Ae Of Coc

Front 1

When oral contraceptives are initiated 30-50% of women complain of

Back 1

Bleeding or spotting

Front 2

Common side effects resolve by

Back 2

Third or fourth cycle

Front 3

What to take into consideration before changing formulations If bleeding or spotting occur?

Back 3

Other more serious causes such as

Pregnancy, infection, poor oral absorption of oral contraceptive owning to drug interaction or GI problem

Front 4

Women who have spotting or bleeding before they finish their active pills need

Back 4

Higher progestin content to increase endometrial support.

1- monophasic with higher progestin

2- triphasic with increased dose of progestin

Front 5

Women with continued bleeding after menses need

Back 5

More estrogen support.

1- increase estrogen component

2- have lower early progestin component in triphasic pills

Front 6

If midcycle bleeding occurs

Back 6

Hard to determine the cause, increase both estrogen and progestin

Front 7

Formulations that may increase the risk of breakthrough bleeding

Back 7

Lower dose estrogen

Front 8

How to minimize breakthrough bleeding?

Back 8

Higher estrogen formulation

Triphasic formulations

But they will increase amount of withdrawal bleeding

Front 9

Side effects that maybe related to progestins with higher androgenicity

Back 9

Acne

PMDD

Hirsutism

Front 10

High androgenicity formulations that may cause the previous side effects?

Less androgenic formulations and have greater acne improvement?

Back 10

Norgestrel and levongestrel.

Lesa: Norgestimate, norethindrone

Front 11

____ has both antiandrogenic and antimicrobial activity and has shown improvement in PMDD, Hirsutism, acne.

Back 11

Drospirenone

Front 12

GI complaints are often seen.

____ Can induce nausea and vomiting via the cns.

_____ slows peristalsis, causing constipation and feeling of bloating and distention

Back 12

Estrogen

Progestin

Front 13

Strategy to cope with nausea

Back 13

Take pill at bedtime or with food

Front 14

If unable to tolerate GI side effects

Back 14

1- decrease in EE to a low dose 20 mcg

2- decrease in progestin may minimize bloating or constipation

3- progestin only products if 1 failed

Front 15

Headache must be evaluated because

Back 15

They are a major sign of stroke

Front 16

If headaches become worse

Back 16

1- all differential diagnoses must be considered

2- BP to rule out HTN

3- stop immediately if neurologic symptoms or blurred vision occur

Front 17

Migraine headache with aura showed a significant increase in

Back 17

Ischemic stroke

Front 18

Headaches are still troublesome?

Back 18

1- discontinue

2- lower estrogen

3- lower progestin

4- for women with headace during the pill-free interval, eleminate the pill-free interval for two to three consecutive cycles

Front 19

Some mood and sexual problems of using COC

Back 19

Decrease in libido and depression

Decrease vaginal lubrication

Painful Intercourse

Nuvaring may help with the lubrication problem

Front 20

Increase HDL-C, tgc, TCL and decrease LDL-C

Back 20

estrogen

Front 21

Decrease HDL-C, tgc and increase LDL-C

Back 21

Androgenic progestin

Front 22

Mastalgia can occur in ___% due to

Back 22

30%

Estrogen component

Front 23

Average woman breast volume increase ___ owning to__

Back 23

20%

Venous and lymphatic engorgement

Front 24

Cause adipose cell hypertrophy

Back 24

Estrogen

Front 25

If tenderness occurs prior to menses

Back 25

Switch to unique oral contraceptives

Front 26

Melasma and chloasma can occur secondary to

Back 26

Estrogen simulation of monocyte production

Front 27

Women who are more susceptible to hyperpigmentation effects

Back 27

Women with darker pigmentation

Front 28

To avoid hyperpigmentation

Back 28

Use sunscreen

Use progestin only formulations