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2016 Endocrine > Test 1 Contraception > Flashcards

Test 1 Contraception Flashcards

1
Q

Contraception Epidemiology

A
  • 49% of all pregnancies in the US are unintended
  • Of the intended pregnancies the outcomes are
    • Birth (80%)
    • Fetal Loss (20%)
  • Unintended pregnancies result in
    • Birth (about 50%)
    • Fetal Loss (about 10%)
    • Abortion (about 40%)
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2
Q

Methods of contraception used by women 15-44 years of age in the US

A
  • From Highest use to lowest
    • Not using contraception
    • Sterilization (Tubal ligation is more common than vasectomy)
    • Pill
    • Condom
    • IUD (increased from 2nd to last in 2002 to fifth in 2013)
    • Progestin Injection
    • Withdrawal Method
    • Other
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3
Q

Contraception Effectiveness

A
  • Measured by failure rates in the first year of use:
    • Typical use = % of couples using the method for 1 year, but not perfectly (not correctly and/or not consistently)
      • More common
    • Perfect use = % of couples who use the method perfectly for 1 year (correctly and consistently)
  • Generally speaking, hormonal methods are more effective than non-hormonal methods (with the exception of copper IUD)
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4
Q

Contraception Effectiveness: Greatest to worst

A
  • Effectiveness Greatest to worst
    • Implanon
    • Male sterilization
    • Mirena
    • Female sterilization
    • Paragard
    • Depo
    • Pill, patch, ring
    • diaphragm, sponge
    • male condom
    • female condom
    • Withdrawal
    • Fertility based awareness methods
    • spermicides
    • No method
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5
Q

Non-Hormonal Forms of Contraception

A
  • Lactational Amenorrhea
  • Fertility Awareness-Based Methods
  • Barrier techniques
  • Spermicides
  • Sponge
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6
Q

Lactational Amenorrhea

A
  • Non-hormonal form
  • Exclusive breast-feeding
    • When they are not exclusively breast fed, milk production decreases and menstruation resumes
  • Amenorrheic (no periods occurring) first 2 months some bleeding is ok
  • Infant less than 6 months old
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7
Q

Fertility Awareness-Based Methods

A
  • Non-hormonal method
  • Beads, bracelets, apps
  • Monitor cervical mucus, breast tenderness – signs of ovulation
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8
Q

Barrier techniques

A
  • Non-hormonal Method
    • Diaphragm
    • Cerivical cap
    • Male Condome
    • Female Condom
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9
Q

Diaphragm

A
  • Non-hormonal method
  • Bigger, more flexible
  • Cover the cervix
  • Must add spermicide
  • Must be fitted for the appropriate size
  • Can be placed 6 hours before needed
  • Must be left in for 6 hours after intercourse
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10
Q

Cervical Cap

A
  • Non-hormonal Method
  • Smaller, harder – like a thimble
  • Same as diaphragm
    • Cover the cervix
    • Must add spermicide
    • Must be fitted for the appropriate size
    • Can be placed 6 hours before needed
    • Must be left in for 6 hours after intercourse
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11
Q

Male condom

A
  • Non-hormonal method
  • Latex (most common)
    • Oil-based drug formulations and lubricants can decrease the barrier strength of latex by 90% in 60 seconds
    • Medicated creams can also decrease the barrier strength
    • Impermeable to viruses
    • Can be used with water-based lubricants
  • Lambskin
    • Not impermeable to viruses – can pass through
    • May recommend for someone with a latex allergy
  • Synthetic (usually polyurethane)
    • Impermeable to viruses
    • May recommend to someone with a latex allergy
    • Can use an oil-based lubricant – will not degrade
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12
Q

Spermicides

A
  • Non-hormonal Method
  • nonoxynol-9 (only one in the US available)
    • Foams, creams, suppositories, jellies, films
    • Films, vaginal tablets
      • If it is something that needs to be dissolved, it must be inserted ~30 minutes prior to be effectively absorbed
    • May increase risk of HIV transmission
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13
Q

Sponge

A
  • Non-hormonal method
  • Contains 1 g of nonoxynol-9
    • Acts partially as a barrier, partially as a spermicide
    • Like a diaphragm or cervical cap – can be placed 6 hours before, and must be kept in for 6 hours after intercourse
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14
Q

