Contraception: Treatment

Question 1

Contraceptive Names

Answer 1

“LO” = </= 35 mcg of estrogen
-less estrogenic side effects (ex, Loestrin)

“FE” = iron supplement included (ex, Microgestin Fe 1/20)

“24” = shorter placebo time (24 active, 4 placebo = 28 d cycle, like Minastrin 24 Fe)

“PRO” = progestin included (ex, Depo-Provera)

Question 2

Monophasic Formulations

Answer 2

-Junel Fe 1/20
-Microgestin Fe 1/20,
-Sprintec 28
-Loestrin 1/20
-Yasmin 28
-Yaz
-Lo Loestrin Fe

Provides the same dose of progestin and estrogen throughout the active pill days
-Ex: Junel 1/20 contains 1 mg norethindrone and 20 mcg EE

Question 3

Biphasic/Triphasic Formulations

Answer 3

-Tri-Sprintec
-Nortrel 7/7/7
-Velivet
-Ortho Tri-Cyclen Lo
-Trivora-28

Question 4

Quadriphasic Formulations

Answer 4

-Natazia

Question 5

Extended Cycle Formulations

Answer 5

-Jolessa
-Seasonique
-Camrese (+lo)
-Amethia

*period every 3 months

Question 6

Continuous Formulations

Answer 6

-Amethyst

*no period occurs, no placebo pills

Question 7

Drospirenone Containing Formulations

Answer 7

-Yasmin 28
-Yaz
-Loryna
-Ocella,
-Nextstellis
-Nikki
-Safyral
-Syeda
-Beyaz

CI in renal/liver disease

Question 8

Patches

Answer 8

-Xulane
-Zafemy
-Twirla

*Weeks 1-3: apply once weekly; week 4: off

Question 9

Rings

Answer 9

-NuvaRing
-EluRing
-Haloette
-Annovera

*Insert monthly: leave in x 3 weeks; remove x 1 week
*Annovera: reusable vaginal ring: wash and store when it is removed, then reinsert; used for 1 year

Question 10

Progestin-Only Pills (Mini-Pill/POP)

Answer 10

fixed dose of norethindrone (no placebo days):
-Errin
-Nora-BE
-Camila

-Incassia
-Slynd (drospirenone only)
-Opill (approved for use without RX)

Question 11

Injection

Answer 11

Depo-Provera

contains DMPA

Inject 150 mg IM or 104 mg SC every 3 months

Question 12

Estrogen Side Effects

Answer 12

LOOK BAD
-Nausea
-Breast tenderness
-Bloating, weight gain
-Increased BP
-Melasma (dark skin patches)

Serious, rare
-Thrombosis (MI, stroke, DVT, PE)
Sx (ACHES)
-Abdominal pain (severe)
-Chest pain
-Headaches
-Eye problems
-Swelling/leg pain

Question 13

Progestin Side Effects

Answer 13

FEEL BAD
-Breast tenderness
-Headache
-Fatigue
-Depression

Question 14

Drospirenone: CI

Answer 14

-Clotting risk (higher)
-Kidney/liver/adrenal gland disease (inc K) or high K at baseline
-Injection: loss in BMD

Question 15

Breakthrough Bleeding

Answer 15

More with continuous contraception

Resolves in 2-3 months

If persists:
-Currently on <30 mcg estrogen daily: increase estrogen dose
-Currently on 30+ mcg estrogen daily: try a different progestin

Question 16

BBW for All CHC (pills, ring, patch)

Answer 16

CI in > 35 years who smoke
-risk of CV events

Question 17

BBW for Estrogen/Progestin Patch

Answer 17

CI in BMI 30+
-due to increased risk of TE events with Xulane/Zafemy
-lower efficacy with Twirla

Question 18

BBW for Depo-Provera

Answer 18

-Loss of BMD with long-term use

Question 19

DO NOT use Estrogen with these conditions

Answer 19

-DVT/PE
-Stroke
-CAD
-Thrombosis of heart valves
-Hypercoagulopathies
-Breast, ovarian, liver, endometrial cancer
-Uncontrolled HTN (>160/100)
-Severe headaches or migraines with aura
-Diabetes with vascular disease
-Uterine bleeding unexplained

Question 20

DDIs with Hormonal Contraceptives

Answer 20

-Rifampin (needs back up contraception for 6 weeks after rifampin dc)
-Rifabutin
-Anticonvulsants (carb, oxcarb, pheny, primidone, topiramate)
-SJW
-Tobacco (smoking)
-Ritonavir
-Mycophenolate
-Mounjaro (for COCs: use back up for 4 weeks after initiation/increases)

Question 21

Starting Birth Control Pills

Answer 21

COC
-Start same day: “quick start”
-Sunday start: start Sun after onset of menstruation (if wants menstruation during the week and complete before weekend)
-First day start: start first day of menses (bc started within 5d of menses = no back up needed, protection is immediate)

Progestin-only
-Start any time
*use back up for 48 hours, unless within 5 days of start of menses
(protection begins after two days)

Question 22

COC: Late or Missed Pills

Answer 22

1 late/missed pill (<48hr since last dose)
-Take pill as soon as remembered
-Take next dose on schedule (even if that means 2 pills in 1 day)
-No back up needed
-EC not usually needed (consider if missed doses happened earlier in same cycle or in week 3 of previous cycle)

2 missed pills (48+ hr since last dose)
-Take most recent missed pill as soon as remembered
-Take next dose on schedule (even if that means 2 pills in 1 day)
-If during Week 3: omit hormone-free week and start next pack of pills right after finishing current pack
-Back up needed for 7 days
-EC: consider if Week 1 and unprotected sex in last 5 days, also consider in Weeks 2-3

Question 23

POP: Late or Missed Pills

Answer 23

If > 3 hours past scheduled time
-Take asap and take next dose on schedule
-Back up needed for 48 hours
-Consider EC if unprotected sex in last 5 days

Question 24

Nexplanon

Answer 24

-plastic rod placed subdermally in the arm
-releases the progestin etonogestrel for 3 years

Question 25

Paragard

Answer 25

-used for EC or regular BC -up to 10 years -heavier bleeding/cramping NONHORMONAL

Question 26

IUDs

Answer 26

Mirena, Skyla, Kyleena, Liletta -contain progestin levonorgestrel -lighter bleeding/cramping Mirena, Liletta -FDA-app for heavy bleeding IUDs can be left in place for 3-8 years Half of women become amenorrheic after 2 years of use