WOMEN Flashcards
how do progestins help in coc
blocks LH surge + estrogen
suppresses FSH release
prevents ovulation
factors to choose high/low dose for estrogen
1. adolescence/age more than 35
2. underweight <50kg
3. peri-menopausal
4. fewer side effects
5. obesity or > 70.5kg
6. early to mid cycle breakthrough
7. non adherence
1-4 low
5-7 high
type of agents to choose for pts w oily skin/acne
drosperinone/cyproterone(diane)
risk of cyproterone? what kind of pts should take
thromboembolism. only if patient has both acne issues and needs contraception
monophasic vs multiphasic coc
monophasic: take everyday, less complicated dosing
multiphasic: tend to have lower progestin (less side effects such as acne, hair growth)
if you start coc on first day of period, need contraceptive?
no
if you start coc on first sunday of cycle, need contraceptive?
7 days
if you start coc now, need contraceptive?
7 days and potentially till next cycle begins
late bleeding should have more estrogen or progestin
progestin
in which groups to avoid /contraindicated in coc
- age > 40
- family history of breast cancer (only can use POP)
- breast cancer currently STOP
- migraine with aura CI
which factors do estrogen increase production of in coag cascade
7,10, fibrinogen
what is the contraindication for smoking
smoke more than 15 sticks a day and more than 35 years old
what do estrogens do in COC
suppress FSH release
stabilised endometrial lining
why are the progestin only pills more troublesome
Need to be taken about the same time everyday
Late dose by >3h: back up 2d
if patient experiences nausea, vomiting, bloating, what component of COC should you reduce
estrogen
what is the 1 contraindication for progesterone only pill
current / hx of breast cancer
how should you start POP
if within 5 days of start of menstrual cycle, no backup needed
otherwise +2d backup
side effects of progestin injections (list 2)
how long can one be on progestin injections
- weight gain
- short term bone loss
max 2 years
what is the main difference between levonorgestrol and copper IUD
which can be used for emergency contraception?
levonorgestrol: reduces flow
copper: increases flow
copper
how long can a copper vs levonorgestrel IUD be put in place before replacing?
copper: 10 years
levo: 5 years
warning signs rendering immediate discontinuation (ACHES)
abdominal pain
chest pain
headaches
eye problems
severe leg pain
who should avoid transdermal coc patches
women more than 90kg
what risk is greater in transdermal patches than coc pills
VTE
non pharm for mild vasomotor symptoms (list 5)
- lower room temp
- decrease intake of caffeine, spicy food
- smoking cessation
- exercise
- healthy eating
