Women's Health

• 2d before to 2d after ovulation
• every other day to allow sperm to mature fully between sessions

• Progesterone and Estrogen are inversely related to LH and FSH
• FSH and LH are high at the beginning of the cycle and Progesterone and Estrogen are are high later in the cycle

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

ethinyl estradiol

inhibit FSH secretion to prevent development of a dominant follicle

• inhibit LH surge so ovulation is prevented
• creates atrophied endometrium to prevent implantation
• thickens mucus to inhibit sperm transport
• alters fallopian tube secretions

It's effective immediately so no back-up protection is needed

Avoids menses on the weekends

• Less iron deficiency anemia
• Decreased cramping
• Decreased ectopic pregnancy
• Decreased rate of PID
• Protection against ovarian and endometrial cancer
• Suppression of development of functional ovarian cysts
• Protection against fibrocystic breast disease
• may increase BMD in peri and postmenopausal women
• Less menstrual cycles

• Compliance
• Increase in thromboembolism and stroke risk
• Increased triglycerides
• Elevation of BP
• Increased risk of benign hepatocellular adenomas
• Increased risk of breast cancer (maybe)
• Increased risk of cervical cancer (maybe)

• Nausea
• Bloating/edema
• Cervical mucorrhea, polyposis
• HTN
• Migraine
• Breast tenderness/fullness

• Early-mid cycle breakthrough bleeding (day 1-20)
• Increased spotting
• Hypomenorrhea

• Increased appetite
• Wt gain
• Tiredness, fatigue
• Hypomenorrhea
• Acne, oily scalp
• Hair loss or hirsutism
• Depression
• Monilial vaginitis
• Breast regression

• Late breakthrough bleeding (day 10-28)
• Amenorrhea
• Hypermenorrhea

• Anticonvulsants
• AB
• Rifampin
• Theophylline
• St. John's Wort
• NNRTI
• PI
• Sulfonamides
• Griseofulvin
• Bosentan
• Tacrolimus
• Modafinil

• 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

• Abdominal pain
• Chest pain
• Headaches
• Eye problems
• Severe leg pain

• Plan B
• Ella (progesterone agonist/antagonist and also delays ovulation)
• Preven (high dose of esrogen - problem for VTE risk)

• May be used in lactating women because it doesn't effect quantity or quality of milk like estrogen
• May be used in women with CV risk, HTN, headaches, smokers, CVA, liver impairment/tumor, current DVT
• Allows avoidance of estrogen-related SE
• Lower rate of PID

• Increased amenorrhea or frequent spotting
• Increased chance of ectopic pregnancy because ovulation not inhibited
• Does not consistently suppress ovulation in lower doses
• Efficacy due to mucus changes only
• May increase risk of contracting DM in women who had gestational diabetes
• Must be taken every day at the same time - back-up protection for 2d needed if miss a dose (>3h late)

first day of menses, using back-up protection until next menses

• Low failure rate
• Decreased or no menses or cramping
• Decreased yeast infections, ectopic pregnancy, PID
• No lactation suppression
• No increased risk of thromboembolism
• May be used in CV risk, HTN, migraines
• Passive contraception
• Avoids estrogen SE
• Less drug interactions (watch rifabutin, rifampin)
• May be an alternative for women taking anticonvulsants

• Return of fertility may be delayed
• Possible breakthrough bleeding
• Wt gain of 1kg/yr
• Decreased HDL, increased triglycerides
• Office visit required
• Bone mineral density decreased - limit to < 2yrs