PHRD 603: Contraceptives

3 types of emergency contraceptives

Copper IUD

Ulipristal acetate (ella)

Levonorgestrel 1.5 mg (Plan B One-Step)

Copper IUD EC Effective Duration

Within 5 days

Ulipristal acetate (Ella) EC Effective Duration

Within 5 days

Levonorgestrel (Plan B One-Step) EC Effective Duration

Within 3 days

Ulipristal acetate brand

Ella

Ulipristal acetate dosing

30 mg x 1 dose

Levonorgestrel brand

Plan B One-Step

Levonorgestrel dosing

1.5 mg x 1 dose

Ulipristal acetate MOA

Delays ovulation, may prevent implantation

Levonorgestrel MOA

Prevents or delays ovulation, thickens cervical mucus

Excess estrogen

Nausea

Breast tenderness

Headache

Bloating

Increased blood pressure

Melasma (dark patches on face)

Excess progestin

Breast tenderness

Headache

Fatigue

Mood changes

Increased androgenic activity

Weight gain

Acne

Hirsutism

Increased LDL, Decreased HDL

Estrogen deficiency

Spotting

Breakthrough bleeding (early cycle)

Progestin deficiency

Breakthrough bleeding (late cycle)

A in ACHES

Abdominal pain (severe) - gallbladder disease, hepatic adenoma, blood clot, pancreatitis

C in ACHES

Chest pain (severe), shortness of breath, coughing up blood - blood clot in lungs or MI

H in ACHES

Headache (severe), dizziness, weakness, numbness - Stroke, HTN, migraine

E in ACHES

Eye problems (vision loss or blurring), speech problems - stroke, HTN, temporary vascular problem

S in ACHES

Severe leg pain (calf or thigh) - blood clot in legs

Aubra generation

2nd

Loestrin-21 1/20 generation

1st

Lo/Ovral-28 generation

2nd

Desogen generation

3rd

Yasmin generation

4th

Ortho-cyclen generation

3rd

Nextstellis generation

4th

Ortho Tri-Cyclen Lo generation

3rd

Cyclessa generation

3rd

Ortho-Novum 7/7/7 generation

1st

Natazia generation

4th

2nd generation common side effects

Weight Gain

Hirsutism

Acne

4th generation important side effect

Hyperkalemia

How to treat late cycle breakthrough bleeding

Increase progestin

How to treat early cycle breakthrough bleeding

Increase estrogen

How do combined oral contraceptives (COCs) work?

1. Inhibits ovulation

2. Thickens cervical mucus

3. Thins uterus lining

Contraindications for COCs

Current breast cancer

Smokes 15+ cigarettes per day and age 35+

Migraines with aura for any age; migraines without aura and age 35+

Hx/risk of DVT and PE and not on anticoagulation

Thrombogenic mutations

Major surgery leading to prolonged immobilization

Uncontrolled HTN (160+ systolic, 100+ diastolic)

COC 1 late/missed pill (within 48 hours of last dose)

Take as soon as possible and take next dose on schedule even if 2 pills/day

No backup contraception needed

COC 2 missed pills (over 48 hours since last dose)

Take as soon as possible and take next dose on schedule even if 2 pills/day

Backup contraception for 7 days

EC can be used

POPs missed dose

If late more than 3 hrs, take as soon as possible and take next dose on schedule

Backup contraception for 48 hrs

EC can be used

Paragard Copper T IUD duration

10 years

Miudella Copper IUD duration

3 years

Liletta duration

8 years

Mirena duration

8 years

Kyleena duration

5 years

Skyla duration

3 years

G0P0

0 pregnancies, 0 deliveries

G1P0

Currently pregnant, not yet delivered

G1P2

Delivered 2 babies

Contraceptive patch is CI in patients with…

BMI over 25