General Principles of Combined Hormonal Contraceptives

A
  • Estrogen- inhibits ovulation by suppressing FSH and LH by suppressing feedback loop
    • 1 of 3 estrogens is used in combined hormonal contraceptives
      • Ethinyl estradiol (EE) – most common
      • Mestranol – gets converted to EE
      • Estradiol valerate – newest; prodrug that is metabolized to estradiol
        • Marketed as being better tolerated; may be better for clotting, but there are no studies to prove it
    • High dose = 50 mcg
    • Low dose = 30 – 35 mcg (most women start here)
    • Ultra-low dose = 20 – 25 mcg
  • Progestin – Inhibits ovulation by suppressing LH surge, thicken cervical mucous, make endometrial thin.
    • Progestins vary in their amount of progestational, estrogenic, and androgenic effect
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15
Q

1st generation progestins

A
  • Norethindrone
    • moderate estrogen, progestin, and andogen activity)
  • Norethindrone acetate
    • (moderate estrogen and androgen activity, high progestin activity)
  • Ethynodiol diacetate
    • moderate estrogen, high progestin, low androgen activity
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16
Q

2nd genertaion progestins

A
  • More potent than 1st generation
  • Norgestrel
    • no estrogen, high progestin and androgen activiy
  • Levonorgestrel
    • no estrogen, very high progestin and androgen activity
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17
Q

3rd generation progestins

A
  • Fewer androgenic and metabolic effects vs 1st generation
  • Norgestimate
    • no estrogen, mod progestin and androgen activity
  • Desogestrel
    • no-low estrogen, very high progestin, and mod androgen activity
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18
Q

Other progestins

A
  • Antiandrogen effects
  • Drosperenone
    • no estrogen, no-low progestin, no androgen activity
  • Dienogest
    • no estrogen, no-low progestin, no androgen activity
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19
Q

Androgen activity

A

hair growth

  • acne
  • deepening of the voice
    • pick one that doesn’t have androgen activity or even negative activity if the patient is showing signs of androgen activity already
      • drosperenone would be a good one
  • Drosperenone – very similar to spironolactone – monitor K+
  • Dienogest – newer agent – does not affect K+
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20
Q

Progestin prodrugs

A
  • Norelgestromin (prodrug) – similar to norgestimate
    • Found in the BC patch
  • Etonogestrel (prodrug) – similar to desogestrel
    • Found in the implant and vaginal ring
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21
Q

Combination Side effects

A
  • Based on estrogenic, progestational, and androgenic components (estrogens have the most fatal side effects)
    • Warning signals
      • A = abdominal pain (ectopic pregnancy, gallbladder disease, clot in abdominal vein)
      • C = chest pain (clot in the heart (MI) or lung (pulmonary embolism))
      • H = headache (clot in the brain (stroke))
      • E = eye problems (stroke)
      • S = severe leg pain (DVT
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22
Q

Combination Drug Interactions

A
  • Rifampin – potent inducer
  • May see a problem with broad-spectrum antibiotics (like tetracycline), but data doesn’t support this claim
    • Still put the label on
  • Enzyme inducers – carbamazepine, phenobarbital
  • Drugs that alter GI mobility, or block absorption (cholestyramine)
  • Drugs that affect K+ in patients taking Drosperenone (ACEi, spironolactone, NSAIDs)
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23
Q

Combination Monitoring

A
  • Blood pressure – due to estrogen (increases 6-8mmHG)
  • K+ – if the patient is on Drosperenone
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24
Q

Noncontraceptive benefits of combination contraception

A
  • Relief from menstruation-related problems (less menstrual cramps, less ovulatory pain or mittelschmerz, less menstrual blood loss)
  • Improvedin menstrual regularity
  • Increased hemoglobin concentrations
  • Improvement in acne
  • Reduced risk of ovarian and endometrial cancer
  • Reduced risk of ovarian cysts
  • Reduced risk of ectopic pregnancy
  • Reduced risk of pelvic inflammatory disease
  • Reduced risk of benign breast disease
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25
Q

Considerations for Initiating Combined Oral Contraceptives (COC)

A
  • Concomitant medical conditions
  • Examinations before initiating Contraceptives
  • Estrogen and progestin dose
  • Monophasic vs phasic
  • Cycle length
  • Start date
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26
Q

