Steroid Contraception

Question 1

What are the two types of classification of oral contraceptives?

Answer 1

Combination OC

Progestin-only pill

Question 2

What is the mechanism of action of combination OC?

Answer 2

INHIBITION OF OVULATION
Alteration of cervical mucus
Alteration of the endometrium

Question 3

What is the theoretical effectiveness of combination OCs?

Answer 3

99%

Question 4

What is the composition of combination OCs?

Answer 4

ETHINYL ESTRADIOL

Progestin (derivatives of testosterone and progesterone)

Question 5

Combination OCs original progestins:

Answer 5

Norethindrone
Norethindrone acetate
Norgestrel

Question 6

Combination OCs original progestins:

Answer 6

Desogestrel
Gestodene
Norgestimate
DROSPIRENONE (possible risk of thrombosis)

Question 7

What is an example of a present day Drospirenone?

Answer 7

Yaz, Yazmine

Question 8

Combination OCs estrogen content:

Answer 8

Intermediate strength- 50 ug of ethinyl estradiol

Low dose- 20-35 micrograms

Question 9

What are the classifications of low dose combination pills?

Answer 9

Fixed dose pills
Triphasic pills (vary the dose of estrogen, progestin, or both)

Question 10

What are the common side effects of combination OCs?

Answer 10

N/V
Fluid retention
Breast tenderness
Mood changes
Breakthrough bleeding
Chloasma (melasma)

Question 11

What is the risk assessment of oral contraceptives?

Answer 11

absolute risk- of greatest importance

relative risk - receives greatest publicity

Question 12

Serious complications of oral contraceptives with relative risk of each:

Answer 12

SVT - 2
DVT - 4
Thrombotic CVA - 3
Hemorrhagic CVA - 2

The absolute risk is very low and less than the risk associated with pregnancy

Question 13

What are serious complications of OCs?

Answer 13

MI
Hepatic toxicity
Cholelithiasis
Pancreatitis
Hyperlipidemia
HTN
Postpill amenorrhea
Depression

Question 14

What are absolute contradictions to combination pills?

Answer 14

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

Question 15

What are the relative contradiction to combination pills?

Answer 15

diabetes with out vascular disease
vascular headaches
mild HTN
SS or SC disease
Uterine leiomyoma
Age > 35
Smoking
Seizure disorder
Imminent elective surgery

Question 16

What are the medical benefits of combination pills?

Answer 16

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

Question 17

What doe the Contraceptive Patch contain?

Answer 17

6 mg norelgestromin
.75 mg ethinyl estradiol

Daily dose (150 micrograms norelgestromin, 20 micrograms ethinyl estradiol)

Question 18

Conraceptive patch vs OC

Answer 18

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

Question 19

Contraceptive ring (NuvaRing) composition

Answer 19

ethinyl estradiol

etonogestrel

Question 20

What is the duration of effect of the contraceptive ring?

Answer 20

3 weeks, one week with no ring, insert a new ring one week later

Question 21

What is a type of emergency post-coital contraception?

Answer 21

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)

Question 22

How long do you have to take Plan B?

Answer 22

Administer within 72 hr of unprotected coitus (may be effective up to 120 hr)

Question 23

What is the effectiveness of Plan B?

Answer 23

75%

Question 24

What is Plan B’s MOA?

Answer 24

undetermined

Question 25

What is the effectiveness of a Copper IUD?

Answer 25

99%

Question 26

What is the compostition of Progestin-only pills?

Answer 26

35 micrograms of norethindrone or .75 mg of norgestrel

Question 27

What is the mechanism of the progestin-only pill?

Answer 27

alteration of cervical mucus and endometrium

Question 28

Who is the progestin-only pill usually prescribed to?

Answer 28

lactating women

Question 29

What are the complications of the progestin-only pill?

Answer 29

Pregnancy 2-8% or the time still

Breakthrough bleeding in 30-40% of patients

Question 30

What is depo-provera used for in contraception?

Answer 30

a highly effective method of contraception
difficult compliance with daily pills
contraindications too, or poor tolerance of, combination pills

Question 31

What is the mechanism of action of depo-provera?

Answer 31

inhibits ovulation and alters endometrium

Question 32

What dose of depo-provera is prescribed?

Answer 32

150mg IM q 3 months

Question 33

What is the efficacy of DP?

Answer 33

99-100%

Question 34

What are the adverse effects of DP?

Answer 34

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

Question 35

Depo-provera use in the puerperium:

Answer 35

May be administered immediately to women who bottle feed

manufacturers suggest waiting 6 weeks to administer to women who breast feed

Question 36

What is EXPLANON?

Answer 36

A contraceptive implant containing etonogestrel
a single implanted rod, hard to remove
duration of protection for 3 years