Progesterone only hormonal Flashcards
Can progesterone-only contraceptive pill (POCP) be used in breastfeeding?
Yes. It can also be used in hypertension (unlike COCP)
(5) names of Progesterone-only contraceptive pills (POCP)
- Femulen® – etynodiol diacetate
- Norgeston® – levonorgestrel
- Noriday® – norethisterone
- Micronor® – norethisterone
- Cerazette® – desogestrel
MoA of progesterone-only contraceptive pill (POCP)
- thickens cervical mucus →due to high progesterone levels → entry of sperm is prevented
- suppress ovulation / inhibit ovulation (depends on the substance used in a pill)
- thinning of the endometrium → so implantation is prevented
Advantages of use of progesterone-only pill
- More effective than barrier methods when taken correctly
- Sex doesn’t need to be interrupted to use contraception.
- Can be used in many patients for whom the combined oral contraceptive is contraindicated.
- May reduce risk of endometrial cancer
Disadvantages of progesterone-only pills use
- user dependent → need to be taken correctly
- can produce irregular menstruations or amenorrhoea
- SEs when pills are first started: headaches, skin changes, breast tenderness
- increased risk of ovarian cysts
- small increase in risk of breast cancer
Contraindications for POCPs
- current or past Hx of breast cancer
- liver cirrhosis or tumour
- lower efficiency in women over 70kg
- stroke or coronary heart disease
What is the name of only one progesterone-only implant licensed in the UK?
Nexplanon
How big is progesterone only implant and ho long does it last for?
- 40 mm long
- contains 68mg of etonogestrel (steroidal progestin) →released into systemic circulation for 3 years
Mechanism of action of Nexplanon (implant)
- inhibits ovulation
- thickening of cervical mucus (sperm cannot pass)
- thinning of the endometrium (due to high progesterone level) →prevent implantation if an egg is to be fertilised
Advantages of the progesterone-only implant (Nexplanon)
- extremely effective
- can be used in those for whom COCP is contraindicated
- no need to think about contraception for 3 years
- can be used while breastfeeding
- normal fertility returns as soon as the implant is removed
- effective in women of all BMIs → although in high BMI, an earlier replacement of implant is recommended
- may reduce risk of endometrial cancer
Disadvantages of Nexplanon (progesterone-only implant)
- irregular bleeding patterns in 50% of women
- procedure required to fit and to remove the implant → pain, irritation and bruising
- small increase in risk of breast cancer
- implant can sometimes break/bend when in situ
Contraindications to Nexplanon (progesterone-only implant)
- pregnancy
- unexplained vaginal bleeding
- liver cirrhosis or tumour
- Hx of breast cancer
- stroke or TIA while using an implant
(3) names of progesterone-only injectable contraceptives
- Depo-Provera®
- SAYANA PRESS®
- Noristerat®
How long for and how is administrated Depo-Provera?
Depo-Provera (progesterone-only injectable)
- deep IM injection
- given every 12 weeks
*Depo-Provera is most commonly used progesterone-only injectable
How long for a is Sayanna-Press administrated for?
SAYANNA -PRESS = injectable progesterone- only
- injections given every 12 weeks
What’s Noristerat?
- route of administration
- how often must be administrated
Noristerat = injectable progesterone-only
- deep IM injection
- every 8 weeks
*rarely used as licensed only to use for short term use (to sets of injections)
MoA of progesterone-only injectables
- inhibit ovulation
- thickens cervical mucus
- thinning of endometrial lining (so if an egg becomes fertilised it will be difficult for it implant)
Advantages of injectables progesterone-only
- very effective
- users do not need to think about contraception for as long as the injection last
- not known interaction with any drug
- it can be used when COCP is contraindicated (e.g. migraine, breastfeeding)
- can be used in women with BMI <35
- may reduce risk of endometrial cancer
Disadvantages of progesterone-only injectibles
- not readily reversible → can take up to a year for normal fertility and menstruation to return
- altered bleeding patterns (including persistent bleeding)
- increase in body weight (up to 2-3 kg over a year)
- slightly increased risk of breast cancer
- loss of bone mineral density in long-term use (over a year) *but no evidence that increases risk of fractures
Contraindication of progesterone-only injectibles
- current cancer or present within the last 5 years
- Hx of severe arterial disease or very high risk factors
- pregnancy
- diabetes with any vascular disease (e.g. retinopathy)
- people who will want to return their fertility in a near future
