drospirenone a spironolactone analog as progestin acne PMDD PCOS Good for women

Drospirenone a spironolactone analog as progestin

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- 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
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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
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