GYN Flashcards
Hormonal
1-COC/OCP/Oral pill
2- POP/mini pills
3- Injectables
4- Implants
5- Emergency contraception
IUCD
Inert devices
Iucd
Barrier Methods
Condoms
Diaphragms
Cervical caps
Vaginal vault caps
Spermicides
Progestogen
First generation: Norethisterone acetate (NET) - Ethynodiol acetate - Lynestronol
2nd: Laevonorgestrol( LNG)
3rd : generation: gestogen - Destogestrel - Cyproterone acetate-Gestodene. (PCOS)
4th: Drospirenone ( less androgenic but increased risk of DVT)
Diane 35 (less androgenic preparations)
EE+ cyproterone acetate(3rd)
Use for hirsuitism and acne
Marvelon (less androgenic preparations)
EE+ Desogestral
Used for acne
Yasmin (less androgenic preparations)
EE+Drospirenone. (Aldosterone antagonist)
Used for PMS, ACNE
RISK: VTE
Being mild diuretic, it causes decreased bloating and fluid retention.
Biphasic pill
Reduce incidence of breakthrough bleeding and spotting
Triphasic pill
A-Change both Estrogen and Progestron
B- given for women with acne
C-
COC absolute CI
1)Stroke
2)Age >or =35 years and smoking >/= 15 cigarettes per day.
3) Diabetes complicated by nephropathy, retinopathy or vascular disease.
4) Estrogen dependent tumors like breast cancer.
5) Active liver disease( active hepatitis, adenoma/ hepatoma, cancer, severe cirrhosis).
6) Known thrombogenic mutations( Factor 5 Leiden/ Prothrombin mutations, Protein S and
Protein C and antithrombin deficiencies)
7)Raynaud’s with lupus anticoagulant.
8) SLE with antiphospholipid antibodies.
9) BMI >/ = 40 .
10) Major surgery with prolonged immobilisation.
COC absolute CI cont…
11) Pregnancy
12) Breast feeding and </= to 6weeks post partum
13) Current or past history of VTE
14) Vascular disease
15) Presence of multiple risk factors for CVD like older age, smoking
16) HT with systolic >/=160 or diastolic >/= 100 mm Hg
17) Complicated valvular heart disease( pulmonary HT, atrial fibrillation, h/o sub acute bacterial endocarditis)
18) Current or past history of IHD
19) Migraine with aura and focal neurological symptoms
COC relative CI
1) Adequately controlled HT
2) HT(systolic 140-159/ diastolic 90-99)
3) Migraine over 35 years
4) Current gall bladder disease
5) Mild cirrhosis
6) H/o COC related cholestasis
7) Smoker over age of 35 years(<15/day)
8) Use of medications interfering with COC metabolism
COC advantages
Decreased menorrhagia, dysmenorrhea and pre-menstrual syndrome
Periods become shorter, lighter and regular
Decreased iron deficiency anaemia
Decreased benign breast disease, PMS
Decreased incidence of functional ovarian cysts, sebaceous disorders (acne)
Decreased incidence of cancer of ovary,
endometrium and colon
COC side effect
COC precautions
Missed Pill
COC different use
diane 35
Delaying periods
POP ( mini pill)
POP INDICATION
Could be used in contraindications to estrogen content of COC
In DM, Migraine with aura, lactation, HT, history or current DVT/VTE IHD, stroke, biliary tract disease, Raynaud’s with lupus anticoagulant
POP CONTRAINDICATION
POP ADMINISTRATION
Pop side effects
1- irregular bleeding ( 40%)
2- Amenorrhea (20%)
3- Breast tenderness
4- Headache
5- Risk of of getting follicular ovarian cysts
POP: Missed Pills