Contraception Flashcards by Kat Che

Estrogen and progesterone ____ feedback to anterior pituitary to prevent___

negative

ovulation

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What is the difference between endogenous estrogen vs what is in the pill

exogenous is more potent

the pill has ethinyl estradiol

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What are qualities of the 4 different generations of progesterone

1st: potent, well tolerated
2nd: longer half life, more androgenic
3rd: work on minerocorticoids too, fewer androgenic side effects. risk of thromboembolism
4th: increased thromboembolism, antimineralcorticoid and antiandrogen

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What are 1st gen progesterone? 2nd? 3rd? 4th?

1st: morethinddrone, ethylnodiol
2nd: levonorgestrel, norgestrel
3rd: norgestimate, desogestrel
4th: drospirenone, dienogest, segesterone

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estrogen suppresses ___ which causes what

FSH-> no follicles grow, no LH surge so no ovulation

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Progesterone acts at the ______

cervical mucus and thickens it. less lush endometrium, impaired tubal motility

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Endogenous hormones have ___ oral absorption

poor

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extensive first pass metabolism with estrogen at _____

CYP3A4

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Proposed male contraception is proposed to work to reduce ___

GnRH. need to have androgen as well so body doesn’t rev up (?)

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What are the risks of OCP

VTE! (varies by estrogen, age, BMI, smoking)

Stroke: be careful in individuals with HTN, DM, obesity, migraines with aura, cirrhosis

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What are the risk profiles with using OCP and cancer

ovarian and endometrial: decreased risk
cervical: maybe increased
breast cancer: mixed

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What are side effects of cOCPs

mood changes, libido changes, nausea, breast tender, HA, breakthrough bleeding, amenorrhea

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The patch gives you (increased/decreased) systemic exposure to estrogen becasue____

increased, bypass the first pass metabolism

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What do you do if the patch falls off

if it falls off >24 hours, or if interval lasts longer than 9 days, use backup method

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The patch is not indicated for _____

individuals BMI>30, >200lb

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What are the differences between NuvaRing vs Annovera. Similarities?

Nuva-> every 4 weeks insert new ring
Annovera: you can insert same ring after removal for 1 week
keep in for 3 weeks, remove for 1

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There is ____ variability in level of hormones for the ring and patch

less. the level of hormone is sustained more.

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What are some of the risks for the patch and ring

VTE, CV, cancer risk (maybe)

overall same as OCPs

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For the patch there is a relative contraindication for people will

morbid obesity. There is not the same contraindication with the ring

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What is lactation amenorrhea?

nursing-> hypothalamus-> decreased GnRH pulse frequency-> hormones disrupted-> no egg, no pregnancy

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Estrogen inhibits ___ more than progesterone

lactation

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Norethindrone has a _____ half life, so if you miss a dose >/= 3 hrs, you need to ___

short

backup method for 48 hours

Drospirenone is the new progesterone containing tablet and could cause an increased in ___ and if you miss a dose >24 hours, use______

potassium

use backup method for 7 days

What is the risks for drospirenone?

higher increase for VTEs, be VERY careful in individuals who were just pregnant

POPs MOA?

thicken cerical mucus, endometrial decidualization and atrophy, impaired tubal motility

With progesterone only pills, they may not______

prevent ovulation. Not predicable for cycle control

POPs side effects

irregular bleeding, increased acne, no impact on weight gain

POP contraindications

Pregnancy, breast cancer, uterine bleeding, liver disease

Women who have undergone________ or taking ______ are not advised to use POPs

malabsoptive bariatric surgeries, certain anticonvulsants

Even with perfect use, POPs have a __% failure rate

What molecule is in depo

medroxyprogesterone

There are two versions of depo. There are:

IM and SQ

How does depo work for 3 months?

acetate group added that keeps the molecule there for longer

Depo should be administered by the ___ day of menses

5th

Depo inhibits ____, produces shallow endometrium, and thickens ___

FSH and LH | cervical mucus

There is erratic absorption of depo when given ___

IM. The SC formula is less eratic

Return to ovulation after depo could take up to

10 months

Are the worries with bone mineral density with depo

Not really. physiologically yes but not seen clinically

Depo is ok in women with history of __

VTE

What are common side effects of depo

irregular periods, no periods, bone density loss, weight gain, delayed return to fertility, injection reactions

Depo contraindications

pregnancy, breast cancer, uterine bleeding, liver disease, long term risk of corticosteroid therapy

nexplanon is a single rod implant of _____ and it releases 60mcg/day for ___ years

etonogestrel | 3 years

Implant Nexplanon during days ___ of the cycle

1-5

MOA of Nexplanon

inhibits gonadotropins (FSH, estrogen), produce shallow and atrophic endometrium and produces vertical mucus

Nexplanon return to ovulation within ____ after removal

7-14 days

What are the 4 commonly used progestin-based IUDs

Mirena (7 years) Liletta (6 years) Kyleena (5 years) Skyla (3 years)

MOA of IUDs

low grade intrauterine inflammation, increased prostaglandin formation primarily spermicidal, interfere with implantation endometrial suppression

Nexplanon risk and side effects

no VTE, CV risk, no impact on breast cancer | irregular bleeding, increased acne, HA, local inflammation or bruising on placement

Hormonal IUD risks and side effects?

no VTE, CV, breast cancer risk. perforation with placement/expulsion. ectopic pregnancy irregular bleeding, cramping

Hormonal IUD contraindications that are not the standard contraindications

severely distorted uterine cavity | active PID

Copper IUD can be used as _____

emergency contraception

What is the MOA of copper IUD

????? (intrauterine inflammation-> increased prostaglandin formation -> spermicidal/impaired sperm transport. Also interferes with implantation)

Risks of copper IUD? Side effects?

expulsion/perforation, ectopic pregnancy | continued cyclic bleeding (heavier), cycles may be longer and crampier

What is a contraindication for copper IUD that is different from the usual contraceptives?

Wilson's disease/copper allergy (Relative: heavy periods, anticoagulation use, coagulopathy) And strike liver disease from the typical list