Progestin Only Pills (POPs)

-Progestin-only pills (POPs) (Norethindrone in the USA and desogestrel outside of the USA) are one option for women who cannot or prefer not to use estrogen-containing contraception.

-The pills are dispensed in packs of 28 active pills, which are taken continuously.

-The progestin dose is substantially lower than the dose in any combination oral contraceptive.

-it is essential that the pill be taken at the same time each day to maximize contraceptive efficacy.

Mechanisms of Action:  thickening cervical mucus to inhibit sperm migration, suppressing ovulation, lowering the midcycle peaks of follicle-stimulating hormone and luteinizing hormone, slowing movement of an egg through the fallopian tubes, and thinning the endometrium.

-Typical failure rate: 9 percent

-Most common side effects of POPs: unscheduled bleeding, changes in menses

Contraindications:

Pregnancy

Breast Cancer

Abnormal uterine bleeding

Liver tumors, cirrhosis

Noncontraceptive benefits of POPs

lighter menstrual bleeding

reduced iron deficiency anemia

protection against endometrial cancer

reduction in risk of upper genital tract infections

-Only POP available in the United States: Norethindrone

Initiation: On the first day of menses. Use backup contraception (eg, condoms) if the patient starts POPs more than five days from the onset of menses.

Question: Can you use a POP in a patient taking lamotrigine? Yes

Combined estrogen-progestin oral contraceptives (COCs)

-Estrogen used in most COCs: Ethinyl estradiol

-Most available progestins have both progestogenic and androgenic activity

-Mechanism of action: Suppression of GnRH, pituitary gonadotropin secretion; Inhibition of the midcycle luteinizing hormone (LH) surge, preventing ovulation; making endometrium less suitable for implantation.

-Typical-use failure rate: 8 percent

-Hormonal contraception can be continued until the age of menopause (average age 50 to 51 years) in healthy, nonsmoking, normal-weight women

-COC use has been associated with increased risks of myocardial infarction, hypertension,stroke, increase risk of venous thromboembolism.

-Contraindications for COC initiation:

Migraines with aura

Age > 35 years

Smoking

Hypertension

Venous thromboembolism

Known thrombogenic mutations

Ischemic heart disease or severe valvular heart disease

History of stroke

Current breast cancer

Liver cancer or cirrhosis

Non-Contraceptive Benefits of COCs: improves abnormal uterine bleeding, premenstrual syndrome, dysmenorrhea, painful ovarian cysts, acne, hirsutism, polycystic ovary syndrome,bone density, reduces the risk of endometrial and ovarian cancer;

Don’t Get Confused: COCs and Cancer: They increase the risk for developing cervical cancer; They reduce the risk of developing ovarian and endometrial cancers. Overall, the pill is not associated with an increased risk of cancer.

Initiation: COCs can be started anytime during the cycle after excluding the pregnancy.

Quick Start method: begin taking COCs on the day she is given the prescription.

Sunday Start method: start the pill on the first Sunday after her period

-Drugs which decrease the efficacy of a COC: Phenobarbital, Phenytoin,topiramate, primidone Griseofulvin, Rifampin

-Only antibiotic proven to decrease serum ethinyl estradiol and progestin levels in women taking COCs: Rifampin

కయీను: డాక్టర్ పాల్ కట్టుపల్లి సందేశం