Week 7 contraception Flashcards by Yuko Porter

Mechanisms 1
Prevent a) ______ from entering the vagina/cervix

b) What are the methods?

a) sperm

b) barrier methods
male sterilization

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Mechanisms 2
Prevent b) _____ from entering the area if fertilization

What are the methods?

a) egg

b) hormonal, female sterilization

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Fertility awareness 3
受胎能力
What are they?

Calendar method
Cervical mucus viscosity
Basal body temperature

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Hormonal contraception

Manipulates a____ and b_____ to convince the body that it is already pregnant

a) estrogen
b) progestin

Ovulation does not occur

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What is the main component that prevents ovaluation?

progestin

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Combination oral contraceptives
COCs

When does it introduce?
First COCs are in higher or lower doses than today?

a) 1960
b) higher

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Estrogen content

Ultra low
Low
High

< 20 mcg
30-35mcg
> 35mcg

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Types of COCs

21 active pills
7 inactive pills

Monophasic COC
E: Ethinyl estradiol
P: Progestin (nonspecific)
all 21 pills are identical in progestin

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Types of COCs

Day 1- 10 active pills are a different dose of progestin
11-21 active pills
7 inactive pills

Biphasic COCs
E: Ethinyl estradiol
P: Progestin (nonspecific)

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Types of COCs

Week1, week2 week 3 active pills
have different dosage
7 inactive pills

Triphasic COCs
E: Ethinyl estradiol
P: Progestin (nonspecific)

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Hormonal contraceptive

Effectiveness
a) Perfect use
b) Typical use

Fail reason

a) 0.3%
b) 8%

Missed pills (50% of 1st-time users missed >3pills during their 3rd cycle)

Stop taking pills without back-up method

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Hormonal contraceptive

advantages

Highly effectiveness
Rapid reversibility
Improve acne
less cramping and pain

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Hormonal contraceptive

Disadvantage

Daily administration
Prescription required
Not protect from SDIs

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COCs health complications

What is the most concerning complication?

VTE
Venous thromboembolism

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FDA contraindication of CDCs

1) VTE risks pt
2) Cancer that responds hormones
3) Liver issues
4) Suspected pregnant
Hypersensitivity

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What is the first day start?

Pills are taken on the first day of period=when bleeding

-No back -up needed

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What is Sunday start?

Pills are taken on the first Sunday of period
-Period free weekends
-Requires to backup if period starts on Monday or Tuesday
Used back up until COCs is used for 7days

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COCs
drug interactions

Anticonvulsants
Antibiotics
-Only rifampin(TB)
Antiretrovirals
-Covid, HIV
St. John’s worth
-Herbal OTC

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COCs
Missed 1 to 2pills

Take 1 active pills ASAP then continue taking daily pills
Emergency contraception in the first week and had sex

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COCs
Missed > 3 pills during first 2 weeks
of pack

Take 1 active pill ASAP then continue taking daily pills
back-up until taking 7 active pills in a row

Ovulation starts day 14
Prevent ovulation

COCs
Missed>3 pills during the 3 rd week of the pack

Just finish the active pills
Start a new pack the next day without using any placebo pills

COCs
Side effects
Unscheduled vaginal bleeding

DO NOT change pill until 3 month
By the 3rd pack of pills, 70-90% have no further bleeding

COCs
Side effects
Headaches

New onset or worsening should be evaluated
One of the VTE risks is stroke.
Stroke’s symptoms is a headache

We need to make sure the headache is just ADR or stroke sing

Unique COCs
Yasmin what’s a cycle?
Yaz what’s a cycle?

a) 7 placebo pills cycle
longer period
b) 4 placebo pills cycle
shorter than Yasmin

Yasmin+ Yaz Contains?

E: Ethinyl Estradiol P: Drosperinone Progestin with ant mineralocorticoid activity Claims less water weight gain that other COCs

Unique COCs Nextstellis Contains?

E: Estetrol P: Drosperinone A new estrogen May see less bleeding May see less risk of VTE $190!!

Unique COCs Seasonal

E: Ethinyl Estradiol P: Nonspecific First COC approved for extended cycles Period every 3 moths Increased bleeding

Unique COCs Seasonique loseasonique

E: Ethinyl Estradiol P: Levonorgestrel Low EE No placebo so must take it everyday less bleeding

Unique COCs Lybrel

First COC approved for continuous use No period!! No placebo so must take it every day many reports of unscheduled bleeding

NuvaRing What consists?

E: Ethinyl estradiol 15mcg P: Etonorgestrel 120mcg It doesn't pass the liver so low dosage is OK

NuvaRing How to use it? Effectiveness? ADRs?

Inserted into the vagina and left for 21days Wait 7 days and insert the new one Perfect use 0.3% Typical use: 8% ADR: Same May less abnormality bleeding

NuvaRing Advantage

Slow, steady release of hormones Rapidly effective and rapidly reversible

NuvaRing a) Ring out less than 3 hr b) Out more than 3 hr during week 1-2 c) Out more than 3 hr during 3weeks

a) Rinse with water and re-insert b) Rinse with water and re-insert Backup for 7days Offer EC if had sex c) Discard ring and insert new one immediately Backup for 7days

Xulane What contain?

E: Ethinyl estradiol 20mcg P: Nonrelgestromin 150mcg

Xulane How to use it?

Apply patch and leave in place for 1 week replace another for week 2 replace another for week 3 remove the patch and wait 7 days Patch can be on abdomen, butt, upper torso, upper outer arm

Xulane Advantages

Weekly regimen Rapidly reversible

Xulane Disadvantage

Same ADRs as COCs Skin reactions Breast discomfort, engorgement

Xulane If patch detach a) <24hr b) >24 hr or unknown

a) Try to re-adhere with pressure If not put the new one b) Start a new one Use backup for 7days

Minipills Progestin-only pills a) contain? b) the main failure?

a) Norethindrone b) Lower progestin does have a shorter duration action Late pill-taking can compromise efficacy

Minipill action

Inhibits ovulation Thickens cervical mucus Reduce ovum transport through fallopian tubes Altered endometrium

Minipills a) advantage b) disadvantage

a) Lack of estrogen and lower progestin b) causes bleeding changes short cycle, irregular periods Must take at the same time

Minipills If take 3hr late?

Consider missed pill take soon as remember backup for 48hr Must take EVERY DAY and SAME TIME

Nexplanon What contains?

A single matchstick 68mg etonorgestrel (P) Inserted under the skin Effective for at least 3 years 0.05% failure

Nexplanon a) Advantage b) disadvantage

a) Same as other progestin-only methods c) Clinical dependent Insertion complications Obesity tend to fail

IUD ParaGard

Copper wire Inhibits spermatic functioning

IUD Mirena

P: levonorgestrel system Local hormonal effect -thickens cervical mucus -inhibits sperm survival -suppress endometrium

IUD a) advantage b) disadvantage

a) long-lasting b) irregular bleeding Cramping, pain Missing strings Inc ectopic pregnancy risk Inc miscarry risk

Phexxi

pH control gel used within 1 hour BEFORE of intercourse Perfect fail 7% Typical 14% non-hormone require prescription Can't use women history of UTI

Emergency contraception What is the option 1,2,3?

1) Plan B up to 72 hr 2) Ulipristal up to 5days 3) Copper T IUD up to 5days