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Questions and Answers
What is the major effect of progestin-only contraceptive pills?
What is the major effect of progestin-only contraceptive pills?
When can a non-lactating woman start combined oral contraceptive (COC) pills after delivery?
When can a non-lactating woman start combined oral contraceptive (COC) pills after delivery?
What is the mechanism of action of progestin-only contraceptive pills?
What is the mechanism of action of progestin-only contraceptive pills?
Which adverse effect is NOT associated with hormonal contraceptive use?
Which adverse effect is NOT associated with hormonal contraceptive use?
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What is a contraindication for the use of progestin-only contraceptive pills?
What is a contraindication for the use of progestin-only contraceptive pills?
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What is the primary mechanism of action of combined oral contraceptive (COC) pills?
What is the primary mechanism of action of combined oral contraceptive (COC) pills?
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Which condition is a contraindication for contraceptive pills?
Which condition is a contraindication for contraceptive pills?
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What is the mechanism of clomiphene citrate?
What is the mechanism of clomiphene citrate?
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Which medication is an agonist in bone but has no effect on the uterus or breast?
Which medication is an agonist in bone but has no effect on the uterus or breast?
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Which group of women are advised against taking contraceptive pills?
Which group of women are advised against taking contraceptive pills?
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What effect does paraffin oil have on contraceptive pills?
What effect does paraffin oil have on contraceptive pills?
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Which group of antibiotics can cause failure of contraceptive pills?
Which group of antibiotics can cause failure of contraceptive pills?
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Which of the following is NOT a type of hormonal contraceptive?
Which of the following is NOT a type of hormonal contraceptive?
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What is the mechanism of action of combined oral contraceptive pills (COCs)?
What is the mechanism of action of combined oral contraceptive pills (COCs)?
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Which of the following is a contraindication for hormonal contraceptives?
Which of the following is a contraindication for hormonal contraceptives?
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What is the advantage of progesterone-only contraceptives (minipills)?
What is the advantage of progesterone-only contraceptives (minipills)?
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Which of the following is an adverse effect associated with stopping the use of 2-methyltestosterone?
Which of the following is an adverse effect associated with stopping the use of 2-methyltestosterone?
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What is the purpose of the 7-day break in combined oral contraceptive (COC) regimens?
What is the purpose of the 7-day break in combined oral contraceptive (COC) regimens?
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Study Notes
Hormonal Contraceptives
- Progestin-only pills (mini-pills) have a major effect on anovulation and increase the viscosity of cervical mucus, impeding sperm penetration.
- Indications for progestin-only pills: lactating women, women over 40 years old, and smokers.
Progestin-Only Pills
- Preparations: • Norethindrone (0.350mg) • Levonorgestrel (0.075mg) • Norgestral (0.030mg)
- Mechanism of action: • Thickening cervical mucus, which starts in 2-4 hours and lasts for 20-24 hours • Inhibiting ovulation
- Schedule: 1st day of menstruation, with a backup method for 7 days; 6 weeks after delivery, no backup method; missed tablet, backup method for 48 hours
- Advantages: can be used above 16 years of age, smokers, better in DM, CVS diseases, SLE, and obesity
- Disadvantages: irregular bleeding, acne, mastalgia, and amenorrhea
- Contraindications: pregnancy, breast cancer, and unexplained vaginal bleeding
Adverse Effects of Hormonal Contraceptives
- CVS: hypertension, myocardial infarction, thrombosis, and increased triglycerides
- CNS: mood changes, depression, and migraine headache
- GIT: nausea, vomiting, cholecystitis, and gallstones
- Endocrine: hyperglycemia, DM, weight gain, edema, menstrual irregularities, acne, and hirsutism
- Cancer: increased risk of breast cancer
Contraindications of Hormonal Contraceptives
- Hypertension or ischemic heart disease
- History of embolism, thrombosis, or cerebral hemorrhage
- History of breast cancer
- Migraine headache
- Diabetes mellitus
- Obesity, smokers, women above 35
- Pregnancy
- Depression
Anti-Estrogens
- Clomiphene citrate: blocks estrogen receptors in the hypothalamus and pituitary, increasing FSH and LH, stimulating ovulation
- Adverse effect: ovarian enlargement
- Selective estrogen receptor modulators (SERMs):
- Tamoxifen: estrogen antagonist in the breast, agonist in the uterus and bone
- Raloxifene: agonist in bone, no effect on uterus or breast
- Adverse effects of tamoxifen: increased risk of endometrial cancer and thrombotic complications
- Adverse effects of raloxifene: reduction in spermatogenesis after stopping, methyltestosterone is hepatotoxic
Hormonal Contraceptives: Types
- Combined preparations (most effective type): contain both estrogen and progesterone, given from the 5th day of menstruation for 21 days
- Single entity preparations:
- Progesterone alone (minipills): do not affect lactation, no risk of thrombosis, but can cause uterine bleeding
- Estrogen alone: used within 72 hours after sexual intercourse for 5 days
- Slow release progestins: medroxyprogesterone acetate (depo-provera), given I.M every 3 months, suitable for unreliable women
- Implantable progestin preparation
Combined Oral Contraceptives (COCs)
- Most effective and reversible method of fertility control
- One tablet is taken every day for 21 days, followed by a 7-day break to induce withdrawal bleeding
- Mechanism of action: negative feedback inhibition of pituitary gonadotropins (suppressing FSH and LH release)
- Estrogen and progesterone produce endometrial changes
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Description
Test your knowledge on hormonal contraceptives, their types, and associated adverse effects such as reduction in spermatogenesis and hepatotoxicity. Explore contraindications and the differences between combined preparations, single entity preparations, and progesterone-only minipills.
