Contraception/EC 1

beginning of the cycle

first day of bleeding/menses

follicular phase

FSH spurs follicle developement and cuases estrogen to surge. Estrogen peaks by the end of this phase- signaling LH and FSH to increase

Ovulatory phase

LH surge triggers ovuation 24-36 hrs later. Egg/ova is released from the ovary

Luteal phase

start of ovulation begins last phase; corpus luteum develops in the ovaries. lasts ~14 days. progesterone is dominant in this phase

role of estrogen and progesterone

cause endometrium to thicken and prepare for an embyro

how long does an oocyte live once release

24 hrs

how long does sperm live once released

3d

ovulation tests detect what surge of hormone in the urine

LH

how long after the LH surge should a woman wishing concieve have intercourse

During surge and following 2 days

when is hCG the highest/should you test the urine?

firs urine in the morning

how much folate does a normal person need vs prenatal dosing

400mcg vs 600mcg/d

folic acid/folate/vitamin b9 deficiency leads to what in fetus

neural tube defects

only reversible contraeptive method that has a delay in return to fetility

medroxyprogesterone injection

preferred contraceptive method for women in teens-20s

hormonal contraception

preferred contraceptive method for women >35 yrs

sterilixation

OTC contraceptive methods (foams, films, creams, supp, sponges and jellies) have what spermacide

nonoxynol-9

prescription only vaginal gel

Phexxi

phexxi moa

maintains acid ph (range 3.5-4.5) which is inhospitable to sperm, reduces mobility

monphasic cocs

same dose of estrogen oan progestin throughout the pill back

dosprienone

progestin tahts also a mild potassium sparing diuretic; decreases bloating, pms symptoms and weight gain. less anti-androgenic activity

progestins with low androgenci activity

norgestimate, desogestrel and dienogest

first line for endometriosis

COCs

what agent is approved for severe pain assaitioned wtih endometriosis

elagolix/orilissa

agents indicating for heavy menstrual bleeding

NATAZIA (COC), Mirena (levonorgestrel releasing IUD)

indicated for heavy menastrual bleedign associated with uterine fibroids but not a contraceptive

oriahnn (estradiol, norethindrone, elagolix)

POP (acronym)

progestin-only pills

COC (acronym)

combination oral contraception

CHC (acronym)

combined hormonal contraceptive

What population are POPs preferred in

breastfeeding women (estrogen lowers breast milk)

how soon postpartum can POPs be started

3-6 weeks

which is preferred in patients with migraines with aura

POPs (estrogen is a stroke risk)

POPs adherence needs

within 3 hrs of scheudled dose

what contraception has the highest clotting risk

patches (higher systemic exposure)

when should patches be avoided

patients >35 who smoke, patients with cv disease of hx blood clots, postpartum clots, BMI >30 (less effective or increased risk of clots)

injectable has what progestin in it

depot medroxyprogesterone acetate (DMPA)

emergency contraceptive options

copper IUD, ulipristal acetate, levonorgestrel

how soon must ulipristal acetate/ella be taken after sex

within 5 days (asap)

how soon must lelvonorgestrel/plan b be taken after sex

3 days (asap)- may have some efficacy up to 5 days

levonorgestrel dosing

1.5mg x 1 dose

levonorgestrel side effects

nausea, vomiting

levonorgestrel moa

thickening cervical mucus and preventing/delaying ovulation

ulipristal relation to mifepristone/mifeprex

chemical cousins

ulipristal/ella moa

prevents delays ovulation; may alter the endometrium to impair implantation

ulipristal/ella dose

30mg x 1 d

ulipristal counseling

cannot be used within 5 days of POPs (makes less effective); can only use once during cycle; may need a barrier method for rest of cycle