Contraceptives/HRT/Testosterone Flashcards
Main groups of hormonal contraceptives (2 groups)
Estrogen-progestin contraceptives
Progestin-only contraceptive
Estrogen-progestin contraceptives - MOA
Estrogens: suppress FSH release, stabilize the endometrial lining, provide cycle control
Progestins: block the LH surge = no ovulation, thicken cervical mucus delay sperm transport, induce endometrial atrophy/inhibit endometrial proliferation
Estrogen-progestin contraceptives - indications
Abnormal bleeding (menorrhagia/ metrorrhagia/ amenorrhea) – assuming other causes have been excluded, Dysmenorrhea Endometriosis, PCOS Acne, PMS/PMDD
Estrogen-progestin contraceptives - cautions
breastfeeding - may decrease milk supply, HLD, DM with complications, prolonged immobility/long leg cast (clot), migraine without aura over the age of 35
Estrogen-progestin contraceptives - contraindications
Thromboembolic disease, CAD, Active liver disease, Breast cancer, Smoker over 35 yo, Migraine with aura, Uncontrolled HTN, Undiagnosed vaginal bleeding
Estrogen adverse effects (Excess and deficiency)
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High doses of estrogen-progestin contraceptives increases the risk of
Breast cancer, stroke, MI, DVT
Estrogen/progestin contraceptive counseling
How/when to start
Whether or not a back up method is needed
Common side effects and how to avoid Dangerous side effects
No protection against STIs
Follow-up visit
For pills: strategies to remember to take and what to do if a dose is missed
ACHES
Continuous dosing of estrogen-progestin ocps is possible with which formulation?
monophasic
Transdermal contraceptive patch - adverse effects
Greater incidence of venous throboembolism (black box warning_
-60% more estrogen exposure than OC
Not indicated for weight > 198lbs
Progestin adverse effects (excess and deficiency)
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Androgenic adverse effects
Acne
Weight gain
Hirsutism
Fatigue
Depression
Progestin only contraceptive options
Minipill
Nexplanon implant
DMPA injection - Depo-Provera
IUD - Mirena, Skyla, Lilletta
Depo Provera risks/side effects
Bleeding irregularities
Delayed return of fertility (up to 6-18 months)
-don’t use more than 2 yrs
Weight gain
Decrease in bone mineral density
Progestin-only contraceptives - MOA
Inhibition of ovulation- suppression of midcycle peaks of LH & FSH
Thickened, decreased cervical mucous
Thinner, atrophic endometrium