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Hormonal Contraception

Hormonal Contraception

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Hormonal Contraception

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  1. Hormonal Contraception Considering Benefits, Risks, and Age Melissa Sanborn Advisor: Bettye Hollins, Ph. D.

  2. Objectives • Familiarize with non-contraceptive benefits • Determine risks of hormonal contraceptives • Identify patients most at risk for adverse effects • Age-related considerations • Physician Assistant Role

  3. Androgen excess disorders Seborrhea, Acne, Hirsutism, Alopecia Estrogen, antiandrogenic progestins-Estrostep, Ortho Tri-Cyclen, Yasmin, Tri Cilest Hypoestrogenic states Turner’s Syndrome, premature ovarian failure, radiation, chemotherapy, bilateral oophorectomy, and in adolescents with eating disorders and exercise-induced amenorrhea Ovarian Cancer Progestin-related; 4 yr. Use=40%↓; 12 yr. Use=60%↓ Endometrial Cancer Duration associated; 1 yr. Use=20%↓; 4 yr. Use=60%↓ Colorectal Cancer Non-contraceptive Benefits

  4. Dysmenorrhea Decreased endometrial proliferation, uterine motility & cramping from decreased flow volume & prostaglandins Menorrhagia Ovulatory dysfunction vs. nonovulatory dysfunction Endometriosis Thin endometrium and decrease menstrual flow PMS / PDD Prevent ovulation and fluctuations of ovarian steroids; provide stabile hormone levels Non-contraceptive benefits

  5. