Steroid Contraception Flashcards
What are the two types of classification of oral contraceptives?
Combination OC
Progestin-only pill
What is the mechanism of action of combination OC?
INHIBITION OF OVULATION
Alteration of cervical mucus
Alteration of the endometrium
What is the theoretical effectiveness of combination OCs?
99%
What is the composition of combination OCs?
ETHINYL ESTRADIOL
Progestin (derivatives of testosterone and progesterone)
Combination OCs original progestins:
Norethindrone
Norethindrone acetate
Norgestrel
Combination OCs original progestins:
Desogestrel
Gestodene
Norgestimate
DROSPIRENONE (possible risk of thrombosis)
What is an example of a present day Drospirenone?
Yaz, Yazmine
Combination OCs estrogen content:
Intermediate strength- 50 ug of ethinyl estradiol
Low dose- 20-35 micrograms
What are the classifications of low dose combination pills?
Fixed dose pills Triphasic pills (vary the dose of estrogen, progestin, or both)
What are the common side effects of combination OCs?
N/V Fluid retention Breast tenderness Mood changes Breakthrough bleeding Chloasma (melasma)
What is the risk assessment of oral contraceptives?
absolute risk- of greatest importance
relative risk - receives greatest publicity
Serious complications of oral contraceptives with relative risk of each:
SVT - 2
DVT - 4
Thrombotic CVA - 3
Hemorrhagic CVA - 2
The absolute risk is very low and less than the risk associated with pregnancy
What are serious complications of OCs?
MI Hepatic toxicity Cholelithiasis Pancreatitis Hyperlipidemia HTN Postpill amenorrhea Depression
What are absolute contradictions to combination pills?
Estrogen dependent tumor History of DVT or PE Pregnancy Undiagnosed genital tract bleeding Serious liver disease Heart disease (ischemic, valvular, cardiomyopathy) Smoking and age >35 Hyperlipidemia Diabetes with long duration with vascular disease Poorly controlled HTN SLE Migraine and aura Stroke Solid organ transplant Thrombophilia Major surgery - prolonged immobilization
What are the relative contradiction to combination pills?
diabetes with out vascular disease vascular headaches mild HTN SS or SC disease Uterine leiomyoma Age > 35 Smoking Seizure disorder Imminent elective surgery
What are the medical benefits of combination pills?
Decreased menstrual loss
Decreased severity of dysmenorrhea
Decreased frequency of function ovarian cysts
Decreased frequency of ectopic pregnancy
Decreased frequency of breast cysts
Decreased frequency of PID
Decreased frequency of ovarian and endometrial cancer
What doe the Contraceptive Patch contain?
6 mg norelgestromin
.75 mg ethinyl estradiol
Daily dose (150 micrograms norelgestromin, 20 micrograms ethinyl estradiol)
Conraceptive patch vs OC
Equivalent in effectiveness to the combination pill but increases estrogen exposure.
patch is changed weekly x3
applied to buttocks, abdomen, arm or torso
slightly more expensive than the pill
48 hr saftey, if over 48 hr use a different type of contraceptive for the month
Contraceptive ring (NuvaRing) composition
ethinyl estradiol
etonogestrel
What is the duration of effect of the contraceptive ring?
3 weeks, one week with no ring, insert a new ring one week later
What is a type of emergency post-coital contraception?
Plan B (levonorgestrel (.75mg) q 12 h x 2 doses or in one dose
Copper IUD - can be taken within 5 days of unprotected intercourse. (levonorgestrel- releasing intrauterine system is not effective)
How long do you have to take Plan B?
Administer within 72 hr of unprotected coitus (may be effective up to 120 hr)
What is the effectiveness of Plan B?
75%
What is Plan B’s MOA?
undetermined
What is the effectiveness of a Copper IUD?
99%
What is the compostition of Progestin-only pills?
35 micrograms of norethindrone or .75 mg of norgestrel
What is the mechanism of the progestin-only pill?
alteration of cervical mucus and endometrium
Who is the progestin-only pill usually prescribed to?
lactating women
What are the complications of the progestin-only pill?
Pregnancy 2-8% or the time still
Breakthrough bleeding in 30-40% of patients
What is depo-provera used for in contraception?
a highly effective method of contraception
difficult compliance with daily pills
contraindications too, or poor tolerance of, combination pills
What is the mechanism of action of depo-provera?
inhibits ovulation and alters endometrium
What dose of depo-provera is prescribed?
150mg IM q 3 months
What is the efficacy of DP?
99-100%
What are the adverse effects of DP?
Breakthrough bleeding- 10-30%
Unacceptable weight gain- <5%
*Bone Loss- variable depending upon duration of use
Does not adversely affect subsequent fertility
does not cause congenital abnormalities
does not increase the risk of breast or genital tract cancer
Depo-provera use in the puerperium:
May be administered immediately to women who bottle feed
manufacturers suggest waiting 6 weeks to administer to women who breast feed
What is EXPLANON?
A contraceptive implant containing etonogestrel
a single implanted rod, hard to remove
duration of protection for 3 years
