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Contraception - Coggle Diagram
Contraception
Background
Etiologies
Menstrual Cycle
-Follicular phase: FSH rises and stimulates follicle growth/development (dominant follicle will emerge); FSH allows follicle synthesis of estradiol, progesterone, and estrogen. Estradiol stops menstrual flow and thickens endometrium
-Ovulation: Elevated estradiol lvls for period of time -> LH surge from pituitary to stimulate final stages of follicular ovulation & maturation. After ovulation oocyte released goes to fallopian tube (can be fertilized & sent to embryo for implantation)
-Luteal phase: remaining luteinized follicles -> corpus luteum; corpus luteum synthesizes androgen, estrogen, progesterone; progesterone maintains endometrial lining (sustains embryo/maintains pregnancy); if no pregnancy luteum degenerates and estrogen/progesterone lvls decline, leading to eventual rise in FSH and cycle starts over
Risk Factors
Effectiveness of contraceptive hard to measure due to perfect-use failure & typical-use failure (user error)
Conception most likely 2 days before ovulation - day of ovulation
Typical Symptoms
Oral Contraceptives: most common AE is irregular bleeding; can cause weight gain/acne
-Serious AE: loss of vision, slurring of speech, severe pain in chest, neck, legs
Typical Physical Findings
Consider testing LH levels for support of EC use
Body temperature rises
Cervical mucus thins
Required Diagnostics
No medical exam or Pap smear required
Look at medical hx, BP, and discuss risks/benefits
Non-contraceptive benefits of contraception
- condoms: prevention of STIs/STDs
- hormonal contraceptives: improvements in menstrual cycle regularity, improvements in certain health conditions, managements of perimenopause
- daily use of progestin protects against endometrial cancer
Class
Emergency contraception
- first line: progestin-only and progesterone receptor modulator products: ulipristal acetate (Ella)
- copper IUD (ParaGard)
- higher doses of combined OCs (Yuzpe method)
ulipristal (Ella)
Indication/Category EC, selective progesterone receptor modulator with mixed progesterone agonist and antagonist properties
MOA delay ovulation by preventing progestin from binding to progesterone receptor; may also alter the normal endometrium, impairing implantation
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Avoid
- using in breastfeeding women
- using hormonal contraceptive method or initiating a new hormonal contraceptive for at least 5d after administration
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ADE headache, nausea, abdominal and upper abdominal pain
DDI CYP3A4 inducers and inhibitors, felbamate, griseofulvin, oxcarbazepine, topiramate
levonorgestrel (Plan B)
Indication/Category EC, progestin
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MOA thickening of cervical mucus, inhibition of ovulation from negative feedback mechanism on hypothalamus, altering endometrium
ADE fatigue, hypermenorrhea, ab pain, nausea, dizziness, headache, amenorrhea, breast tenderness
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DDI CYP3A4 inducers and inhibitors, felbamate, griseofulvin, oxcarbazepine, topiramate, protease inhibitors
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