- drospirenone (a spironolactone analog) as progestin- acne, PMDD, PCOS
Good 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 + Progestin
Can be off for 24 hours’
max (can be taped), then use a backup method for 7 days
Effectiveness ≥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 & LH
Estrogen + Progestin
Does not need to be fitted, may be good for adolescence, no remember daily pill
Can be out for 3 hours, then backup method for 7 days
PROGESTIN ONLY PILLS
- Effects endometrium rendering it less suitable for implantation
Endometrial decidualization and atrophy
Thicken Cervical Mucus
Impairment of normal tubal motility and peristalsis
Derived from testosterone (androgen properties)-
HDL
Cause “Breakthrough Bleeding”, for estrogen C/I, Lactation
Drospirenone- Potassium Sparing Diuretic
Advantages
-
Cramps, eventually
Bleeding,
PMS,
Breast Tenderness
Does not alter quality/quantity of breast milk
Used in women w/ CV risk factors
PID & Endometrial Cancer
Women who experience unacceptable estrogen S.E.
GI upset, breast tenderness,
Libido
C/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 ovulation
hypoestrogenic states (endometrium
receptive)
New method? Start no > 15 weeks after last shot
Advantages-
no change in lactation, good for CV,
Cramps/Bleeding/PMS
Protects against endometrial hyperplasia,
PID,
EP,
SCD,
Rx Interactions (seizure)
Disadvantages
- *Uterine bleeding change (irregular), weight gain, HA, nervous, dizzy,
mood
Breast tenderness
Bleeding resolves after the first few months (amenorrhea common after 3-6 months)
Fertility may not return for up to 2 years
Bone Density (2 Year Black Box)
C/I- Breast Cancer (Active), Liver Disease
2 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 rapidly
Inflammatory effects on endometrium (interfering w/sperm/capacitation)
Copper- interferes w/ estrogen uptake & inflammatory response
Levonorgestrel- thickens cervical mucus and thins endometrium (
Bleeding)
*Good for lactating women
Side effects-
Abdominal infections/adhesions, Sepsis, cervical infection/erosion, EP, infertility
Copper- heavier/longer periods,
Cramping
NSAIDs help to
menstrual blood loss
LNg- bleeding pattern change (prolonged/unscheduled/amenorrhea/spotting)
Menorrhagia, anemia, dysmenorrhea, endometriosis-pain
Endometrial hyperplasia, PID
Contrainications- Severe distortion of uterine cavity, Active Pelvic Infection, Pregnancy, Breast Ca
Unexplained uterine bleeding
LNG-IUD
