Podcast
Questions and Answers
Which of the following is a common side effect of high-dose estrogen therapy?
Which of the following is a common side effect of high-dose estrogen therapy?
What is the YUZPE method for emergency contraception?
What is the YUZPE method for emergency contraception?
What is the primary mechanism of action of tamoxifen?
What is the primary mechanism of action of tamoxifen?
Which of the following drugs can reduce the efficacy of tamoxifen?
Which of the following drugs can reduce the efficacy of tamoxifen?
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What is the primary adverse effect of raloxifene?
What is the primary adverse effect of raloxifene?
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What is the primary mechanism of action of clomiphene?
What is the primary mechanism of action of clomiphene?
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Which type of contraceptive is less effective in women weighing over 90 kg?
Which type of contraceptive is less effective in women weighing over 90 kg?
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Which contraceptive method involves subdermal placement in the upper arm for three years?
Which contraceptive method involves subdermal placement in the upper arm for three years?
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Which medication, if continued for more than two years, can predispose patients to osteoporosis and/or fractures?
Which medication, if continued for more than two years, can predispose patients to osteoporosis and/or fractures?
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Which contraceptive is known as the 'Mini-Pill' and used in breastfeeding patients with no effect on milk production?
Which contraceptive is known as the 'Mini-Pill' and used in breastfeeding patients with no effect on milk production?
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Which contraceptive is inserted in the vagina and left for three weeks before removal?
Which contraceptive is inserted in the vagina and left for three weeks before removal?
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Which hormonal contraceptives mimic hormonal changes during the cycle?
Which hormonal contraceptives mimic hormonal changes during the cycle?
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Study Notes
Hormonal Contraceptives
- Side effects of hormonal contraceptives: nausea, breast tenderness, headache, skin pigmentation, depression, weight gain, acne, hirsutism
- Ulipristal: an emergency contraceptive taken within 5 days of unprotected intercourse
- Yuzpe method: ethinyl estradiol (50 mcg) + levonorgestrel (0.25 mcg)
Anti-Estrogens and Anti-Progestins
- Selective Estrogen Receptor Modulators (SERMs): mixed estrogen agonists
- Tamoxifen: treatment of hormone-responsive breast cancer, antagonist of estrogen receptor in the breast, agonist of estrogen receptor in the endometrium
- Side effects of tamoxifen: hot flushes, venous thrombosis
- Drugs that reduce the efficacy of tamoxifen: amiodarone, haloperidol, risperidone
Raloxifene
- Prevention and treatment of osteoporosis in postmenopausal women
- Antagonist effects in breast tissue, no estrogenic effect on endometrial tissues
- Adverse effects: hot flushes, leg cramps, increased risk of venous thrombosis
Bazedoxifene
- Treatment of menopausal symptoms, prophylaxis of post-menopausal osteoporosis
- Combines with conjugated estrogens
Clomiphene
- Partial agonist of estrogen receptor, induces ovulation
- Blocks estrogen receptor in pituitary, leading to increased FSH and LH
- Treatment of infertility
- Adverse effects: headache, nausea, vasomotor flushes, visual disturbances, ovarian enlargement, risk of multiple gestation
Osphena
- Treatment of dyspareunia (painful intercourse) related to menopause
- Stimulates endometrial growth, consider progesterone in women with uterus
Hormonal Contraceptives
- Types: oral, injections, SQ implants, transdermal patches, vaginal rings, intrauterine devices (IUDs)
- Oral contraceptives:
- Monophasic preparations: constant dose of estrogen and progestin
- Combination preparations:
- Biphasic: constant dose of estrogen, increasing dose of progestin
- Triphasic: constant dose of estrogen, increasing dose of progestin
- Quadriphasic: dose changes during the month (both estrogen and progestin)
Transdermal Patches
- Ethinyl estradiol + norelgestromin
- Patch worn for three weeks, no patch on the fourth week
- Less effective in women >90 kg
Vaginal Rings
- Ethinyl estradiol + etonogestrel
- Ring inserted in the vagina and left for three weeks
- After three weeks, remove the ring
Progestin-Only Pills
- Norethindrone, used in breastfeeding patients
- No effect on milk production
- Less effective than OCP
- Irregular menstrual cycles
Injectable Progestin
- Medroxyprogesterone acetate
- If continued for more than two years, predisposes to osteoporosis and/or fractures
Progestin Implants
- Etonogestrel
- Subdermal placement in the upper arm
- Contraception for three years
- Adverse effects: irregular menstrual bleeding, headaches
Progestin IUD
- Levonorgestrel-releasing IUD
- 3-5 years of contraception
- Highly effective treatment for heavy menstrual bleeding
- Contraindication: pelvic inflammatory disease, history of ectopic pregnancy
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Description
Test your knowledge on different types of hormonal contraceptives including oral, injections, implants, patches, rings, and intrauterine devices. Learn about the three types of oral contraceptives - monophasic, combination, and progestin-only preparations.
