Week 9 Hormone Contraceptive Therapy Flashcards
Reasons for using hormonal contraceptives:
- Pregnancy prevention
- Menstrual cycle regulation
- Premenstrual symptoms
- Acne
Consideration factors when choosing a contraceptive method:
- Contraindications
- Risks/benefits
- Goal of contraception
- Personal preference/sexual partner preference
- Cost
Combined Hormonal Contraceptive Indications for Use:
FDA-APPROVED INDICATIONS
Prevent pregnancy
-Typical failure rate of 9%
-Return to fertility: average is 3 months
Reduce acne (Estrostep®, Ortho-Tri-Cyclen®, YAZ®, Beyaz®)
Post-menstrual dysphoric disorder (PMDD) (YAZ®, Beyaz®)
Heavy menstrual bleeding (Natazia®)
NON-FDA APPROVED USES
Decrease hirsutism
Reduce acne
Regulate menstrual cycle
Improve dysmenorrhea, menses-related headaches
Pain associated with endometriosis
Bleeding associated with uterine fibroids
Pre-menstrual syndrome
Reduce bleeding associated with menorrhagia
Formulations of combined hormonal contraceptives include:
- Combined oral contraceptives (COCs) Various combinations, brands, generics, etc.
- Chewable combined oral contraceptive Femcon® Fe, Generess™ Fe
- Transdermal contraceptive patch Ortho Evra ®
- Contraceptive vaginal ring NuvaRing®
*NOTE*: All contain various estrogens and progestins
Doses of Ethinyl Estradiol (EE): high, low, very-low
High dose: 50 mcg
Low dose: 30-35 mcg
Very-low dose: 20-25 mcg
Estrogen Mechanism of Action (MOA), metabolism and SE
MOA: Feed-back inhibition of hormones to the pituitary gland
FSH not secreted ->Follicles do not develop ->No ovulation ->LH not secreted ->Prevents ovulation
Metabolized via CYP 3A4 isoenzyme and undergoes first-pass metabolism; highly protein-bound, enters enterohepatic circulation
Side effects: water retention, mood changes, headache, nausea, vomiting, lack of withdrawal bleed, blood clots
Progestin MOA, metabolism and SE
MOA: thickens cervical mucus, inhibits the LH surge, causes atrophy of the endometrial lining
- Undergoes first-pass metabolism in the liver, some progestins are activated in the liver
- Side effects: mood changes, acne, weight gain, irregular bleeding *Drospirenone: hyperkalemia
Types of Progestins
COC Monophasic?
COC Biphasic?
COC Triphasic?
COC Quadriphasic?
Quadriphasic: twenty-eight–day schedule with four hormone doses over a cycle
EXTENDED USE COCs: ADVANTAGES/DISADVANTAGES
ABSOLUTE COC CONTRAINDICATIONS
ADVANTAGES/DISADVANTAGES TO PROGESTIN ONLY CONTRACEPTION
POTENTIAL SEVERE ADVERSE EFFECTS OF COCs
How does OBESITY impact birth control options?
PROGESTIN ONLY CONTRACEPTION: MOA, CONTRAINDICATIONS, ADVANTAGES, DISADVANTAGES
