Oral Ortho Evra NuvaRing DeproProvera Implanon IUD Emergency

Type Pill Transdermal Patch Intravaginal ring SQ injection Implanted rod Paraguard - copper wire Pill
- inserted in upper arm, medial
Monophasic - 1 level throughout cycle surface 6-8cm from elbow in bicep Mirena plastic
groove
Biphasic - 2 combo of EE and P

Triphasic - 3 combo of EE an P (P:

increase or stay same; EE: increase or
decrease) mimics normal cycle - best
place to start
Medication Estradiol (EE) and progestin 22 mcg EE/day 0.12 mg etonogestrel Medroxyprogesterone (P 68mg etonogestrel Paraguard - none 1.5mg levonogestrel
EE always the same, Progestin (thought to mimic serum and 0.15 mg EE only) (single dose)
CHANGES! levels of a 35 mcg pill) 104 mcg DMPA Mirena - 20mg
levonorgestrel daily
mini pill = progestin ONLY IM dose - 150 mcg (higher
dose bc absorbed quicker)
MOA EE/P - suppress release of FSH and LH Inhibit ovulation via negative Absorbed through vaginal -Transforms a proliferative Active metabolite of desogestrol; Copper wire - causes -Thickens cervical mucus,
w/out ovulation pregnancy cannot feedback mechanism on mucosa (tampons do not endometrium into a secretory 1.suppressing ovulation inflammation to prevent -MAY prevent ovulation,
occur hypothalamus, which alters ABSORB) endometrium. 2.increasing viscosity of cervical implantation -implantation if ovulation
normal secretion of FSH and -inhibits secretion of FSH and mucosa has already occurred.
EE- suppress FSH and LH, speeds ovum LH LH which prevents follicular 3.inhibiting endometrial Plastic - causes some
transport decreasing fertilization maturation, ovulation and proliferation inflammation, but also
time causes endometrial thinning. atrophies uterine lining
-Atrophy of endometrial (MORE CRAMPING)
P - suppress release of LH, suppress tissue
ovulation. thickens cervical mucosa
creates hostile environment for
implantation
Effects Progestin - androgenic activity (acts NO 1st pass effect = higher EE Lower dose Amenorrhea Weight gain Amenorrhea Migraine
like testosterone) Bypass 1st pass Weight gain Spotting Acne
MORE more acne, bloating, Deceased bone density Acne Expulsion common in 1 st
Mood changes
hirsuitism Vaginitis Decreased HDL Mood changes month Amenorrhea
Increased migraines Increased LDL Abd pain
Increased migraines Risk of CVA Increased total cholesterol cramping Abnormal uterine bleeding
Risk of CVA Blood clots Vulvovaginal infection
Blood clots HTN
HTN Mood changes
Mood changes Gallbladder disease
Gallbladder disease Acne
Acne Bloating
Bloating Hair loss/ hirsuitism
Hair loss/ hirsuitism
ACHES (abd pain, chest pain, HA, eye
problems, swelling/aching legs)
Lactation Progestin Only! NO NO Progestin only! Use with caution - enters breast Paraguard - Yes Use with caution,
(also for hx of blood clots and migrains) Jaundice and breast milk Mirena - Use with caution, enters breast milk
enlargement enters breast milk
To Know Must be taken at THE SAME TIME Worn for 3 weeks, off for 1 In place for 3 week, out When administered within 5 Inserted within 5 days of LMP Placed within 5 days of LMP Take as soon as possible
EACH DAY! for 1 days of LMP immediately immediately effective after unprotected sex
- If pill missed use backup method - Not as effective in women - if left in for 4 weeks, may effective! Provides contraception for 3
- May have irregular spotting >198 lbs. not have menses YEARS! Mirena - good for 5 years Will NOT WORK if patient
- more weight = higher dose of EE/P - more expensive - if left beyond 4 week Given every 3 months is already pregnant!!
LOW dose migrains, uterine fibroids, - can come off early = preg test before new ring - if dose is missed pregnancy Failure rate = 0.5% Can cause perforation when
heavy flow, HTN, fibrocystic breasts decreased effect insertion test is mandatory and must be inserted OTC
STARTING TIME - visible negative for injection!
Quick - regardless of cycle start, backup Start within 5 days of LMP, Check strings monthly (need
method until next cycle, highest no backup method needed. - spotting for first few months eval if cannot be felt)
breakthrough bleeding at during 1st - can be removed for up to and then AMENORRHEIC
month of start. 3 hrs. with no backup
First Day - on 1st day of next cycle, NO method needed. - not advised for women who
backup needed - if longer need backup for want to conceive in 1-2 years
Sunday - 1st Sunday after cycle start, 7 days! (long return to fertility)
need backup for 7 days
Less chance of Use beyond 2 years NOT
Breakthrough Bleeding breakthrough bleeding RECC!!
Early (1-10) - more EE
Later (10-21) - more P
Combined Hormone= Pill, Patch, Ring Progestin only = mini pill, Depo-Provera, IUD