Women's Health - Contraception
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What is contraception?
- Contraception is the prevention of pregnancy by one of two methods:
- 1. Preventing implantation of the fertilized ovum in the endometrium
- 2. Inhibiting contact of sperm with mature ovum
What is the relationship among the hormones during the menstrual cycle?
- Progesterone & Estrogen are inversely related to LH & FSH
- FSH & LH are high at the beginning of the cycle and Progesterone & Estrogen are are high later in the cycle
What is the MOA of combination oral contraceptives?
High doses of estrogen and progestin during the follicular phase and early luteal phase keep FSH and LH low, which means fewer follicles are produced and no dominant follicle is chosen
What is the role of estrogen in contraceptives?
Estrogens prevent development of a dominant follicle by suppression of follicle-stimulating hormone (FSH).
What type of estrogen is used in combination oral contraceptives?
- ethinyl estradiol
What is the role of progestin in contraceptives?
- inhibit LH surge --> to prevent ovulation
- creates atrophied endometrium --> to prevent implantation
- thickens mucus --> to inhibit sperm transport
- alters fallopian tube secretions
What type of progestin is used in combination oral contraceptives?
Which hormone can be used as long-term injectable or implanted products?
What are the advantages of progestin-only oral contraceptives?
- May be used in lactating women because it doesn't effect quantity or quality of milk like estrogen
- Free of cardiovascular risks associated with estrogen-containing products
- Lower rate of PID (pelvic inflammatory disease)
Which progestin product has progestogenic, anti-androgenic, and anti-mineralocorticoid activity?
Patient instructions & counseling on oral contraceptives
- 1. Efficacy is high but depends on appropriate use & adherence
- 2. Oral contraceptives do not prevent the transmission of sexually transmitted disease
What are the advantages of combination oral contraceptives?
- Less iron deficiency anemia
- Decreased cramping
- Decreased ectopic pregnancy
- Decreased rate of pelvic inflammatory disease (PID)
- Protection against ovarian and endometrial cancer
- Protection against fibrocystic breast disease
- May increase bone mineral density (BMD) in peri- and postmenopausal women
- Less menstrual cycles
What is ectopic pregnancy?
An ectopic pregnancy, or eccysis, is a complication of pregnancy in which the embryo implants outside the uterine cavity and mainly in the fallopian tube.
What are the disadvantages of combination oral contraceptives?
- Increase in DVT and pulmonary edema
- Increase risk of stroke
- Increase risk of CVD or CAD
- Increased triglycerides
- Elevation of BP
- Increased risk of liver disease
- Increased risk of breast cancer
What does ACHES stand for?
- Abdominal pain
- Chest pain (SOB, coughing up blood)
- Eye problems (blurred vision, blindness)
- Severe leg pain in the calf or thigh
What is the advantage of a Day 1 Start of oral contraceptives?
It's effective immediately so no back-up protection is needed
What is the advantage of a Sunday Start of oral contraceptives?
Avoids menses on the weekends
What are the most common adverse drug events of oral contraceptives?
- N/V (usually resolves within 3 months)
- Breakthrough bleeding, spotting
- Altered menstrual flow
- Melasma (tan or dark skin discoloration)
- Weight change/edema
What is the BBW for oral contraceptives?
Cigarette smoking increases the risk of serious cardiovascular events from oral contraceptive use. This risk increases with age, particularly in women over 35 years of age, and with the number of cigarettes smoked. Women who are over 35 years of age and smoke should not use oral contraceptives
What are the SE of excess estrogen?
- Breast tenderness/fullness
What are the SE of estrogen deficiency?
- Breakthrough bleeding (early-mid cycle (day 1-20))
- Increased spotting
Menorrhagia (or hypermenorrhea) is an abnormally heavy and prolonged menstrual period at regular intervals.
Causes may be due to abnormal blood clotting, disruption of normal hormonal regulation of periods, or disorders of the endometrial lining of the uterus.
Dysmenorrhea (or dysmenorrhoea) is a gynecological medical condition of pain during menstruation that interferes with daily activities.
Hypomenorrhea or hypomenorrhoea, also known as scanty periods and spotting at periods, is extremely light menstrual blood flow.
Amenorrhoea or amenorrhea (AmE), is the absence of a menstrual period in a woman of reproductive age.
What are the SE of excess progestin
- Breast tenderness
- Acne/oily scalp
- Increase appetite/weight gain
What are the SE of progestin deficiency?
- Late breakthrough bleeding (day 10-28)
How should pts be counseled on missed doses of oral contraceptives?
- 1 dose: take as soon as remember even if it means taking two doses at once
- 2 doses: take 2 when you remember and 2 the next day, use alternative contraception for the rest of the cycle
- ≥2 doses: discard the rest of the pack, start a new pack using the same method as originally did, use alternative contraception for the rest of the cycle
Define the "Morning After" emergency contraceptives?
- Emergency contraceptive pills or the "morning-after pill"—may contain higher doses of the same hormones (estrogens, progestins, or both) found in regular combined oral contraceptive pills.
- Taken after unprotected sexual intercourse or contraceptive failure, such higher doses may prevent pregnancy from occurring
Depending on the drug, they are licensed for use for up to 107 to 120 hours after unprotected sexual intercourse
or contraceptive failure.
What are the "Morning After" emergency contraceptives?
- Plan B - progestin-only (two 750 µg levonorgestrel pills)
- Ella - (progesterone agonist/antagonist and also delays ovulation)
- Preven - (high dose of estrogen - problem for VTE risk)
When do you start progestin-only oral contraceptives?
first day of menses, using back-up protection until next menses
Name some non-drug therapies in preventing pregnancy
- Intrauterine devices (IUD) - an object, placed in the uterus, to prevent pregnancy
- Spermicides - a contraceptive substance that eradicates sperm, inserted vaginally prior to intercourse to prevent pregnancy
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