HORMONAL CONTRACEPTION

Question 1

combined pill of ESTROGEN + PROGESTIN → estrogen component:

Answer 1

1. ethinyl estradiol

2. mestranol

Question 2

combined pill of ESTROGEN + PROGESTIN → progestin component:

Answer 2

1. levonorgestrel
2. norgestrel
3. norethindrone
4. desogestrel
5. drospirenone
6. gestodene

Question 3

combined pill of ESTROGEN + PROGESTIN → advantages:

Answer 3

1. failure rate < 0.3% with perfect use (8% typical use)
2. fertility returns rapidly
3. bleeding is decreased & less painful
4. better cycle predictability
5. decreased risk of benign breast disease, PID, ovarian & endometrial cancers

Question 4

combined pill of ESTROGEN + PROGESTIN → DISadvantages:

Answer 4

1. increased risk of stroke, acute MI, venous thromboembolic disease
2. increased risk of hepatic adenoma, cervical cancer, breast cancer
3. do NOT protect against STD’s
4. interactions with antibiotics or anticonvulsants → efficacy may be decreased

Question 5

progesterone-ONLY pill: (drug names)

Answer 5

1. norgestrel
2. levonorgestrel
3. norethisterone

Question 6

progesterone-IMPLANT: (drug name)

Answer 6

1. etonogestrel

Question 7

progesterone-INJECTIONS: (drug name)

Answer 7

1. medroxyprogesterone acetate

Question 8

pill of PROGESTIN only → advantages:

Answer 8

1. REDUCED risk of serious complications to which estrogen contributes
2. decreased dysmenorrhea, menstrual blood loss
3. no migraine
4. fertility returns immediately after cessation

Question 9

pill of PROGESTIN only → DISadvantages:

Answer 9

1. require compliance

2. more common breakthrough bleeding

Question 10

mechanism of action:

Answer 10

1. both estrogen & progestins → neg. feedback effects on LH & FSH secretion from the ant. pituitary
2. progestins → local effects on cervical mucus composition

Question 11

CONTRAindications:

Answer 11

1. smoker of > 35y. → encourage smoking cessation in pat. < 35y.
2. history of breast cancer
3. hepatic neoplasm
4. cerebrovascular disease
5. congenital hyperlipidemia
6. IHD
7. severe hypertension
8. migraine
9. diabetes >20 years OR with SEVERE vascular disease, nephropathy, retinopathy, neuropathy
10. major surgery with prolonged immobilization
11. AVH / Impaired liver function
12. abnormal vaginal bleeding of unknown etiology
13. thrombophlebitis, thromboembolic disease or known thrombogenic mutations

Question 12

side effects:

Answer 12

1. hypertension
2. breast cancer???! (risk of endometrial and ovarian is REDUCED)
3. thromboembolism → pat. with higher risk of thromboembolism = sedentary, overweight, smokers, hypertensive, diabetic, hypercholesterolemic
4. gall bladder disease
5. weight gain, nausea, mood changes, skin pigmentation