Concomitant medical conditions

A
  • U.S. Medical Eligibility Criteria for Contraceptive Use – 4 categories
    • Category 1 – condition for which there is no restriction for the use of the contraceptive method
      • Perfectly safe – no restrictions
    • Category 2 – condition for which the advantages of using the method generally outweigh the theoretical or proven risks
      • Generally considered safe
    • Category 3 – condition for which the theoretical or proven risks usually outweigh the advantages of using the method
      • Don’t recommend
    • Category 4 – condition that represents an unacceptable health risk if the contraceptive method is used
      • Don’t recommend
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27
Q

Examinations before initiating Contraceptives

A
  • Don’t need PAP Smear
  • Don’t need pregnancy test but you have to be reasonably sure that the patient is not pregnant
  • Needs blood pressure taken
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28
Q

Estrogen and progestin dose

A
  • 30 – 35 mcg estrogen – most women start on this dose
  • Some women will be started w/ 20 – 25 mcg estrogen dose
    • younger women and very thin, or > 35 years old
  • Progestin – usually start w/ a low androgen activity progestin
    • norethindrone, norgestimate
29
Q

Monophasic vs phasic

A
  • Monophasic = same dose every day, then placebo week
    • Generally start w/ monophasic – it’s easier to identify SE and adjust
  • Biphasic = two different doses
    • Women tend to have more breakthrough bleeding
  • Triphasic = three separate doses
    • Good for women who needs less progestin (contain a lower dose overall)
  • Four-phasic = four separate doses
    • Only one product available (Natazia)
30
Q

Cycle length

A
  • The only disadvantages of changing cycle length from traditional is break through bleeding. There are no studies to prove any other disadvantages.
    • Traditional monthly cycle
      • 21 active pills + 7 placebo pills
    • Monthly regimens, shortened placebo
      • 24 active pills + 4 placebo
      • 24 active pills + 4 iron only
      • 24 active pills + 4 folic acid only
      • 21 active pills + 2 placebo + 5 estrogen only
      • 22 active pills + 2 placebo + 4 estrogen only
    • Extended regimen, regular placebo
      • 84 active pills + 7 placebo
        • Advantage – no periods
        • Disadvantage – spotting/breakthrough bleeding in the first few months (give it a few months); it costs more; not having a period may cause anxiety
    • Continuous regimen, no placebo
      • 84 active pills + 7 estrogen only
      • 91 active pills
31
Q

Start date

A
  • First day start = take the first pill on the first day of the next menstrual cycle
    • No backup protection needed – starting during menses and adequate hormone production will inhibit ovulation
  • Sunday start = take first pill on Sunday after the next menstrual cycle – most popular in the US
    • You won’t have bleeding on a weekend
    • Not necessarily the best method
    • Must use backup protection for 7 days after starting
  • Quick start = same day of the office visit - Preference
    • Must do a pregnancy test to make sure they aren’t currently pregnant
    • Must use backup protection for 7 days – they could be starting the pack around ovulation and it takes several days to inhibit ovulation
    • Next menses will be delayed until they reach their placebo week
    • More likely to continue using it – won’t forget to pick it up from the pharmacy
  • All methods are appropriate
32
Q

What is the best day for a woman to begin taking oral contraceptives?

A

WHO recommends same day as office visit

33
Q

Patient Counseling for Combined Oral Contraceptives

A
  • Compliance
    • Take every day as close to the same time as possible
  • Common side effects and warning signals
    • ACHES
  • Benefits and risks
    • Patients should understand that COC does not protect against STDs
  • Drug interactions
    • Use a high-dose estrogen + backup protection for rifampin use
    • For most Dis, backup protection is appropriate
  • When to use backup method
  • Instructions for missed pills (Don’t have to memorize for test)
34
Q

Managing Side Effects of Combined Oral :

Estrogen Excess/Deficiency

Know!!

A
  • Excess
    • Nausea
    • Melasma
    • Hypertension
    • Headaches
    • Breast fullness or tenderness
    • Weight gain
  • Deficiency
    • Early or mid-cycle breakthrough bleeding
    • Increased spotting
35
Q

Managing Side Effects of Combined Oral Contraceptives

Progestin excess/Deficiency

Know!!

A
  • Excess
    • Increased appetite
    • Weight gain
    • Tiredness, fatigue
    • Depression
    • Mood changes
    • Breast tenderness
  • Deficiency
    • Late breakthrough bleeding
36
Q

Managing Side Effects of Combined Oral Contraceptives

Androgen Excess/Deficiency

Know!!

A
  • Excess
    • Acne
    • Hirsutism
    • Increased libido
    • Oily skin and scalp
    • Rash and pruritus
    • Weight gain
  • deficiency
    • none
37
Q

When will combination side effects be gone?

