what are the progestin only contraceptives?
LNG- IUS
progestin only pills
implant
injection
what are examples of progestin only pills
norethindrone 0.35mg (Movisse)
Drospirenone 4mg (Slynd)
which pill is called the “mini pill”
Movisse
when should you consider progestin only pills?
if you have to avoid estrogen
- migraines, smokers over 35yo
postpartum + breastfeeding
how does norethindrone work?
thickens cervical mucus
inhibits LH - inhibits ovulation
used DAILY - no pill breaks
when should Movisse be started?
any day
recommend backup contraception for 48 hours
when should Movisse be taken?
same time every day
more than 3 hour delay = less effective
how does drospirenone work?
inhibits ovulation
thickens cervical mucus
what is the drospirenone regimen?
24/4
start any day, but use condoms for 7 days
does Slynd or Movisse have a longer half life?
Slynd (30 Hours)
what to do if you missed the 3 hour window with Movisse?
condoms for 48 hours
what to do if you missed a dose of Slynd?
if 2 or more tabs missed, condoms for 7 days
what are the a/e of Slynd?
BTB
hyperkalemia
progestin related
what are the a/e of Movisse?
BTB
progestin related
is the DMPA (depot-medroxyprogesterone) injection a LARC or SARC?
considered LARC
when to consider the injection?
need to avoid estrogen
- migraines, smokers over 35yo
when are POC c/I?
current/hx of breast cancer
liver disease
AUB
CYP3A4 inducers like seizure meds and rifampin*
*anticonvulsant meds are not c/I with the injection
how does the injection work?
once every 12 weeks
inhibits ovulation
thickens cervical mucus
thins the endometrium
when should DMPA be started?
start in first 5 days of cycle
backup contraception for 7 days IF injection isn’t started within 5 days of cycle
how long is the delay in fertility after stopping the injection?
9 months
a/e of injection?
irregular bleeds
amenorrhea
progestin related - headaches, mood, breast tenderness
weight gain - 5 pounds in 1 year
what to do if it’s been >14 weeks since last injection?
use condoms for 7 days
what are the risks of the injection?
reduced bone mineral density in first year of use
- returns to normal after d/c
more concerning if being used by less than 18y or perimenopause
which age range is safe for the injection?
18-45yo
