Contraception - Dr. Taylor

What is estrogen's primary contraceptive action in combined hormonal contraception?

Suppresses FSH and LH to inhibit ovulation.

What are the three key progestin contraceptive actions?

Suppresses LH, thickens cervical mucus, and thins the endometrium.

Which contraception routes contain both estrogen and progestin?

Combined oral pills, transdermal patches, and vaginal rings.

Which brands are combined contraceptive patches, and what is their schedule?

Xulane, Zafemy, Twirla; new patch weekly for 3 weeks, then 1 patch-free week.

Which brands are combined vaginal rings, and what is their schedule?

NuvaRing and Annovera; ring in for 3 weeks, then out for 1 week.

How do NuvaRing and Annovera differ in reuse?

NuvaRing is discarded after one cycle; Annovera is reused for 13 cycles (about 1 year).

How do monophasic, biphasic, and triphasic combined OCPs differ?

Monophasic has constant hormone doses; biphasic changes the hormone ratio once; triphasic changes it twice.

What three fertility-awareness methods are identified in Taylor's lecture?

Standard Days, Temperature Rhythm, and Cervical Mucus Rhythm.

What distinguishes extended-cycle from continuous-cycle pills?

Extended-cycle regimens have less frequent or shorter placebo intervals; continuous-cycle regimens have no placebo interval.

What are the three combined-OCP initiation approaches in the lecture?

Quick start (today), first-day start (first day of menses), and Sunday start (Sunday after menses begins).

What backup does Taylor's lecture advise after starting a combined OCP, patch, or ring?

Use additional contraception or abstain for 7 days.

How is one missed combined-OCP active tablet managed according to the lecture?

Take 2 tablets the next day.

How are two or more missed combined-OCP active tablets managed according to the lecture?

Take 1 tablet ASAP, discard other missed tablets, and use backup for 7 days; check product instructions.

Which combined-hormonal adverse effects often improve by the third cycle, and what vital sign is important to monitor?

Mild nausea, breast tenderness, headaches, and irregular bleeding often improve; monitor blood pressure.

What serious adverse effects are emphasized for estrogen-containing contraception?

VTE (DVT/PE), MI, and stroke; assess concerning symptoms urgently.

Which migraine history rules out combined hormonal contraception in Taylor's lecture?

Migraine with aura.

What smoking pattern makes combined hormonal contraception contraindicated?

Age 35 or older with heavy smoking, particularly 15 or more cigarettes daily.

What blood-pressure level is a contraindication to combined hormonal contraception?

Severe hypertension, approximately 160 systolic or 100 diastolic mmHg.

Name three other major combined-hormonal contraindication patterns from the lecture.

Current/past DVT or PE, major surgery with prolonged immobilization, and current breast cancer (among others).

Which enzyme-inducing drugs on the lecture's interaction slide can reduce hormonal contraceptive effectiveness?

Carbamazepine, phenytoin, phenobarbital, rifampin, and St. John's wort.

Why is changing from a combined pill to a patch or ring not a solution to carbamazepine interactions?

These methods still provide systemic hormones whose effectiveness can be reduced by enzyme induction.

Which contraceptive methods avoid clinically significant CYP-inducer interactions in Taylor's lecture?

Levonorgestrel IUD or copper IUD; DMPA is another option when an IUD is declined.

Which drugs can increase combined contraceptive concentrations according to the lecture?

Azole antifungals, clarithromycin/erythromycin, and verapamil/diltiazem (among listed examples).

Which combined OCP brand is highlighted for PMDD, and what are its components?

Yaz; drospirenone plus ethinyl estradiol.

What are the three POP generic/brand pairings emphasized?

Drospirenone-Slynd, norgestrel-Opill (OTC), and norethindrone-multiple brands.

How do norethindrone/Opill versus Slynd tablet schedules differ?

Norethindrone and Opill have 28 active pills; Slynd has 24 active and 4 placebo pills.