A

Most side effects will be gone at 3 months – if they persist, make changes to the drug

38
Q

A patient started on COC 4 months ago is still complaining of nausea. What do you recommend?

A

Decrease estrogen component

39
Q

: A patient started on COC 6 months ago is still complaining of increased appetite and weight gain. What do you recommend?

A

Decrease progestin component

40
Q

Special Considerations with Combined Hormonal Contraceptives

A
  • Women over 40
  • Smoking
  • Hypertension
  • Hyperlipidemia
  • Diabetes
  • Migraines
  • Breast Cancer
  • thromboembolism
  • Obesity
  • Postpartum and lactating women
41
Q

Special Considerations with Combined Hormonal Contraceptives:

Women over 40

A
  • category 2 but still can use
    • No increased risk of MI or stroke among healthy, nonsmoking women older than 40 years who use COC with less than 50 mcg EE
    • May recommend 25 mcg estrogen
42
Q

Special Considerations with Combined Hormonal Contraceptives:

Smoking

A
  • Increases risk of MI and stroke
    • Cigarettes per day=Times MI risk is increased
      • Less than 15=1.2 times
      • 15-24=4.1 times
      • More than 24=11.3 times
    • Less than 35 years old
      • Category 2 – some providers still won’t do it
    • Over 35 years old – don’t do it
      • < 15 cigarettes = category 3 (don’t recommend CHC)
      • > 15 cigarettes = category 4 (don’t recommend CHC)
43
Q

Special Considerations with Combined Hormonal Contraceptives:

Hypertension

A

o Increases BP 6 – 8 mmHg

o Monitor BP – check before and after starting

o If BP goes up, stop CHC and it will go down (takes 3 – 6 months)

o Contraindicated in > 160/100 mmHg (category 4)

44
Q

Special Considerations with Combined Hormonal Contraceptives:

Hyperlipidemia

A
  • Controlled – may give
    • Pick a CHC that has low androgenic activity
  • High – may not recommend
  • Estrogen increases triglycerides even more
    • Puts patient at risk for pancreatitis
45
Q

Special Considerations with Combined Hormonal Contraceptives:

Diabetes

A
  • Pick a progestin with low androgenic activity
  • Diabetes for 20 years or complications from diabetes – high risk of having microvascular complications
    • Do not recommend
46
Q

Special Considerations with Combined Hormonal Contraceptives:

Migraines

A

o Higher risk of stroke in women who have migraines with aura than in those who have migraine without aura (blurred vision, halos, unusual smells)

o Adding estrogen can add complications – do not recommend

o Over 35 + migraines with aura = category 4 (don’t recommend)

o Over 35 + migraines without aura = category 2

o Develop migraine after starting CHC à discontinue use

47
Q

Special Considerations with Combined Hormonal Contraceptives:

Breast cancer

A

o No link between breast cancer and CHC in women who take lower dose CHC

o Localized, non-metastatic breast cancer can be seen in women who take high-dose CHC

o Do not recommend for a woman who has had breast cancer (category 3 or 4)

48
Q

Special Considerations with Combined Hormonal Contraceptives:

Thromboembolism

A

o Estrogen increases hepatic production of Factors VII, X, and fibrinogen

o Risk increased in women with underlying hypercoagulable states, obesity, pregnancy, surgery, air travel, certain malignancies, age, estrogen dose

o Estrogen increases the risk of thrombosis (less than in pregnancy)

o Some progestins also increase the risk of thrombosis (3rd generations but risk is still lower than pregnancy clots)

49
Q

Special Considerations with Combined Hormonal Contraceptives:

Obesity

A

o Higher risk of contraceptive failure – efficacy decreases

o Higher risk of venous thromboembolism (VTE)

50
Q

Special Considerations with Combined Hormonal Contraceptives:

Postpartum/Lactating

A

o Hypercoagulable

o Avoid in the first 6 weeks – category 4

o Do not give in breastfeeding women – decreases milk supply

o Give mini pills (progestin only pills)

