POPs

Question 1

Progesterone type

Answer 1

Norethidrone

Question 2

Dose

Answer 2

(1) Errin - .35mg (2) Slynd 4mg

Question 3

Contraindications

Answer 3

(1) known or suspected pregnancy (2) known or suspected BCA (3) undiagnosed AUB (4) benign or malignant liver tumors, severe cirrhosis, or acute liver disease (5) malabsorptive bariatric surgeries (6) those taking certain anticonvulsants

Question 4

Failure rate

Answer 4

9% in 1st year of use; some prescribers authorize 2 pills daily to improve efficacy in non-PP, lactating or perimenopausal women

Question 5

Side effects

Answer 5

1. Menstrual changes 2. Follicular cysts 3. DM in BF Latina women w/ hx GDM

Question 6

Noncontraceptive benefits

Answer 6

dysmenorrhea, AUB, and endometriosis-related pain, but at higher doses (2.5-15.0 mg/day).

Question 7

How to start

Answer 7

If > 5 days from menses onset, BUC is needed for 2 days

Question 8

Missed dose

Answer 8

If > 3 hours, BUC is needed for 48 hrs; take missed and current dose even if 2 pills are taken on the same day

Question 9

When to offer EC

Answer 9

Can be offered if unprotected sex happened during that 48 hrs of missed dose (but not ulipristal acetate)

Question 10

Impacts on efficacy

Answer 10

Diarrhea, Vomiting within 3 hours of taking POP

Question 11

If switching from IUD to POPs

Answer 11

Take POPs for 2 days prior to IUD removal OR abstinence/condom must be used for 7 days prior to IUD removal OR if unprotected sex happened within 7 days of IUD removal, EC should be offered (if using ulipristal, POP cannot be started until 5 days later)

Question 12

If switching from POP to IUD, nexplanon or depo

Answer 12

BU is needed for 7 days if the switch occurs > 5-7 days from onset of menses

Question 13

Drug Interactions

Answer 13

Efficacy of POPs can be reduced by 1. Anti-epileptic medications: phenytoin, carbamazepine, topiramate, and barbiturates 2. Anti-microbial medications: rifampicin and rifabutin