Progestin Contraceptives

Question 1

CONS of Progestins

Answer 1

-

-Increase LDL levels

Question 2

PROS of Progestins

Answer 2

-

-Increases quality and duration of lactation

Question 3

First-Generation Progestins

Answer 3

• Norethindrone
• Norethindrone acetate
• Ethynodiol diacetate

MOA = Has affinity for progesterone and androgen receptors (at lower affinity than 2nd generations)

Question 4

Second-Generation Progestins

Answer 4

• Norgestrel
• Levonorgestrel

MOA= Has affinity for progesterone and androgen receptors (higher affinity than 1st generations)

• Less breakthrough bleed or spotting d/t higher affinity for progesterone receptors
• May cause more acne, hirsutism, dyslipidemia, weight gain b/c higher affinity for androgen receptors

Question 5

Third-Generation Progestins

Answer 5

• Norgestimate
• Desogestrel

MOA = Lower activity on androgen receptors. Also binds to progesterone receptors

-Less androgenic side effects (Acne, DLP, wt gain, hirsutism)

Question 6

Other New Progestins

Answer 6

• Drospirenone
• Dienogest

MOA = Binds primarily to progesterone receptors with little to no affinity for other steroid receptors. Possible anti-androgen effects

Question 7

Signs of “TOO MUCH” Progestin

Answer 7

• Breast tenderness
• Headache
• Fatigue
• Mood changes

Question 8

Signs of “TOO LITTLE” Progestin

Answer 8

-Breakthrough bleeding in late cycle

Question 9

Progestin-only Pills (POPs) “minipills”

Answer 9

Available as “Norethindrone 350 mcg (Micronor, Jencycla)

• Short half-life, so if taken more than 3 hrs late, it can increase risk of pregnancy (use backup contraceptive)
• No hormone-free days
• PRO = Less bleeding during menstruation
• CON = More irregular/unpredictable breakthrough bleeding/spotting