51
Q

Non-Oral Dosage Forms of Combined Hormonal Contraceptives

A

Transdermal contraception

Vaginal ring

52
Q

Transdermal contraceptive

A
  • Xulane patch
  • 20 mcg EE + 150 mcg norelgestromin released daily
  • Due to no first-pass metabolism, women are exposed to approximately 60% more estrogen than from a COC containing 35 mcg of EE
    • Exposed to more estrogen – does this increase the risk of DVT? Controversial studies
  • Apply to abdomen, buttocks, upper torso, or upper arm once weekly x 3 weeks, followed by 1 patch-free week
    • May skip the patch-free week, but may increase the risk of DVT
  • Use backup method if:
    • If the patch is not replaced after 9 days
  • If it comes off partially, they should take it off and apply a new patch
53
Q

Vaginal ring

A
  • NuvaRing
  • 15 mcg EE + 120 mcg etonogestrel released daily
  • Inserted by patient and left in place for 3 weeks, followed by 1 ring-free week
  • Use backup method if:
    • It gets expelled and is out for more than 3 hours
  • Women should not douche, but may use a topical therapy
54
Q

Progestin-only Pills (POP)

A
  • Also known as minipills
  • 28 active pills, no placebo – the same dose the whole time
  • Effectiveness – less than CHC
    • Some women still ovulate (40%)
  • Concerns
    • It increases cervical mucus (effects only last 24 hours) – taking this form of BC at the same time is very important
    • If they are > 3 hours late in taking their medication, they must use a backup form of birth control
  • Patient counseling
    • Timing (recommend taking at noon if they have sex during the night or morning usuall)
    • They may have irregular bleeding (they may or may not ovulate)
  • Return to fertility
    • Immediate (3 hour window)
55
Q

Progestin Injection

A

· 150 mg medroxyprogesterone actetate – IM

· 104 mg medroxyprogesterone acetate – SQ

56
Q

Progestin injection concerns

A
  • Black box warning: If used >2 years, significantly reduced bone mineral density of lumbar spine and femoral neck
    • However, most professionals believe it can still be used beyond 2 years
      • When it is stopped, bone mass increases (maybe not back to baseline)
      • No link to fractures and bone loss
    • Recommend women take Ca++
  • Amenorrhea (most after 1 year)
  • Weight gain
    • Average: 5lbs in 1st year, 16 lb at 5 years
    • Can counsel on diet and exercise
  • May increase glucose, increase LDL, decrease HDL (effects of high-dose progestin)
57
Q

Progestin injection counseling

A
  • Counseling
    • IM injection (deltoid or gluteus maximus) or SQ Injection (anterior thigh or abdominal wall)
    • Patient should return every 3 months
    • If they are more than 1 week late, they must take a pregnancy test
  • Return to fertility
    • Delayed – average is 10 months
58
Q

Progestin Implants

A
  • Implanon, Nexplanon (radiopaque)
  • Considered a LARC (long acting reversible contraception)
    • Good for 3 years:super effective (better than sterilization)
  • 68 mg etonogestrel released at 60 mcg/day initially and decreasing to 25-30 mcg/day by end of year 3
    • Inhibits ovulation, makes the endometrium very thin
  • Concerns
    • Insertion complications
    • Efficacy may be reduced in women weighing more than 130% of their ideal body weight
  • Patient counseling
    • Patients may have very unpredictable irregular bleeding that can persist
  • Return to fertility
    • Immediate
  • Cost ~$500 to $800
59
Q

Intrauterine Devices

A
  • LARCs
    • T380A Intrauterine Copper IUD
    • Levonorgestrel Intrauterine System
60
Q

T380A Intrauterine Copper IUD

A
  • Paragard – good for 10 years
  • Non-hormonal method of contraception
    • Mechanism of action
      • Copper ions inhibit sperm motility and acrosomal enzyme activation so that sperm rarely reach fallopian tube
      • Sterile inflammatory reaction in endometrium phagocytizes sperm
  • Concerns
    • Bleeding increases (only with this IUD)
      • Copper increases prostaglandins à increases bleeding
    • Patients with copper problems (Wilson’s disease)
    • Uterine perforation
  • Return to fertility
    • Immediate
61
Q

Levonorgestrel Intrauterine System

A
  • Liletta, Mirena, Skyla
  • Mirena 52 mg (5 years) releases 20 mcg/day of levonorgestrel initially (decreases to 50% by end)
    • Indicated for heavy menstrual bleeding
  • Skyla 13.5 mg (3 years) Releases 14 mcg/day of levonorgestrel initially and decreasing to 5 mcg/day
    • Lower dose, smaller size
    • Have a small uterus
  • Liletta 52mg (3 years) Releases 18.6 mcg/day of levonorgestrel initially and decreasing to 12.6 mcg/day
    • Similar to Mirena, but is only good for 3 years and is much cheaper (~$50 at some clinics)
  • Kyleena 19.5mg 5 years Releases 17.5 mcg/day of levonorgestrel initially and decreasing to 7.4 mcg/day
    • Similar to Mirena, newest one.
  • Concerns
    • Amenorrhea – 60% of women
    • Uterine perforation on insertion
  • Return to fertility
    • Immediate
62
Q

