Contraception Medications Flashcards
how does estrogen in CHC inhibit contracenption
how does progesterone
Estrogen
- supresses FSH release from the pituitary
- body thinks there is enough, so it doesnt release FSH, thus no maturation of a follicle
- inhibition of LH = no ovulation
- no maturation of the follicule: no LH surge
Progesterone
- suppressed LH release
- consistent amout of progesterone stops LH from spiking
- inhibtis LH surger: prevents ovulation
- thickens cervical mucus
- induces endometrial atrophy
- slows tubal motility and delays sperm transport
Estrogen Types in Contraceptions
- which one has high, medium and low
Estrogen: types
Ethinyl Estradiol (EE)
- high dose (50mcg) (rarely used since high SE profile)
- low dose (25-35 mcg)
- very low dose (20 mcg)
Mestranol
- 50% less potenet thatn EE
- converted to EE by the liver
Estradiol valerate (E2V)
- more potent: 2mg = 20 of EE
Progestins in Contraceptives
androgen activity
Progestins
- mutliple types depending on generation
- differ by prgestin activity, androgen effects, etc.
Androgen Activity by type
Low Activity
- norgestimate
- desogesterol
- etonorgesterl
- norethindrone
Medium
- ethynodiol diacetate
High
- norgesterel
- levonorgesterol -.15
NO activity: medroxyprogesterone (injectable)
ANTI-androgen: drosprenone (like spironolactone: watch potassium) AND Dienogest
Side Effects of
Estrogen
too much or too little?
Estrogens : SE
if these symptoms are seen; think you have too high of a rx. of estrogen, decreased dose
- Nausea/vomiting
- bloating/edema
- HTN
- HA
- breast tenderness
- decreased libido
- weight gain: cyclical! with menses
- heavy mentrual flow
too little estrogen with the following effects
- early cyclical bleeding (days 1-9)
- amenorrhea
- vaginal dryness
Side Effects of
Progestins
- too much or too little
Progestins: Side Effect
Too much if
- weight gain
- increased appetit
- fatigue
- depression
- vaginal yeast infections
too little
- LATE cycle bleeding (days 10-21)
- dysmenorrhea
- heavy flow
dont change amout until about 2-3 cycles in: need to adjut
androgenic side effects
Androgenics
- acne/oily skin
- weight gain
- hirsutism
- fatigeu
- depression
Types/Options of Contraception Methods
Combined Hormonal Contraceptives (CHC)
- oral CHC
- hormonal patch
- hormonal vaginal ring
Progestin-Only Contraceptives (POCs)
- oral (POPs)
- Implants (like nexplanone)
- IM injection
Intrauterine devices
- LNG IUD
- Copper IUD
with proper adhearnce and use, these (pathces, pills,etc.) can be extremely effective!! more thatn condoms, etc.
How is the righ Contraceptive Method determined for your pt
- Decide what is SAFE for the pt as an option: use the US MEC
- any speciif pt or drug conditions to consider
- pt. perfers for how they want their contraceptives
- pt. fertility plan
- methods most accessible to pt.
described the US MEC categories 1-4
US MEC Categories
1 = safe to use, no restrictions
2 = advnatages generally outweigh risks
3 = risks outweigh advantages
4 = unaccetable health risks (DO NOT USE)
The Considerations of the Table
- age > 40
- smoking status (20 cigs per pack)
- themboembolsim
- HTN
- migraine HA
- Breast Cancer
- DM
- obestiy
- postpartum
Thromboembolism risk and estrogen, progestin
Trhoboembolism
Estrogen
- stimulates the hepatic clotting factors production (up to 2-3x risk in those with CHC)
Progestins
- drospirenone, desogesterl both increased the throboembolism risk
CHC uses are at an increse risk fo clotting, but even more so IN
- obestiy
- smokers
- personal/fam. hx. of VTE
- prolonge immobilizaion
- HTN
Migraines and Contraceptive USe
Migraines = without aura = all good
migraines + aura: cannot used CHCs
- increased risk of ischemic stroke!!! avoid
Considerations for
breast cancer
DM
obestiy
postpartum
Breast cancer
- prognosis can worsen if exposed to hormones
DM
- wont impact insulin contorl, but be aware of the complicaitons that can result and otehr comorbid conditions
Obestiy
- concenrs for comined hormone patches & their effectiveness (weight cut off)
Postpartum
- consider length of time since they gave birth and if breast feeding
- CHC within 21 days of brith are CI for incresed risk of VTE
Drug Drug Interactions with Estrogen and Progesteins
most interations with the POPs and the CHCs
Antiretrovirals
Anticonvuslants (decreased the efficacy of teh contraceptive method) if using: must have at least 30mcg of the estrogen
Rifampin (the only true abx .to decreased Contraceptive efficacy)
progestin-only pills and estrogen have this effect: with these meds so need to be aware
Combiniation Oral contraceptives (COCs)
types: mono vs multiphascis
conventional extended v continuous
Combined: porgestins and estrogen
- ensure proper adhearence of the medications
Monophasic
- usually start pt. here
- same amount of estrogen/progestin in every pill
- followed with 7 days of placebo pills to allow menses
Multiphastic
- if you want to avoid the cyclical effects
- varibale amounts of either the progestin/estrogen for 21 days
- followed by 7 days of placebo for menses
Conventional
- pills that give you 21 days of hormones, followed by 7 days of placebo pills
- allows for monthly menses
Extended
- pilles that give you 84 days of hormones, then 7 days of placebo
- allows for menses 1x every 3 months
- can lead to possible amenorrhea: desired or not!
Continuous
- pills that give 21 days of homrones, then lower does hormones for days ; no placebos
- this can and most liekly will lead to amenhorrhea
How should oral contraceptive combination pills be inititated
Initiation Strategies
- first day of the bleed: start the pills
- on first sunday after then menstrual cycle started: start pills (common) “sunday start”
- “Quick Start”: take teh first pill on teh day it is Rx. get pregnancy test - first before this
if starting the pill more than 5 days after the first day of menstrual period; want to use back up protection for pregnancy for 7 days
