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Contraception (Non-contraceptive Benefits (Regulation, Reduced risk of…
Contraception
Non-contraceptive Benefits
Regulation
Reduced risk of endometrial & ovarian cancer
Reduced risk of ovarian cysts, endometriosis
Less acne
Reduced overian fibroiods, nonbenign breast disease
Less blood loss, reduced cramping
Perimenopause
Increased BMD -- combo products
Iron-deficient anemia
POP Indications
Smoking <15 cigs/day
Obese >35 yo
Hx of DVT
Develop migraines on CHCs
Emergency contraception
Systemic Lupus w/ antiphospholipid antibodies, vascular complications
Use 21d postpartum if breastfeeding
Uncontrolled HTN
Unintended pregnancies
37% of pregnancies are unintended
Abortions
Socioeconomic hardship
Mental distress of parents
Fetal adverse consequences
Birth defects
Lack of appropriate supplementation
Premature birth
Low birth weight
Vitamins
Folic acid
400-900 mcg/day
Ca
1000-1500 mg/day
Iodine
220-250 mcg/day
Iron
18-30 mg/day
Missed Dose
CHC
1 missed
Take ASAP, next dose normal
2 missed
Take 1 ASAP, next dose normal
Omit second missed dose
3 missed
Take ASAP, next dose normal
Alternate protection for 7 days
If missed during 3rd week
Skip placebo
If missed during 1st week
Consider emergency contraception
PCP
Take at same time each day
If missed >3h
Take ASAP, next dose normal
Alternate protection
Patch
<48 hrs, falls off <24hr
Put on ASAP
If it falls off for <48 h, can use same patch
48 hrs, falls off >24 hr
Put on ASAP
If it falls off >48h w/o patch --> need new patch
Abstain, consider emergency conception, alternate protection
Vaginal Rings
If <3hr w/o ring
Insert new ring ASAP
No additional protection
needed
If >3hr
Insert new ring ASAP
Use backup for 7d
Consider emergency contraception
Pharmacist Role
Prescribe
CA, CO, HA, D.C., WV, NM, ID, MD, UT, OR
Patient ed
OTC options
Missed dose
Emergency Contraception
Levonorgestrel x1.5mg x1 dose (Plan B 1 step/Next Step One Dose)
3d/72h after unprotected sex
OTC
Ulipristal (Ella)
Selective progesterone receptor modulator
Rx only
120h/5d after unprotected sex
30mg x 1 dose
Which is better?
Plan B
Better tolerated & availability
Ella
More efficacious
Obesity
Increased hormonal Cl --> induction of enzymes/increased metabolic rate
Decreased efficacy
Increased adipose --> increased hormonal sequestration
Normal Cycle
Average of 28 days
3 phases
Follicular
Rising levels of hormones
GRH --> FSH (follicular maturation) --> release estradiol/inhibin
estrogen --> cervical mucus production & endometrial lining thickening
Menses from day 1-5
Luteal
Rise and decline in estrogen
Corpus luteum produces estrogen, progesterone, androgens
Pregnant
hCG keeps corpus luteum alive
Secretes estrogen & progesterone
Not pregnant
corpus luteum degenerates
Triggers menses
Ovulation
Peaks of FSH, LH, estrogen
LH surge
Follicle ruptures
CHC indications
DM
HLD