Warning signs for IUDs

A

o P = period being late OR pregnancy (must be removed right away)

o A = abdominal pain OR pain with intercourse (IUD may have moved or become lodged where it shouldn’t be)

o I = infection (avoid in women who have been exposed to several STDs)

o N = not feeling well (fever, chills – concerned with infection)

o S = string (the woman can check to make sure the strings are still there and are the same length – should check once a month)

63
Q

Women who have migraines with aura should not use which of the following forms of contraception?

A

· Contraceptive Patch (because it contains estrogen)

64
Q

Emergency Contraception (EC)

A
  • For Unplanned or inadequate protection
    • High-dose progestin
    • Yuzpe method
    • Copper IUD
    • Selective progesterone receptor modulator
65
Q

General patient counseling with high-dose progestin and Yuzpe method

A
  • The most common form of emergency contraception is high-dose progestin (Plan B)
  • Yuzpe method – use multiple CHC pills
  • Primary mechanism – inhibits ovulation by inhibiting the LH surge (may delay or push it back instead of inhibiting it – important counseling point)
  • Only good for one incidence of unprotected sex
  • Will alter their next menses – may be heavier, longer
  • If they don’t have menses w/in 3 weeks, they should take a pregnancy test – not 100% effective
66
Q

High-dose progestin: Emergency Contraception

A
  • PlanB One-step, next choice
    • Levonorgestrel 1.5 mg x 1 dose or 0.75 mg q12hr x 2 doses
      • May take both tablets at the same time – equally as effective, same SE profile
    • Most effective if taken within 72 hours after intercourse
      • The sooner the better – efficacy declines with time
      • Has been studied up to 120 hours – still works, but efficacy is decreased – may be better options for her
    • Effectiveness
      • 1.1% failure rate
        • 1000 acts results in 12 pregnancies
      • 89% average reduction of pregnancy
      • Decreases in obese women (more than Ella)
    • Side effects
      • Nausea (probably won’t need an anti-emetic)
    • OTC access
      • Available to anyone of any age – sold in the isle, not behind the counter
67
Q

Yuzpe method: Emergency Contraception

A
  • Combined estrogen and progestin oral contraceptives
    • Website Tells how many pills/packs of birth control to use
    • Always 2 doses (4 – 5 tablets per dose) 12 hours apart
  • Effectiveness
    • 2-3.2% failure rate
      • 1000 acts results in 25 pregnancies
    • 74% average reduction of pregnancy rate
  • Side effects
    • Nausea, vomiting (give an anti-emetic)
    • Give dose again if vomiting occurs within 1 hour of taking
68
Q

Copper IUD: Emergency Contraception

A

o The most effective emergency contraceptive available

o Approved for insertion up to 5 days after unprotected intercourse (7 days in Canada)

o Functions as a spermicide, creates a hostile environment in the uterus – may inhibit implantation)

o Good for 10 years after placement

69
Q

Selective progesterone receptor modulator: Emergency Contraception

A
  • Ulipristal 30 mg x 1 dose (Ella)
    • Effectiveness
      • Use up to 120 hours after unprotected sex (same efficacy for the whole time)
      • Pregnancy rate reported at 2%
      • Stable over 5 days
        • More efficacious at day 4 & 5 compared to Plan B
      • Not available OTC
    • Decreases in obese women, but not as much as levonorgestrel
    • Side effects
      • Headache, abdominal pain, nausea, dysmenorrheal, fatigue, dizziness
      • Must repeat dose if vomiting occurs within 3 hours of taking
    • MOA – prevents/delays ovulation by inhibiting development of the follicle
      • May also have an effect on the thickness of the endometrium (may inhibit implantation)
    • Counseling
      • May alter next menses – heavier, longer
      • If menses is delayed more than 1 week from the expected date, take a pregnancy test
      • Decreases the effectiveness of BC pills – she should use a backup method for the rest of the cycle

2016 Endocrine (19 decks)

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