What backup is advised on starting a traditional progestin-only pill in the lecture?

48 hours.

A patient takes norethindrone more than 3 hours late. What do you advise?

Take the missed pill and use backup for 48 hours.

How is Slynd's missed-dose window different from norethindrone's in the lecture?

Slynd (drospirenone) has a greater-than-24-hour missed-dose threshold and is managed like a combined OCP; norethindrone has a greater-than-3-hour threshold.

Which laboratory risk is especially important with Slynd plus spironolactone or an ACE inhibitor?

Hyperkalemia; assess serum potassium risk.

What advantages do POPs have over combined hormonal contraceptives in patients avoiding estrogen?

Minimal effect on clotting and blood pressure and no impairment of milk production during lactation.

What generic, brands, routes, and schedule identify DMPA?

Depot medroxyprogesterone acetate: Depo-Provera IM or Depo-SubQ Provera 104 SQ every 3 months.

When does starting DMPA require 7 days of backup per lecture?

When started after cycle day 7; days 1-7 require no backup.

A patient is over 15 weeks from the last DMPA injection. What does the lecture advise?

Pregnancy screen and restart precautions, including 7 days of backup.

What DMPA adverse effects and duration warning should you recall?

Weight gain, irregular bleeding, decreased BMD, delayed fertility; reassess use beyond 2 years unless alternatives are unsuitable.

Which contraceptive has a notably delayed return to fertility, and by how long in the lecture?

DMPA; up to about a year, versus about 1-2 cycles for most other methods.

What generic drug, location, and lecture duration identify Nexplanon?

Etonogestrel subdermal upper-arm implant; 3 years in Taylor's slides.

When does starting Nexplanon require backup in the lecture?

Insertion after cycle day 5 requires 7 days of backup; insertion on days 1-5 requires none.

Why might carbamazepine compromise Nexplanon but not a levonorgestrel IUD?

Nexplanon releases systemic etonogestrel affected by enzyme induction; the IUD acts predominantly locally.

Match the four levonorgestrel IUD brands to Taylor's listed durations.

Mirena 8 years; Liletta 6 years; Kyleena 5 years; Skyla 3 years.

Which IUD is completely hormone-free, and how long does Taylor list it for?

Paragard, a copper IUD; 10 years.

What is the backup rule for a levonorgestrel IUD in the lecture?

No backup if inserted on cycle days 1-7; otherwise 7 days of backup.

How do hormonal versus copper IUDs differ in menstrual effects?

Hormonal IUDs may reduce bleeding; copper IUDs may worsen menorrhagia and dysmenorrhea.

What IUD-related contraindications or risks should a case prompt you to check?

Active pelvic infection/STI before insertion; insertion pain, infection, perforation, or expulsion; active breast cancer for hormonal IUDs.

How does Taylor manage a patch that has fallen off for less than 24 hours versus more than 24 hours?

Less than 24 hours: reapply same/new patch; more than 24 hours: start new patch and use backup 7 days.

What are the lecture's ring-expulsion cutoffs and backup rule?

NuvaRing more than 3 hours out and Annovera more than 2 hours out: reinsert/restart and use backup for 7 days.

Which condoms protect against STIs, including an option for latex sensitivity?

Latex external condoms and polyurethane internal condoms protect; lamb-intestine condoms do not protect against STIs.

How long must a diaphragm, sponge, and Lea's Shield remain after intercourse?

Diaphragm 6 hours; sponge 6 hours; Lea's Shield 8 hours.

What is Phexxi made of, how does it work, and when is it used?

Lactic acid, citric acid, potassium bicarbonate; maintains acidic vaginal pH; use within 1 hour before intercourse; no STI protection.

Match emergency contraception products to generics and lecture timing windows.

Plan B One-Step/My Way = oral levonorgestrel within 72 hours; Ella = oral ulipristal within 120 hours; Paragard and Mirena/Liletta IUDs = within 120 hours.