Q6 - Menstruation, Menopause, Contraception And Pregnancy

Question 1

Monophonic COC (same dose of progestin and estrogen in active pills)
-June FE, Microgesting Fe, Sprintec, Loestrin, Yasmin
LOW estrogen.

Question 2

Biphasic COCs – same dose of estrogen, progestin dose decreased ½ way
Extended cycle formulations (Seasonique) <- why would someone want an extended cycle formulation?

Answer 2

Decrease the amount of bleeding they have throughout the year.

Question 3

What is different about Amethyst?

Answer 3

Continuous COC - no placebo pills so no periods. Menstrual related anemia and menstrual migraines.
Only approved continuous COC, however others are used off label this way as well.

Question 4

Starting COCs?

Answer 4

“Quick start” - use back up protection for 7 days with COC, but with protestin only pills, quick start only requires back up protection for first 48hours.
Sunday start
First day of Menses

Question 5

Missed dose of COC?

Answer 5

1 pill is late or missed - take as soon as you remember. No back up needed
48hrs of missed pills? Take one as soon as you remember, and discard the other one. Skip placebo week. Back up for 7 days.
Progestin only pill Late pill (>3hrs)? - take as soon as you remember and back up protection for 48hrs.

Question 6

SEs tend to decrease _____ after starting OCPs.

Answer 6

3months

Question 7

Xulane, Zafemy, Twirla

Answer 7

Contraceptive patches

Question 8

Contraceptive patches have ______ estrogen exposure than COCs. What does this mean?

Answer 8

Higher.
CI are more strict - higher risk of clotting

Question 9

What could happen with obese patients on contraceptive patches?

Answer 9

Decreased contraception effectiveness in Those who weigh >198lbs

Question 10

postpartum women should NOT be given a ________ - why?

Answer 10

Patch. Higher concentration of estrogen, so higher blood clotting risk.

Question 11

NuvaRing and Annovera.
SE?

Answer 11

Vaginal ring. Same SE profile as COCs.

Question 12

Annovera is reusable - 1 ring for the whole year.

Question 13

Most effective forms of reversible contraception?

Answer 13

IUDs

Question 14

IUD AEs?

Answer 14

Uterine perforation, PID, embedment, IUD breakage.

Question 15

Nexplanon - 3 year implantable progestin only.

Question 16

1st line for menstrual cramps?
CI?

Answer 16

NSAIDS - started 1-2 days prior to onset of menses or at the start. Decrease prostaglandin synthesis.
Renal impairment

Question 17

1st line for Dysmenorrhea

Answer 17

NSAIDS – start 1-2 days prior to your period. CI in renal impairment.

Question 18

1st line for amenorrhea

Answer 18

AFTER identifying cause – nutrition, hormonal, endocrine disorder)
Transdermal estrogen patch + cyclic (long term) oral progestins.

Question 19

Tx of heavy menstruation

Answer 19

AFTER ruling out other causes)
NSAIDS, CHCs, Progestins, Iron supp (WITH stool softener)
TXA

Question 20

TXA MOA? AEs?

Answer 20

Prevent fibrin degradation to reduce bleeding. AEs? Abd px, HA, back px, MSK px and sinus symptoms.

Question 21

Menopause is a decrease in __________ which causes ____ to increase, leading to __________ symptoms

Answer 21

Estrogen/progestin, FSH, vasomotor

Question 22

Expected results of estrogen to treat menopause?

Answer 22

Estrogen Decreases LH and helps with maintaining temp control and bone mineral density

Question 23

SE and CI for Estrogen replacement therapy

Answer 23

SE – dementia, clots, breast cancer, ovarian cancer, increase HDL, TG, decreases LDL
CI – hx breast ca, active VTE, coagulopatheis, hepatic impairment or pregnancy.

Question 24

Progestin replacement therapy in menopause

Answer 24

MOA: suppresses release of FSH and LH. SE – mood disorders and spotting.

Question 25

Would topical estrogen formulation be helpful for someone experiencing mental fogginess, HA, night sweats and vaginal dryness?

Answer 25

No

Question 26

HRT comes in 4 different options:

Answer 26

Topical estrogen only Systemic estrogen only Systemic combination (estrogen and progestin) Systemic progestin only.

Question 27

T/F: HRT patch must be removed prior to MRI?

Answer 27

True

Question 28

Approved Non-hormonal method for VMS in menopause tx? MOA? BBW? SE?

Answer 28

Paroxetine (Brisdelle) MOA: SSRI regulate body temp BBW: suicide SE: sedation, insomnia, restlessness, tremor, weakness, dry mouth, constipation, diaphroesis. 4 weeks to take effect

Question 29

Treatment for Dyspareunia? MOA? SE? What line?

Answer 29

Ospemifene – oral estrogen agonist/antagonist – short term use only. Hot flashes, vaginal discharge, hyper hidrosis. Only for severe not treated with vaginal estrogen gel

Question 30

Intrarosa – clinical considerations?

Answer 30

Used to treat dyspareunia. Can take 12 weeks to see results. Moderate to severe vaginal dryness and dyspareunia. Administer 1 vaginal insert at bedtime QD.

Question 31

Teratogens:

Answer 31

Acne: Isotretinoin, topical retinoids Antibiotics: quinolones, tetracyclines Anticoagulants: warfarin Dyslipidemia, HF and HT: statins, RAAS inhibitors (ACE inhibitors, ARBs, aliskiren, sacubitril/valsartan) Hormones: estradiol, progesterone, raloxifene, testosterone Migraine: dihydroergotamine Others: hydroxyurea, lithium, methotrexate, misoprostol, NSAIDs, paroxetine, ribavirin, thalidomide, topiramate, weight loss drugs, valproic acid/divalproex

Question 32

Meds for heartburn in pregnancy?

Answer 32

Tums, simethicone.

Question 33

Tx Constipation in pregnancy?

Answer 33

Metamucil with LOTS of fluids Docusate.

Question 34

Cough/cold/allergies in pregnancy

Answer 34

Cromolyn, Benadryll, loratadide, cetirizine, fluticasone. Avoid products with alcohol. Phenelyphrine and Sudafed are NOT to be used in 1st trimester because they can cause constriction of blood vessels to the fetus.

Question 35

Pain in pregnancy

Answer 35

Tylenol - no more than 3.5G/day (less than normal 4G) NO NSAIDS/opioids (xcept for aspirin in preeclampsia prevention)

Question 36

Infection in pregnancy

Answer 36

PCN, cefalosporins, erythromycin, Azithromycin, topicals. NOT SAFE: FQ, tetracyclines, doxy

Question 37

UTI in pregnancy

Answer 37

Cephalexin, ampicillin (w/Clav). Nitrofurantoin/bactrim reserved for last line - can cause hemolytic anemia/increased chance of jaundice.

Question 38

T/F: all bacteriuria in pregnancy must be treated

Answer 38

True. Whether symptomatic or not.

Question 39

Macrobid and bactrim in pregnancy

Answer 39

Last line. - not for first trimester or >36wks.

Question 40

T/F: ibuprofen and Tylenol safe while breastfeeding

Answer 40

True.