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12 Cards in this Set
- Front
- Back
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Most common synthetic oestrogen
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EE - Ethinylestradiol
(mestranol is the less common one) |
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Synthetic Progestogens used in OCs
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1st gen - no longer used
2nd gen (acne & wt gain) - Levonorgestrel, Norethisterone 3rd gen - Desogestrel, Gestodene |
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Mechanism of combined OCs
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1. Inhibit ovulation - high neg feedback of e&p to prevent LH & FSH - MAIN EFFECT
2. fertilisation inhibition - thicken cervical mucus (p) 3. implantation inhibition - reduce receptivity of endometirum (e&p) |
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What reduces the effectiveness of combined OCs
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if taken correctly - over 99% effective
Reduced by: 1. delayed initiation of next cycle of pills 2. hepatic enzyme induction (some antiepileptics, antibiotics, st john's wort) 3. vomiting, diarrhoea (less absorbed) |
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Regimens/Formulations of Combined OCs
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1. monophasic
2. biphasic - progestogen increases in second half of the 21 day pill regime 3. triphasic - estrogen increased only in the middle few days (decr. breakthrough bleeding) and progestogen incr stepwise no contraceptive advantage over monophasic regimens |
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Common Side-Effects of the Combined Pill
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1) breakthrough bleeding
2) nausea 3) fluid retention, breast tenderness 4) chloasma androgenic/anti-androgenic side effects: 1) acne & wt gain 2) depression, fatigue 3) decr libido |
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Rare serious adverse effects of combined OCs
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1. Oestrogens - enhanced coagulation (MI, DVT/PE, stroke risk)
2. Modest (1.24x) incr risk for breast cancer (but pill takers may see dr more) 3. Small incr risk for cervical cancer (but pill takers may be more sexually active) |
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Contraindications for combined OCs
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1) pregnancy
2) history of thromboembolic disoders (DVT/PE/stroke) 3) History of estrogen dependent tumours (breast, endometrial) 4) migraine with 'aura' (stroke risk) 5) hepatic disease 6) major elective surgery (stop taking 4 weeks before, due to clotting risk) 7) breastfeeding 8) >35yo smoker with HT and DM |
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Benefits for Combined OCs
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decr risk of ovarian & endometrial cancer
decr ovarian cysts decr PID, salpingitis, extopic preg decr benign breast disease improvement in acne significant improvement in mestrual related problems |
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Progestogen-Only OCPs (mini pill)
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for some women risks of COC > benefits
ie. breastfeeding focal migraines >35 smokers with CVD before major surgery not as effective (3h window, COC - 12h window) |
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Mini Pill (PO-OC) mechanism of action
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1. Inhibits ovulation (P inhibits LH surge)
but... 30-40% of women on it still ovulate 2&3. Also thickens cervial mucous (fertilisation) and thins endometrium (implantation) Progestrogen-only contraceptives also include IUD and Implanon. |
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Prescribing Contraceptive Formulations
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1. Lowest doses (of e&p to reduce side-effects - balance)
2. Carfeul Hx - exclude contraindications and select best pill 3. Instructions - give patient all info 4. Follow up - to incr compliance and juggle doses 5. Annual BP monitoring - recommended but 2' HT is rare |
