

Contraindications! More risk of ischemic stroke NO CHC , avoid estrogen

Question 38

What is the recommendations for pts with MIGRAINE ?

Answer 38

Are they linked to hormones ? continuous or HFI Continue with CHC or estrogen in HFI Recommend if worse care : POP, IUD, implant.

Question 39

What are the recommendations for obese pts ?

Answer 39

Assumed lower efficacy in patches, COC → Increase the risk of VTE with more weight Recommend : IUD ( even with LNG )

Question 40

When can a breastfeeding mom potentially use CHC or POP ?

Answer 40

Decrease breastfeeding → ovulation can start < 6weeks : avoid CHC only POP , estrogen → affects prolactin > 6 weeks : preference of POP >> CHC

Question 41

What does WHO say for non breastfeeding mom ?

Answer 41

WHO : <3 weeks + Not Breastfeeding → avoid CHC, hypercoagulale state Wait 6 weeks if VTE risk !!

Question 42

When is the ideal time to use IUD postpartum ?

Answer 42

< 48 hours ideal but HIGHER rates of expulsion > 48 hours → wait 4 weeks

Question 43

When can contraceptives be used by postpartum women ?

Answer 43

> 4 weeks

Question 44

What are the SE of copper IUD ?

Answer 44

More Irregular bleeding or breakthrough bleeding More risks of dysmenorrhea, pelvic pain, cramps Pain at placement