Contraception

Margaret Sanger, Katherine McCormick

Who designed the first birth control bill (Enovid) that was made from barbasco root?

Birth control league

What was the OG name for planned Parenthood?

Ernst Grafenberg

Who found the G-spot (scientifically speaking)?

“Pseudo-pregnancy”

MOA for Enovid (Mestranol (pre-ethinyl estradiol) + Norethinodryl)

Norethindrone (the mini-pill)

In the mid-1970s what was proven to stop ovulation?

Norethindrone, norethindrone acetate, norethinodryl, norgestral, levonorgestrel, desogen

As some drug companies worked on Norethindrone, others developed different progestins what did this lead to?

history of HTN (unless well controlled), smoker, age, hx of migraines with aura

What are the most common C/I for birth control?

BOTH progesterone and estradiol

Reminder pills, patches, and rings contain

regulate menses, decrease heavy bleeding/cramps, decrease ovarian cyst formation, decrease acne

What are the PROs for combined OCPs

Sore breast, Nausea, spotting, decreased sex drive, slightly increased risk of blood clot

What are the CONs for combined OCPs

99.7% (perfect use); 93% (typical use)

How effective are combined OCPs

Norethindrone (Micronor), Drospirenone (Slynd - more expensive), Opill (Norgestrel - OTC)

What are the 3 types of progesterone ONLY medications in the US?

thicken cervical mucus, inhibits sperm migration, suppresses ovulation (not consistently)

Progesterone Only birth control MOA

unscheduled bleeding, menstrual changes

Compared with OCPs, POPs have a higher frequency of

Suppression of ovulation (inhibits GnRH), stabilizes the endometrium production to maintain a regular withdrawal bleeding pattern (cycle control), thickens cervical mucous, impairs normal tubal motility and peristalsis, endometrial decidualization and eventual atrophy

MOA for OCPs

Anything under 50 mcg (most are 20-35 mcg/day)

What is considered LOW dose for ethinyl estradiol

Monophasic

Which type of OCP am I describing - the same dose of ethinyl estradiol for 3 weeks and then a placebo (most studied)

Biphasic

Which type of OCP am I describing - lower ratio of estrogen/progestin during the 1st half and higher dose during the second half of the cycle

Triphasic

Which type of OCP am I describing - the dose of ethinyl estradiol and progesterone changes every 7 days

unpredictable bleeding/spotting events are more frequent due to atrophic, thin endometrium (7 day breaks are recommended every 84 days)

What is the biggest disadvantage of continuous pills?

Seasonique/Loseasonique (91 day), Amethyst/Lybrel (365)

What are some examples of continuous/extended pills?

OrthoEvra (Xulane - change every week, use in different areas), Twirla (less estrogen, decreased efficacy in women with BMI 25+)

What are some examples of Patch Combined Contraceptives?

Nuva Ring (last 5 weeks), Annovera (last 1 year)

What are some examples of RING based contraceptives?

No intercourse since last normal menses, correctly/consistently using a reliable method of contraception, within 7 days from 1st day of menstrual bleeding, within 4 weeks postpartum (breast feeding), within first 7 days of miscarriage/postabortion, fully/nearly fully breastfeeding, amenorrheic, and less than 6 months post partum

Checklist BEFORE placing an IUD (for sure) and starting birth control

Depo-Provera (IM, SQ)

What is an injectable form of birth control (dosed 1x every 13 weeks)

6% (typical use), 0.2% (perfect use),

Failure rate of Depo

Less blood loss (anemia), fewer corpus luteum cyst, amenorrhea at 1 year (50%) or 5 years (80%), decreased cramps, pain, ovulation; improvement with endometriosis, decreased seizuress

Pros of Depo

Progressive weight gain, irregular bleeding, return visits, slow return to baseline fertility (10 months), BBW for skeletal concerns

Cons of Depo

Nexplanon Implant

A progestin only birth control that is placed in the upper arm and is 99.95% effective (tippy top) that last 3 years

thickens cervical mucus, decreases tubal mobility, inhibits gonadotropin secretion

MOA for Nexplanon

Changes in bleeding pattern (most common reasons), possible migration (seen on x-ray)

ADRs for Nexplanon

Silk intrauterine rings (3.2% failure), 600 Silver rings (1.6% failure), spiral shaped (Margulies -1960), T-shaped (tatum - 1969), Dalkon Shield (1971 - increased risk of PID, Sepsis, infertility)

What are some examples of OG IUDs?

Copper T (paraguard - 1988), Mirena (2001), Skyla (2013), Kyleena (2016), Miudella (2025)

What are the current IUDs that we are rocking with?

Paragard

A hormone free IUD that is approved for 10 years and is 99% effective (MOA - acts as a spermicide and prevents implantation)

Effective and easy to use; Heavier cycles

Pros and Cons to paragard

Miudella

A hormone free IUD made up of a flexible nitonol frame approved for 3 years and is 99%

Mirena, Liletta

Which IUD contains 52 mg levonorgestrel and is approved for 8 years (99% effective) - acts by thickening cervical mucus, preventing implantation, and changes in uterotubal fluid

Decreased bleeding (20% amenorrhea), may reduce risk of cervical/ovarian cancer, approved for AUB; Unscheduled spotting/bleeding, expulsion risk (3-6% in the first year), uterine perforation

Pros and Cons of Mirena, Liletta

Anatomic abnormality of the uterus, pregnancy, current PID, recent postpartum endometritis, vaginal bleeding of unknown cause, GYN malignancy

C/I for Mirena, Liletta

Skyla (3 years), Kyleena (5 years)

Which IUDs are similar to Mirena/Liletta but are smaller and contain lower doses and have less frequent rates of amenorrhea?

Nestorone/testosterone gel (once-daily gel)

What are some forms of male birth control that we are currently working on?