Hormone Contraception

Question 1

Menotropins

Answer 1

human menopausal gonadotropin, or hMG

Question 2

Follicle stimulating hormone (3)

Answer 2

Follitropin alfa (rFSH alfa), Follitropin beta (rFSH beta), Urofollitropin (uFSH)

Question 3

Leuteinizing hormone

Answer 3

Lutropin alfa

Question 4

Human choriogonadotropin hormone

Answer 4

Choriogonadotropin alfa (rhCG)

Question 5

Gonadotropin-releasing hormone analogs (6)

Answer 5

• Leuprolide
  * You have to grow up to ride loop-rollercoasters
• Goserelin, Histrelin, Nafarelin, Triptorelin, Gonadorelin (synthetic human GnRH)
  * Ellen was always very little

Question 6

Gonadotropin-releasing hormone antagonists (3)

Answer 6

Cetrorelix, Degarelix, Ganirelix

Question 7

Estrogens (4)

Answer 7

Conjugated estrogens (Premarin), Estradiol valerate, Ethinyl estradiol, Mestranol

Question 8

Progestins (6)

Answer 8

Desogestrel/Etonogestrel, Drospinenone, Medroxyprogesterone, Norethindrone, Norgestimate, Norgestrel

Question 9

Estrogen and Progesterone inhibitors and antagonists (4 classes)

Answer 9

• Mifepristone
• Selective estrogen receptor modulators (Raloxifene, Tamoxifen Toremifene)
• Aromatase inhibitors (Anastrazole, Exemestane, Letrozole)

Question 10

Which estrogen is commonly found in oral and implantable contraceptives?

Answer 10

Ethinyl estradiol

Question 11

Which has more variation in oral and implantable contraceptives, estrogen or progesterone?

Answer 11

Progesterone

Question 12

Why is Ethinyl estradiol so common?

Answer 12

Very potent; resistant to hepatic metabolism –> can give very low dose

Question 13

Estrogen adverse effects

Answer 13

Nausea, breast tenderness, hyperpigmentation, increased migraines, cholestasis, gallbladder disease, HTN, Breast/Endometrial cancer(?)

Question 14

Estrogen contraindications

Answer 14

Estrogen-dependent neoplasm, genital bleeding, liver disease, blood disorder, heavy smoker, CV disease, migraine with aura

Question 15

Progesterone adverse effects

Answer 15

Breakthrough bleeding, Breast cancer, androgenic effects (weight gain, acne, hirsutism, low HDL)

Question 16

When to give progestin-only contraceptive

Answer 16

Migraines, 35yo+ and smoker or obese, blood disorder, CV disease, HTN, SLE, high cholesterol

Question 17

Which progesterone is not androgenic?

Answer 17

Desogestrel, Norgestimate
Dropsirenone

Dees No Drops (your voice)

Question 18

Acne treatment

Answer 18

Desogestrel, Norgestimate, Dropsirenone

Question 19

Combination oral contraceptives MOA

Answer 19

Prevent ovulation (feedback inhibition)

• suppressed GnRH/LH/FSH
• absent LH surge
• low endogenous steroids

Question 20

Progestin-only pills

Answer 20

Highly effective - thick cervical mucus, impaired implantation; only blocks 60% ovulations

Question 21

Benefits of Combination oral contraceptives

Answer 21

Estrogen - osteoporosis prevention, reduced cholesterol
Combination - reduce ovarian & colon cancer, ectopic pregnancy, breast disease, dysfunctional uterine bleeding/dysmenorrhea; improve PMS, hirsutism, acne

Question 22

Benefit of LARC

Answer 22

e. g. Mirena (Levonorgestrel)

- Rapid return to fertility after removal

Question 23

Implantable contraceptive

Answer 23

Etonogestrel (progestin)

Question 24

Depo-provera

Answer 24

Medroxyprogesterone acetate

• IM or SQ every 3 mos
• can take 6-12 mos for fertility to return

Question 25

Transdermal preparatoin

Answer 25

Ethinyl estradiol & Norelgestromin

Question 26

Vaginal contraceptive ring

Answer 26

Ethinyl estradiol & Etonogestrel (NuvaRing) - rapid return to fertility after removal

Question 27

Failure rate with typical and perfect use - COC - Progestin-only - Transdermal - Vaginal

Answer 27

Typical use: 9% | Perfect use: 0.3%

Question 28

Failure rate with typical and perfect use - IUD - Implant - Sterilization (female)

Answer 28

Typical use - IUD: 0.15-0.4% - Implant: 0.05% - Sterilization: 0.5% Perfect use - IUD: 0.2-0.4% - Implant: 0.05% - Sterilization: 0.5%

Question 29

DDIs

Answer 29

Cytochrome P450 inducers - Phenytoin - Rifampin Antibiotics (interfere with GI flora's ability to increase bioavailability of estrogens)

Question 30

Pregnancy termination

Answer 30

Mifepristone *"But I want my life to be pristine... wahh." - progesterone receptor antagonist - used with Misoprostol (prostaglandin E1) - 95% effective within 7 weeks ADR: prolonged bleeding

Question 31

Morning after

Answer 31

Levonorgestrel - progesterone receptor antagonist - DOES NOT reverse pregnancy - No rx Ulipristal acetate - progesterone receptor antagonist - may interfere with pregnancy - Rx required

Question 32

Time frame for most postcoital contraceptives

Answer 32

72 hours (for 99% effectiveness)

Question 33

Absolute contraindications of estrogen therapy

Answer 33

- Thromboembolic disease - Undiagnosed abnormal genital bleeding - Potential for estrogen-dependent neoplasia - Impaired liver function - Possible pregnancy

Question 34

Selective Estrogen Receptor Modulators (SERMs)

Answer 34

Tamoxifen, Toremifene - competitive partial agonist inhibitors of estradiol * antagonist on breast; agonist at other tissues - Tx of ER+ breast cancer Raloxifene * antagonist on endometrium and breast; agonist on lipids and bone - Prevent osteoporosis and breast cancer

Question 35

Aromatase inhibitors

Answer 35

Anastrazole, Letrozole, Exemestane - inhibit aromatase function (can't produce estrone or estradiole) - Tx of breast cancer in postmenopausal women - DO NOT GIVE TO FERTILE WOMEN

Question 36

What do you NOT give to a fertile woman who has breast cancer?

Answer 36

Aromatase inhibitors (Anastrazole, Letrozole, Exemestane)