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Birth control options
- Barrier methods
- Hormonal methods
- Implantable methods
- Permanent birth control methods
- Emergency contraception
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Natural family planning method/ barrier
Female and male condoms: 80-84%+ effective
Cervical sponge/Cervical shields: 68%+ effective :(
using barrier method or not having sex on most fertile days 5 days prior or 3 days after ovulation
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Hormonal method-oral contraceptives
95%+ effective :)
- Prevent ovulation through a negative feedback to the pituitary-suppressing LH and FSH, increases cervical mucous and changes linning all to prevent implantation and "Swimmers" :p
- Monophasic: one level of estrogen/ progesterone continuous dose for 21 days of the cycle
- Biphasic: two levels of estrogen and progesterone cycles
- Triphasic: Three levels
- Adverse: breast tenderness, upset stomach, changes in menstruation, changes in mood, weight gain, HTN, blood clots, stroke, vision problems-Smoking increases the occurrence of adverse effects.
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Hormonal birth control options
- The pill: not as effective as the biphasic treatments. Risk for ectopic pregnancies, sore breasts, spotting between periods, not associated with breast cancer.
- Patch (Orthro-evra): transdermal release of estrogen and progesterone. Great exposure to estrogen than other methods.
- Shot/injection (Depo Provera): progesterone every 3 months 99%+ effective
Most adverse effects are similar.
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Implantable methods
- Implanon: the rod under the skin in the arm. releases progesterone for 3-5 years. 99%+ effective.
- Adverse: acne, weight gain, ovarian cysts, mood changes, depression, hair loss, headache, nausea, dizziness, sore breasts, changes in menstruation, decreased libido
- Mirena(IUD): effective for 5 years (releases progestin) or up to 10 years for (copper releasing)
- Adverse: cramps, bleeding between periods, PID, infertility, tear or hole in the uterus
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Extended regimen BCP
- seasonale, seasonique
- 84 days.
Contains: levonorgestrel and ethinyl estradiol
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Permanent birth control options
- Sterilization implant: Essure, Adiana- device inserted into fallopian tubes leading to scar tissue build up.
- Surgical sterilization: Cauterized, banded, tied and cut-tubes. 99.9% effective
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Emergency contraception Plan B
Levonorgestrel 750 mcg, 2 doses 12 hours apart. Same hormone used in mirena
must be taken within 72 hours
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Abortifacients-Drugs that induce abortion
- Mifepristone: synthetic steroid that blocks progesterone receptors in the uterus-induces abortion and can be combined with misoprostol
- methotrexate: followed by misoprostol in 5 days
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Post-partum birth control
Should not be used for for at least 3 weeks after giving birth due to blood clots.
- estrogen increases clotting factors
- Women who: Cesarean birth, Obesity, History of blood clots, Smoking, preeclampsia must wait 6 weeks.
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Remember for possible side effects of OC
- A – abdominal pain
- C – chest pain
- H – headache
- E – eye problems
- S – swelling
- Must be reported to health care provider.
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3 different steroid hormones of estrogen?
Estrogen therapy treats what?
- Estradiol
- Estrone
- Estriol
- Treatments for: menopause, female hypogonadism, primary ovarian failure, contraception, replacement therapy, chemotherapy.
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Conjugated estrogens (Premarin, Enjuvia, Cenestin)
Hormone therapy.
- Side effects: headache, infection, cramping, bloating, fluid retention,changes in libido, depression, fatigue....others.
- High occurrence of endometrial cancers when taken without progesterone.
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Progesterone hormone therapy
Medroxyprogesterone acetate (Provera) can treat?
- Limits endometrial growth-cancers.
- Dysfunctional uterine bleeding
- Metastatic endometrial carcinoma
- Secondary amenorrhea
- Contraception
- Inoperable metastatic renal carcinoma
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Hormone replacement therapy
- Used to treat hot flashes, night sweats, irregular menstrual cycles, bone loss.
- Estrogen/progesterone replacement increased risk for MI, Stroke, breast cancer, dementia, embolisms in women over 60.
- Estrogen alone: increase risk of ovarian cancer, CVA, thromboembolism.
- Estrogen alone did not increase risk of breast cancer or MI.
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Hormone therapy for breast cancers
- Tamoxifen: estrogen receptor blocker-restrict tumor growth since it needs estrogen to grow.
- Fluvestrant: causes breakdown of estrogen receptors.
- Letrozole, anastrozole: prevent conversion to estrogen.
- Goserlin, Leuprolide: blocks FSH and LH-preventing production of estrogen.
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Hormone therapy for endometrial cancer
Medroxyprogesterone Acetate
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estrogen (Premarin)
Hormone
- Therapeutic class: Estrogen; endocrine metabolic agent
- Preg: x
- MOA: Stimulates luteinizing hormone (LH), and follicle stimulating hormone (FSH)
- Indications: Dysfunctional uterine bleeding due to hormonal imbalance, postmenopausal osteoporosis, irregular menstrual cycles.
- Contraindications: Breast cancer, DVT history, pregnancy, and thromboembolic diseases
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medroxyprogesterone (Provera)
Progestin
- Therapeutic class: Hormone
- Preg: X
- MOA: targets endometrium of the uterus, inhibits effects of estrogen on the uterus to restore normal hormone levels.
- Indications: Dysfunctional uterine bleeding, secondary amenorrhea, contraception.
- Low dose for contraception and high doses for inoperable metastatic uterine or renal carcinoma.
- Contraindications: pregnancy, carcinoma of the breast, thromboembolic disease, hepatic impairment, undiagnosed vaginal bleeding.
- Adverse: breast tenderness, breakthrough bleeding, menstrual irregularities, weight gain, depression, HTN, N/V, dysmenorrhea.
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Estradiol and Norethindrone (ortho-novum, others)
Estrogen/progestin
- Therapeutic class: Combination oral contraceptive
- Preg: X
- MOA: Avail, in mono, Bi, and triphasic preparations, nearly 99.9% effective. hormones inhibit the release of FSH and LH
- Indications: preventing ovulation, off-label, hypermenorrhea, dysfunctional uterine bleeding.
- Contraindications: Pregnancy, thromboembolic disorders, stroke, coronary artery disease.
- Alert: smoking increases risk of adverse effects. Can also affect clotting factors.
- Adverse: weight gain, breakthrough bleeding, changes in vision gallbladder disease, N/V, dysmenorrhea, breast fullness, fatigue.
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sildenafil (Viagra)
Phosphodiesterase (PDE)-5 inhibitor
- Therapeutic class: Errectile dysfunction
- MOA: relaxing smoth muscles in corpora cavernosa-increasing blood flow to the PENIS
- Indications: ED
- Contraindications: patients taking nitrates
- Adverse: headache, dizziness, flushing, rash, nasal congestion, hypotension.
- ALERT: Concurrent use of nitrates may cause unsafe drop in bp and possible MI
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Testosterone
Androgen; anabolic steroid; antineoplastic
- Therapeutic class: Male sex hormone
- MOA: promotes virilization, including puberty and hypogonadism in males, growth of facial hair, deepening of the voice, increasing libido and ED.
- Contraindications: suspected breast or prostatic carcinomas. prostate enlargement.
- Adverse: increased or decreased libido, salt or water retention, edema
- Alert: Excess testosterone can be metabolized into estrogen.
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ectopic pregnancy treatment
- Treatment: medical management -methyltrexate (stops fetal growth) & misoprostol (can cause uterine contractions to help expel fetus.)
- Surgical management - salpingostomy, salpingectomy if ruptured.
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