Hormonal Contraceptives and Adverse Effects Quiz

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