R7 - Contraception Flashcards
What is a contraceptive?
- “Prevention of conception prior to
implantation” - Acts prior to pregnancy
-prior to measurable serum hCG - No contraceptives are abortifacient!
Progestin (primary)
Combined Hormonal Contraceptives (Pill, Patch, Ring)
Suppresses ovulation
Inhibits (LH)
*Thickens cervical mucus
*Thins endometrium
Ethinyl Estradiol
Combined Hormonal Contraceptives (Pill, Patch, Ring)
Inhibits FSH
*No follicle growth
*Stabilizes endometrium
Non‐contraceptive Benefits CHC
– decreased menstrual flow (and anemia)
– decreased menstrual pain
– decreased acne & hirsutism
– cancer protection
* ovarian
* endometrial
CHC Absolute Contraindications
-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
Combined oral contraceptives (COCs) “The Pill”
21 days active pill, 7 days placebo
Most common side effects
-break through bleeding
-nausea
-breast tenderness
Continuous use
-increase efficacy
-increased breakthrough bleeding
20 mcg vs 30/35 mcg EE
increased spotting with <= 20 mcg pill
Monophasic, bi- or tri-phasic
Tri phasic not necessary
Drospirenone (Antiandrogenic Progestin)
-VTE: +/- increased risk
-PMDD: fewer sys at 3-6 mo but equiv at 2 yr
-Acne: all CHC pills treat, +/- greater benefit
Weekly: Transdermal Contraception “Patch”
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
Monthly: Vaginal Ring
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
Every 12 months: contraceptive ring (annovera)
- 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
Summary: Pills/Patches/rings
- 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)
Every 3 months: Injection (DMPA)
- 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
DMPA & BMD
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