Contraindications
- Current or past VTE
- Ischemic or valvular heart disease
- History of CVA
- Hypertension (160/100)
- Complicated late diabetes
- Undiagnosed vaginal bleeding
- Severe cirrhosis and liver tumor
- Pregnancy
- Post-partum (hypercoagulable state)
- 21 days after pregnancy
- 42-84 days
Combined oral contraceptives
- Mechanisms
- Suppresses gonatropin secretion to prevent ovulation, endometrial atrophy prevents implantation, thickening of cervical mucus affects egg and sperm motility
- Risks
- Venous thromboembolism
- MI/stroke (high estrogen pills)
- Breast cancer
Benefits
cycle regulation, decreased flow
- Side effects
- Spotting, nausea, weight gain, mood changes
Other combined contraceptives
vaginal ring – leukorrhea, foreign body sensation, expulsion, shorter period than oral
, the patch – patch on goes arm, buttocks, thigh, side effects include skin reaction
Mini-pill
partially inhibits ovulation, thickens cervical mucus
risks – delayed fertility (9 months), decreased BMD (reversible)
must be taken at the same time every day within 3 hours, less effective than combined due to this
used when there is a contraindication to endogenous estrogen (history of VTE)
side effects – spotting, weight gain, mood disturbances
Progestin injection (depo provera)
IM injection q12 weeks
similar side effects benefits to progestin only pill
IUD: copper and progestin
Mechanisms – foreign body deters implantation, copper affects sperm motility, progestin alters cervical mucous and has weak ovulation inhibition
risks – uterine perforation (very rare), PID, expulsion, failure (increased risk ectopic if pregnancy occurs)
benefits – amenorrhea, decreased risk of endoemtrial cancer, decreased dysmenorrhea/pelvic pain