Contraception and infertility - Treatment considerations
12 important questions on Contraception and infertility - Treatment considerations
Because it takes 7 days of hormonal pills to reach contraceptive efficacy, back up is needed for 7 days, UNLESS what?
If 1 late or missed pill (<48 hrs since last dose), is back up needed?
Acne or hirsutism patient
progestin with lower androgenic activity [norgestimate (Sprintec 28)] or no androgenic activity [drospirenone (Yaz, Yasmin)]
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Patient with estrogen contraindication (including clotting risk)
Migraine WITH AURA patient
Patient with fluid retention/bloating
Heavy menstrual bleeding (menorrhagia) patient
LNG IUD: Mirena
(COCs with only 4 placebo, instead of 7, OR continuous/extended cycles will minimize bleeding time)
Mood changes/disorder patient
Premenstrual dysphoric disorder (PMDD) patient
SSRI may be needed
Spotting "breakthrough bleeding" from too low estrogen
Later in cycle- increase progestin dose
[common when starting extended cycle or continuous; resolves 3-6 mo]
[when starting conventional forms, wait 3 cycles before switching]
If spotting "breakthrough bleeding" from too low estrogen PERSISTS
Currently taking >/= 30 mcg estrogen daily: try different progestin
If patient wants to avoid monthly cycles/menses
Alt: monophasic 28 day + skip placebo pills
The question on the page originate from the summary of the following study material:
- A unique study and practice tool
- Never study anything twice again
- Get the grades you hope for
- 100% sure, 100% understanding
