1. Long-acting progestins
1.1. Implanon
1.1.1. Rods implanted in skin
1.2. Injection (Depo-Provera)
1.2.1. Can be used for endometriosis, too
1.3. MOA
1.3.1. Inhibit GnRH release
1.3.1.1. Inhibit ovulation
1.3.1.2. Endometrial thinning
1.3.1.3. Decreased E levels
1.4. SE
1.4.1. Menopausal Sx from decreased E
1.4.2. may take a while to regain fertility and normal cycle after use
2. Contraceptive Steroids
2.1. General
2.1.1. Estrogens
2.1.1.1. Ethinyl estradiol
2.1.1.2. mestranol
2.1.2. Progestins
2.1.2.1. If it has "nor" or "gest" in the name
2.1.3. MOA
2.1.3.1. E&P FB to Pit and HT to decrease release of GnRH, LH and FSH
2.1.3.2. Inhibit FSH -> prevent development of follicle
2.1.3.3. Inhibit LH -> prevent release of follicle (ovulation)
2.2. Types
2.2.1. Monophasic (combo of E&P)
2.2.1.1. Each pill in pack has same dose of E/P
2.2.2. Biphasic, triphasic (multiphasic)
2.2.2.1. Earlier in cycle don't need much P to prevent ovulation. Needs increase later in cycle
2.2.2.2. 24-day OCs
2.2.2.2.1. Yaz and Loestrin have 24 active pills
2.2.3. Transdermal, injectable, and vaginal E/P combos
2.2.4. Extended cycle OC
2.2.5. Progestin only
2.2.5.1. Mostly used for women who can't tolerate estrogens (Hx of TE, etc)
2.2.5.2. SE: LOTS of spotting and irregular bleeding
2.2.6. Postcoital (morning after)
2.2.6.1. Diethylstilbestrol (DES) is a teratogen
2.3. MOA
2.3.1. Inhibit ovulation
2.3.2. thicken cervical mucus, alter tubular transport of egg and sperm, make uterus less hospitable for implantation
2.4. PK
2.4.1. Highly lipophilic
2.4.1.1. Need higher dose in overweight (BMI > 27) women
2.4.2. Enters enterohepatic circulation
2.4.2.1. Why you can use such low doses - it just gets recycled
2.5. SE
2.5.1. Mild
2.5.1.1. Estrogen - Nausea, mastalgia, BTB, edema
2.5.1.2. Changes in serum proteins
2.5.1.2.1. Afffect endrocrine fn and will alter testing
2.5.1.3. Headache
2.5.1.3.1. But can improve PMS migraine Sx
2.5.1.3.2. Women w/ migraines w/ auras have increased risk of stroke on OC
2.5.1.4. Diuresis and hyperkalemia w/ drospirenone (similar to spironolactone)
2.5.2. Moderate
2.5.2.1. BTB, Wt gain, acne, hirsutism
2.5.2.2. Vaginal infections
2.5.2.3. increased skin pigmentation
2.5.3. Severe
2.5.3.1. TE Dz, MI, CVD
2.5.3.1.1. Risk increases w/ age and smoking
2.5.3.2. GI disorders
2.5.3.2.1. cholestatic jaundice, GB Dz, hepatic adenoma
2.5.3.3. Depression
2.5.3.4. May or may not increase risk of Ca
2.5.4. Positive: Reduced risk of
2.5.4.1. Ovarian cysts and cancer
2.5.4.2. Endometrial Ca
2.5.4.3. Benign breast Dz
2.5.4.4. Ectopic pregnancy
2.6. DD interactions
2.6.1. effects or oral anticoagulants (Wafarin d/t decreased Vit K-dep CF)
2.6.2. Barbituates, anticonvulsants (phenytoin), metronidazole, St. John's Wort induce microsomal drug-metabolizing NZs
2.6.2.1. Reduce OC efficacy
2.6.2.1.1. Use higher dose OC
2.6.3. Abx (rifampin and griseofulvin)
2.6.3.1. Reduce OC efficacy
2.6.3.2. Decrease normal gut flora needed for enterohepatic circulation
2.6.3.2.1. fall below therapeutic level of OC
3. Vaginal Spermacides
3.1. MOA
3.1.1. Nonoxynol-9 acts as surfactant to damage sperm cell membrane
3.2. SE
3.2.1. Candidiasis, increased vaginal infxns, TSS
3.2.2. Increased risk of STD infxn w/ very frequent use
3.2.2.1. Creates constant irritated state
3.3. Admin
3.3.1. Gel, cream, foam
3.3.2. Sponge
3.3.3. Suppository
4. IUD
4.1. MOA
4.1.1. Device releases copper or progestin to increase efficacy
4.1.1.1. P thickens mucus and causes endometrial changes
4.1.2. creates constant inflammatory state in uterus
4.1.2.1. Inhospitale environment for implantation
4.1.3. Does NOT prevent fertilization
4.1.4. New node
4.2. Devices
4.2.1. Progestasert
4.2.1.1. 1 year
4.2.2. Mirena
4.2.2.1. 5 years
4.2.3. Paragard T380A (copper)
4.2.3.1. 10 years
4.3. SE
4.3.1. Can affect fertility after removal
4.3.2. increased incidence of PID
4.3.2.1. delayed ability to get pregnant
4.3.2.2. Best for women who've had kids
4.3.3. Uterine rupture during implantation
5. Male Contraceptives
5.1. All experimental!
5.2. GnRH analogs
5.2.1. suppress spermatogensis
5.3. Gossypol
5.3.1. Isolated from seed of cotton plant
5.3.2. Interferes with spermatogensis
5.3.3. May produce perminant infertility
5.4. Nifedipine
5.4.1. BP med that inhibits normal sperm fn