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Hormonal Contraception:Combination OCPs
Contain Synthetic Estrogen/Progestin
Modern E2Dosage 50 Mcg
Despite Diversity, Side Effects andEfficacies Similar
Requires Patient Compliance
May Be Monophasic or Triphasic
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Combination OCPs:Mechanism of Action
Suppresses LH / FSH Release
(E2 FSH, P LH)
Progestin Thickens Cervical Mucus andAlters Endometrium
Major Effect Is Anovulation and
Impairment of Sperm Transport andOcyte Implantation
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Combination OCPs:Additional Benefits
Menstrual Regulation
Decreased Risk of Anemia
Ovarian, Endometrial CA: Risk Lower PID Risk
Prevention of Benign Breast Disease
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Combination OCPs:Side Effects
Breakthrough Bleeding ( 25%)
Amenorrhea
Breast Tenderness, Nausea H/A (+/)
?HTN
?Weight Gain
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Combination OCPs:Risks
Thromboembolism ( 35 yo, Smoker)
MI (Smokers Only):
< 15 cig/day: 3X Risk > 15 cig/day : 21X Risk
Liver Adenomas (Very Rare)
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Depo-Provera:
Inhibits Ovulation
150 mg q3months (14 day grace period)
Delayed Ovulation After Discontinuation Main Side-Effects:
Amenorrhea
AUB
Weight Gain
Hair Loss
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Norplant:
Implantable for 5 Years
Similar Side Effects as Depo-Provera
Avg. Yearly Failure Rate: 0.8/100(Increases : > 2/100 after 5 years)
Occasionally Difficult to Remove
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Barrier Methods:
Diaphragm: High Failure Rates
Must Remain in ~6 Hrs post-coitus
Best if Combined with Spermicide UTI Potential
Condom: STD Protection, Inconsistent
Use by Men Female Condom: Cumbersome,
Learning Curve
Today Sponge: As seen on Seinfeld
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IUD: Overview
ParaGard (CuT380A), Progestasert
Very Effective (~ TL), Reversable
Risks OVERBLOWN Monogamy Essential, However
Does Not Protect Against STDs
Can Remain for 10 Years
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IUD:Mechanisms of Action
NOT ABORTIFACIENT!!!!!!!!
Prevents Conception:
Sperm Transport Inhibited Sperm Survival / Capacitation
Diminished
Prevents Implantation: hCG Levels = 0
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IUD:Work-up
History: STDs, Sexual History, Ectopic
PEx: Size / Configuration of Uterus
Cervical Cultures, Pap Counseling
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IUD:Contraindications
Lack of Monogomy, High Risk for STDs
Abnormal Uterine Bleeding
Current Pelvic Infection (GC, Chl) Actinomyces on Pap
???Nulliparity
Pregnancy
Wilsons Dz, Cu Allergy (both rare)
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IUD:Complications
PID: Usually 20 InsertionalContamination
Unproven Role for Prophylactic ABx
Hypermenorrhea Expulsion
Perforation (< 0.1%)
Failure: IUD Should be Removed
??Ectopic
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Emergency Contraception
IUD, OCPs
Specific OCP Regimens Given 72
Hours After Unprotected Intercourse~ 75% Effective
Yuzpe Method: Ovral 2 tabs po now and
2 tabs 120 later May Cause Nausea
Consider Dispensing at Yearly Visit
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Special Circumstances
Postpartum/Postabortion:
IUD, Progestins, Combination OCPs*
Anticonvulsant/Antibiotic Use: TCN Probably OK
Most Anticonvulsants Impair Efficacy
of Hormonal Contraceptives
* may affect lactation before milk flow established