R7 - Contraception Flashcards

1
Q

What is a contraceptive?

A
  • “Prevention of conception prior to
    implantation”
  • Acts prior to pregnancy
    -prior to measurable serum hCG
  • No contraceptives are abortifacient!
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2
Q

Progestin (primary)

A

Combined Hormonal Contraceptives (Pill, Patch, Ring)

Suppresses ovulation
Inhibits (LH)
*Thickens cervical mucus
*Thins endometrium

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3
Q

Ethinyl Estradiol

A

Combined Hormonal Contraceptives (Pill, Patch, Ring)

Inhibits FSH
*No follicle growth
*Stabilizes endometrium

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4
Q

Non‐contraceptive Benefits CHC

A

– decreased menstrual flow (and anemia)
– decreased menstrual pain
– decreased acne & hirsutism
– cancer protection
* ovarian
* endometrial

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5
Q

CHC Absolute Contraindications

A

-Hx of venous thromboembolism (risk of recurrence)
-Migraines with aura
-Hypertension if poorly controlled (over 160 or 100)
-Smoker > 35 yo > 15 cigs/day
-Under 21 days postpartum

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6
Q

Combined oral contraceptives (COCs) “The Pill”

A

21 days active pill, 7 days placebo

Most common side effects
-break through bleeding
-nausea
-breast tenderness

Continuous use
-increase efficacy
-increased breakthrough bleeding

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7
Q

20 mcg vs 30/35 mcg EE

A

increased spotting with <= 20 mcg pill

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8
Q

Monophasic, bi- or tri-phasic

A

Tri phasic not necessary

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9
Q

Drospirenone (Antiandrogenic Progestin)

A

-VTE: +/- increased risk
-PMDD: fewer sys at 3-6 mo but equiv at 2 yr
-Acne: all CHC pills treat, +/- greater benefit

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10
Q

Weekly: Transdermal Contraception “Patch”

A

3 weeks on 1 week off
- 35 and 150 mcg EE, 30 and 120 mcg EE and levo
- Improve compliance
- On trunk, arms, lower back or buttock
- FEWER AE: especially GI, 20% skin irriation
- May be less effective if under 90 kg

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11
Q

Monthly: Vaginal Ring

A

15mcg EE and120 mcg etonogestrel
- Ring in vagina 3 wks, removed for 1 wk
- Constant, low hormone levels

  • Easily placed and removed
  • Most people with a vagina and penis don’t notice during intercourse
  • High acceptability and compliance
  • FEW AE — comparable to pills
    — Less spotting 5%
    — 1% stop method because of discharge
    (physiologic, NOT pathologic)
    — 2.5% stop method because of discomfort
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12
Q

Every 12 months: contraceptive ring (annovera)

A
  • 17.4mg Ethinylestradiol and 103 mcg segesterone acetate
  • One ring every 12months
    – Ring placed in vagina x 3 wks, removed x 1 week
    – Continuous use
  • Efficacy, risks and side effects similar to the EE/ENG ring
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13
Q

Summary: Pills/Patches/rings

A
  • All include combo of estradiol and progestin
  • MOA for all is suppression of ovulation through inhibiting LH and FSH
  • Similar efficacy: 9% failure, <1% perfect use
  • Patches/rings = less frequent dosing, less GI side effects (but higher risk of VTE)
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14
Q

Every 3 months: Injection (DMPA)

A
  • DMPA 150 mg IM every 12-14 weeks
  • Very effective
  • MOA: inhibits ovulation
  • Side effects: delayed return to fertility, irregular bleeding, amenorrhea, increase seizure threshold, weight gain
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15
Q

DMPA & BMD

A

BMD decreases by 1-2% per year

FDA: limit to 2 yrs in young women

WHO and ACOG don’t agree with this
- no evidence of increased fractures
- reverses by 12 months after d/c

No indication for DEXA or Ca supp

Weigh risks against risk of preg

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16
Q

Every 3-5 years: Single-Rod Implant (Nexplanon)
-MOA AND AE

A

Etonogestrel 60 mcg/day

MOST effective > 99%

MOA: suppress ovulation and thicken mucous

Very easy and well tolerated

AE: bleeding, amenorrhea, slight weight gain (SWAGB)

17
Q

Copper IUD: 10-12 years

A

-Prevent fertilization, decrease motility/viability of sperm
-Inhibition of implantation

18
Q

Every 3-8 Years:
Levonorgestrel Intrauterine Systems

A

MOA:
Fertilization inhibition
-thickens mucus
-inhibit sperm motility/function
-endometrium suppressed
-ovulation inhibited

19
Q

IUD:
Dispelling Common Myths

A
  • IUDs :
    DO NOT cause pelvic infection
    DO NOT impair future fertility
    CAN be used for nulligravidas
20
Q

Emergency Contraception

A

Oral LNG available over the counter, UA is not

  • LNG EC = 89% reduction of pregnancy risk
  • LNG EC has minimal to no efficacy in women who are overweight or obese
  • UA more effective for BMI >25
21
Q

Copper T IUD (em. contra)

A

10x more effective than Plan B

spermicidal prevents fertilization, ? Endometrial effects