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- drospirenone (a spironolactone analog) as progestin- acne, PMDD, PCOSGood for women c/o weight gain; K level esp. w/ ACE/ARB<1-2% Patch- changed once a week for 3 weeks then 1 week off (Estrogen Exposure)Estrogen + ProgestinCan be off for 24 hours’ max (can be taped), then use a backup method for 7 daysEffectiveness ≥198 pounds (90 kg)Check weight and BP 3 months after starting (all Estrogen+Progestin)<1-2% Nuva-Ring- worn for 3 weeks then off 1 week, suppress FSH & LHEstrogen + ProgestinDoes not need to be fitted, may be good for adolescence, no remember daily pillCan be out for 3 hours, then backup method for 7 daysPROGESTIN ONLY PILLS- Effects endometrium rendering it less suitable for implantationEndometrial decidualization and atrophyThicken Cervical MucusImpairment of normal tubal motility and peristalsisDerived from testosterone (androgen properties)- HDLCause “Breakthrough Bleeding”, for estrogen C/I, LactationDrospirenone- Potassium Sparing DiureticAdvantages- Cramps, eventually Bleeding, PMS, Breast TendernessDoes not alter quality/quantity of breast milkUsed in women w/ CV risk factorsPID & Endometrial CancerWomen who experience unacceptable estrogen S.E.GI upset, breast tenderness, LibidoC/I- Known/Suspected Breast Cancer, pregnancy, undiagnosed vaginal bleeding
Liver disease, Dx worsened by fluid retention (CHF, stenosis, pulmonary HTN)Missed Pill- Likelihood of Pregnancy (Use Backup)<1% DMPA- Primarily acts by inhibition of gonadotropin secretion, Inhibiting follicular maturation and ovulationhypoestrogenic states (endometrium receptive)New method? Start no > 15 weeks after last shotAdvantages-no change in lactation, good for CV, Cramps/Bleeding/PMSProtects against endometrial hyperplasia, PID, EP, SCD, Rx Interactions (seizure)Disadvantages- *Uterine bleeding change (irregular), weight gain, HA, nervous, dizzy, moodBreast tendernessBleeding resolves after the first few months (amenorrhea common after 3-6 months)Fertility may not return for up to 2 yearsBone Density (2 Year Black Box)C/I- Breast Cancer (Active), Liver Disease2 Year Black Box- Bone Density (immobilized adolescence, pre-puberty, OA)1-3% IUD-Paragard (Copper T380), Mirena & Skyla (levonorgestrel)Motility in fallopian tubes, moving ovum through rapidlyInflammatory effects on endometrium (interfering w/sperm/capacitation)Copper- interferes w/ estrogen uptake & inflammatory responseLevonorgestrel- thickens cervical mucus and thins endometrium (Bleeding)*Good for lactating womenSide effects- Abdominal infections/adhesions, Sepsis, cervical infection/erosion, EP, infertilityCopper- heavier/longer periods, Cramping NSAIDs help to menstrual blood lossLNg- bleeding pattern change (prolonged/unscheduled/amenorrhea/spotting)Menorrhagia, anemia, dysmenorrhea, endometriosis-painEndometrial hyperplasia, PIDContrainications- Severe distortion of uterine cavity, Active Pelvic Infection, Pregnancy, Breast CaUnexplained uterine bleedingLNG-IUD