Estrogen/Androgen LOs

• Adverse effects associated w/ estrogen component of OCs

  Breast tenderness, fluid retention, headache, nausea, increased BP, risk for thromboembolism, thrombophlebitis, MI, PE, stroke
• Adverse effects associated w/ progestin component of OCs

  Negative effects on lipid profile, depression, changes in libido, hirsutism, acne, break through bleeding, risk of thrombosis
• Types of contraception and affect on fertility

  1. Delay fertility: injectable progestin
  2. Immediate pregnancy: progestin implants
• Type of contraceptive products that rely heavily on administration timinf for efficacy

  Oral contraception, especially progestin only pills (norethindrone m.c)
• Which type of contraceptives put women smokers > 35 at greater risk for thrombosis

  Estrogen contraceptives, but the lower the dose, the lower the risk
• Advantages of COC

  1. Regular cycles, less dysmenorrhea, lighter flow, less anemia, fewer ovarian cysts, less PMS
  2. Decreased risk of ectopic, endometriosis, salpingitis, fibrocystic breast disease, acne, hirsutism, endometrial and ovarian cancer
• Progestin Only Pills

  • Contains norethindrone
  • Taken daily on continuous schedule
  • Less effective than combo products
  • May produce irregular menstrual cycles
  • Option for breast-feeding as it doesn't affect milk production
  • Option for women who should not take estrogen
• Transdermal Patch

  • Contains ethinyl estradiol and norelgestromin
  • Applied once weekly for 3 weeks
  • Patch-free week to stimulate withdrawal bleeding
  • Less efficacious in women weighing > 90 kg
  • Total estrogen exposure may be greater than oral contraceptives
• Vaginal Ring

  • Contains ethinyl estradiol and etonogestrel
  • Inserted vaginally for 3 weeks
  • Removed for 4th week to stimulate withdrawal bleeding
  • Can be used continuously
• Injectable Progestin

  • Contains medroxyprogesterone acetate
  • IM or SQ administration every 3 months
  • Return to fertility may be prolonged
  • Should not be used for more than 2 years
  • Can contribute to bone loss and increase risk of osteoporosis and fractures
• Progestin Implants

  • Contains etonogestrel
  • Subdermal implantation
  • Provides contraception for about 3 years
  • Nearly as reliable as sterilization
  • Effects reversible upon surgical removal
  • May be less effective in patients > 130% of ideal body weight
• Progestin Intrauterine Device

  • Contains levonorgestrel
  • Inserted into uterus by healthcare professional
  • Provides contraception for about 3-5 years
  • Avoid in patients with PID or hx of ectopic pregnancy
• When to use topical vs systemic therapy

  Women who have only urogenital symptoms (vaginal atrophy) should be treated w/ vaginal rather than systemic estrogens
• Brand name of Medroxyprogesterone acetate

  Depo-Provera