Quiz 2 Contraception Flashcards
Estrogen-Progestin absolute contraindications
35+yrs and smoking 15+cigs
<21 days postpartum
>160/100, CAD risk factors
VTE/hx, thrombophilia
long/complicated DM
ischemic heart disease, stroke, complicated valvular disease
lupus, migraine w aura, breast CA, cirrhosis, transplant, hepatocellular adenoma, malignant hepatoma
Estrogen-progestin relative contraindications
35+yrs and smoking <15cigs
breastfeeding <42 days postpartum
>140/90 or well controlled on meds
symptomatic cholelithiasis, anticonvulsants
bariatric surgery, migraines w/o aura but 35yrs+, breast CA remission >5 years
progestin-only (pill/depo/implant) contraindications
absolute: current breast CA
relative: bariatric surgery, ischemic heart disease, stroke hx, lupus, migraine w aura, severe cirrhosis, certain anticonvulsants, hepatocellular adenoma, malignant hepatoma
levonorgestrel IUD absolute contraindications
postseptic abortion, postpartum sepsis, gestational trophoblastic disease, current breast CA, distorted uterine cavity
levonorgestrel IUD initiation contraindications
cervical/endometrial CA, unexplained vaginal bleeding, PID, purulent cervicitis, gonorrhea/chlamydia, pelvic TB
levonorgestrel IUD relative contraindications
ischemic heart disease, lupus, severe cirrhosis, hepatocellular adenoma, malignant hepatoma, ^STD risk, transplant
IUD copper (paraguard) absolute contraindications
same as levonorgestrel except use in Breast CA, possible cervix
IUD copper (paraguard) relative contraindications
severe thrombocytopenia, increased risk of STDs, transplant
Estrogen-progestin contraceptives MOA
ovulation suppression, thickening of cervical mucus, endometrial changes that interfere w sperm to egg transport and implantation
Estrogen progestin contraceptives
9% failure with typical use and 0.3% with perfect use at 1 yr
Estrogen-progestin SE
nausea, bloating, HA, mastalgia, depression, acne, hirsutism
Estrogen-progestin break thru bleeding
self limiting after 3 months, if persists change pill
Rule out pregnancy for amenorrhea
Combined oral contraceptives
estrogen type and progestin
all use ethinyl estradiol 10-50ug (start with 30-35ug) w different progestin types
combined oral contraceptives have high VTE risk when
50ug estrogen
3rd generation progestins (norgestimate and desogestrel) ^VTE risk but less androgenic
COC dosing
21/7 regimen 21 active and 7 placebo, can take active pills continuously with 4 yearly scheduled withdrawal bleeds
COC initiation
recommended: quick start
alternative: 1st day of menses or 1st sunday (25% of women will not follow thru)
Weekly hormonal patch (ortho evra, xulane)
releases 20mu/day ethinyl estradiol and 150ug/day norelgestromin
produces higher serum estrogen levels=^clot risk
may cause local irritation, reduced efficacy >90kg
Nuva ring
15ug/day ethinyl estradiol and 120ug/day of etonogestrel
3week or 4week cycle
50% of systemic exposure with COCs, same clot risk
progestin only BC MOA
thickens cervical mucus and thins endometrial lining
Progestin only pill (micronor) efficacy
0.3% failure rate w perfect use, 9% w typical use
Progestin only pill used in women w contraindication to ____ including
estrogen, including breast feeding women after 6wks postpartum
progestin only pill dosing and SE
1 pill same time everyday, no placebos
SE: irregular bleeding
Progestin only injection (Medroxyprogesterone) efficacy
0.2% failure w perfect use, 6% w typical use
medroxyprogesterone dosing
150mg IM or 104mg subQ, q3mo, hormone levels persist for 4mo (2-4wk safety margin)
Medroxyprogesterone SE
irregular bleeding, weight gain (5lb/year), amenorrhea
