contraception

Question 1

What are the 3 types of contraception?

Answer 1

Combined oral contraceptives
Progesterone-only contraceptives
Emergency contraceptives

Question 2

Compare estrogen and progesterone

Answer 2

estrogen - high HDL, low LDL –> reduced risk of CHD
Progesterone - low HDL, high LDL –> increased CHD/DVT risk

when progesterone and estrogen mixed together –> DVT risk + antiandronergic effect (higher generation)

Question 3

MOA, AE, contraindications for COC

Answer 3

MOA - Combination of estrogen and progesterone –> prevents ovulation, thickens cervical mucus, prevents endothelial proliferation

AE - nausea, vomiting, breast enlargement, fluid retention, DVT, breakthrough bleeding

Contraindications:
- CYP inducers e.g. antiepileptics, phenytoin
- breast cancer
- DVT history
- less than 6 weeks PP
- breast feeding
- HTN
- diabetes
- smoking

Question 4

COC RPP

Answer 4

• small, moderate and high dose - high dose only used for pt using anti-epileptics
• 21 active / 7 inactive –> withdrawl bleeding 2-3 days after last active pill
• less than 24 hr window if active pill missed
• monophasic / multiphasic
• tricycling - no bleeding
• if vomiting or diarrhoea, use condoms (altered absorption)
• if missed in beginning or end of cycle, emergency contraception will be needed

Question 5

Progesterone-only contraceptives - MOA, examples, use, RPP and AE

Answer 5

MOA - thickens cervical mucus, prevents endothelial proliferation
Use - used in COC contraindication (breast-feeding, pregnancy, breast cancer)
AE - weight gain, depression, menstrual irregularities
E.g. levonorgestrel (3 hour window, no inactive), drospiredone (24hr window, 4 inactive)
- begin on first day of cycle or 21 days post-partum

Question 6

Emergency contraception

Answer 6

Levonorgesterel - up to 4 days post
Ulipristol - up to 5 days post
- the earlier the better
- over the counter

copper IUD
- expensive and more effort