contraception, pcos, testosterone therapeutics

where does fertilization occur?

in the fallopian tube

sperm can survive up to?

up to 5 days

how long does ova live up to?

ova lives up to 72 hours but is fertilizable for less

Estrogen contraindications

• pregnancy

• breastfeeding

• thromboembolism (pulmonary embolism, myocardial infraction, stroke)

• >/= 35 + smoker (>/= 20/day)

• current bp >/= 160/100

• estrogen or breast dependent cancer

• headache with focal neurological symptoms

• hepatic adenoma, undiagnosed vaginal bleeding, jaundice with pregnancy or prior use, major surgery with prolonged immobilization

Estrogen Precautions

• <21 days postpartum

• >35 and light smoker

• gall bladder disease

• history of breast cancer with no recurrence in atleast 5 yrs

• drug interaction with cyp3a4 inducers (phenytoin, phenobarbital, carbamazepines, rifampin, rifabutin, griseofulvin, nevirapine, st johns wort)

progestin contraindications

• pregnancy

• acute liver disease

• breast cancer

• undiagnosed abdominal vaginal bleeding

what types of patients can take progestin but not estrogen

• breastfeeding

• >35 and smoker

• hx of blood clots

• headaches

• high bp

special progestin

drospirinone bc it is like spironolactone and antiandrogenic

additional CI of drospirinone

hyperkalemia, avoid in kidney disease

additional DDI of drospirenone

• spironolactone

• ACEI (-prils)

• ARBS (sartans)

• triamterene

• K+ supplements

vomiting/diarrhea less than 48 hours

no further action needed

vomiting/diarrhea greater than 48 hours