Oral contraceptives Flashcards
types of oral contraceptives
combination: monophasic or multiphasic
more closely resemble normal menstrual cycle hormonal changes, lower total hormone dose per cycle
Oral contraceptive MOA
progestin: suppression of the LH surge, preventing ovulation; thickening/impearability of cervical mucus; involution/atrophy of endometrium
estrogen: suppression of FSH release, preventing the development of a dominant follicle; potentiation of progestin component action; stabilization of endometrial lining
Pros and Cons of COmbination OCs
Pros: effective contraception, decrease in pregnancy-related death, better cycle control, decrease in IDA, maintenance or improvement of bone density, protection from ovarian and endometrial CA
Cons: no protection against STIs, increase risk of thromboembolism and stroke, may elevate BP, estrogenic and progestin side effects, drug interactions, daily pill taking, cost >$30month
CIs to Combo OCs
hx of stroke, thromboembolic disease, breast CA, pregnancy, heavy smoking, active liver disease
Too much/too little estrogen
N, breast tenderness, increased BP, melasma, HA
too little: early or mid cycle breakthrough bleeding, increased spotting, hypomenorrhea
Progestin generations and hormone activity
first: high estrogen, progestin, and androgen
second: high progestin and androgen
third: high progestin and lower androgen
other: drospirenone (Yaz) lower progestin and no estrogen or androgen
Monophasic products and their activity
Alesse: low P, low E, low A
Ovcon 35: low P, high E, low A
Ovral: high P, high E, high A
Five signals of serious trouble with OC
Abdominal pain Chest pain HA Eye problems Severe leg pain
What is important to note about oral emergency contraceptive options
they vary in OTC and if there is a age limit or not and they should be taken within 72 hours
AE of oral emergency contraceptive
N/V-less with Plan B
Irregular bleeding-mesntrual period occurs 1 week before or after expected time
What OC to use
young and healthy: monophasic
acne: ortho-tricyclen, estrostep, yaz
minimize estrogen exposure: ALESSe, LESSina
breastfeeding or estrogen CI: avoid estrogen with Micronor
PMS, HA, anemia, endometriosis: consider extended cycle like Seasonale
Pt education for use of OC
Adherence to regimen is essential for efficacy
Directions to start taking can be in office right away or start on the sunday after your menstrual cycle
If you miss a pill take it immediately and use back up
identify back up methods, OCs don’t protect against STDs, discuss AEs, discuss benefits, and five possible warning signs
