Contraception Flashcards
(33 cards)
What are the most common contraindications to prescribing OCP?
- HTN
- smoker
- age
- hx of migraines with aura
Use of the USMLE Medical Eligibility Criteria for Contraceptive Use
Helps determine which birth control is right for individual pt factors; Counsel pt and make decision together.
Grade 1: no restrictions
Grade 2: benefits generally outweigh risks
Grade 3: risks usually outweigh benefits
Grade 4: risk too high, do not use
Pros of OCPs?
- regulate menses
- decrease heavy bleeding/cramps
- decrease ovarian cyst formation
- decrease acne
Cons of OCPs?
- sore breasts
- nausea
- spotting
- decreased sex drive
- slight increased risk of DVT (but risk is higher with pregnancy)
Efficacy of OCPs?
perfect use = 99.7% effective
typical use = 93% effective
Two types of progestin-only pills and their pros/cons
- Micronor (norethindrone): 28 active pills; higher likelihood of irregular bleeding
- Slynd (drospirenone): 24 active pills, 4 inert pills; lesser likelihood of irregular bleeding
- compared to combo pills, POPs still have higher risk of irregular bleeding.
- ovulation is not consistently suppressed and about half still ovulate
How do progestin-only pills work?
thicken cervical mucus, inhibit sperm migration, suppress ovulation
Combined pill MOAs? (5)
- suppress ovulation by inhibiting GnRH and LH/FSH, preventing folliculogenesis
- stabilize endometrium production to maintain a regular withdrawal bleeding pattern (cycle control)
- thickens cervical mucus
- impairs normal tubal motility and peristalsis
- endometrial decidualization and eventual atrophy
Combined pill dosing
- ethinyl estradiol dose is most commonly 20mcg/day or 35mcg/day
- 8 different progestins available
monophasic vs biphasic vs triphasic vs continuous combined pills
- monophasic: same does x3wks, then 1 placebo wk
- biphasic: lower ratio of E/P dudring first 2wks, then higher dose during last 2 wks of cycle
- triphasic: dose changes q 7days
- continuous: same dose daily (for 91 day cycle or 365 days)
No pill is superior to another; all equally efficacious
what is the biggest disadvantage of continuous pills?
unpredictable bleeding or spotting are more frequent due to atrophic, thin endometrium (thus, some extended cycle regimens have 7 days breaks q 84days to decrease breakthrough bleeding)
examples of continous/extended pills available
- Seasonique/Lo Seasonique (91 day cycle)
- Amethyst/Lybrel (365 day use)
- technically could use any OCP continuously and skip placebos
How do you pick the right pill for your pt?
- consider pt’s goals and side effects
- consider pt’s PMHx
- discuss bleeding pattern variation of the different pill types (more likely to have breathru bleed w/ lower dose hormones and continuous pills)
- dosing will change if pt misses a pill, dependent on type of pill
The Patch (aka OrthoEvra) - dosing and usage info
150mcg norelgestromin/20mcg ethinyl estradiol qd
- changed weekly x3 weeks, and off for 1wk. use in different areas to decrease skin irritation.
The Ring - Nuva Ring (dose and usage)
0.120mg etonogestrel/0.015mg ethinyl estradiol qd.
lasts up to 5wks (typical use is place for 3wks and remove for 1wk)
The Ring - Annovera (dose and usage)
0.15mg segesterone acetate/0.013mg ethinyl estradiol qd.
lasts for 1yr (place for 3 wks and remove for 1wk)
Depo Provera shot
-injectable depot medroxyprogesterone acetate (progestin-only)
- two forms - subQ injection or IM injection
- given q 13wks (3 months)
- self administration has been effective with higher rates of continuation
Pros of depo provera?
- less blood loss/anemia, fewer corpus luteum cysts
- decreases cramps, pain, ovulation pain
- improvement in endometriosis
- decreased seizures frequency
Cons of depo provera?
- progressive weight gain possible
- irregular bleeding
- frequency of return visits
- slow return to baseline fertility (10 months)
- may cause loss of bone mineral density
Nexplanon implant (hormone, duration of use, efficacy)
- etonogestrel (progestin only) implant placed in inner upper arm.
- 3 yrs of use
- 99.95% effective; has lower failure rate than a tubal ligation
MOA of Nexplanon implant?
works by changing cervical mucus and decreasing tubal motility and inhibits gonadotropin secretion
most common side effect of nexplanon implant?
- changes in bleeding pattern/spotting; also most common reason for discontinuation
-(there have been some cases of the device migrating to lungs)
Ernst Grafenburg tested IUDs made of _______ because he believed it ___________. What was the problem with the design?
tested silk/silver intrauterine rings;
believed it prevented blastocyst formation.
Problem was difficulty removing the ring without a string attached.
in 1969, Howard Tatum worked to do what with IUDs?
- improve side effects and decrease size of IUD
- minimize expulsion rates
- developed the ‘T’ shape
- added copper wire
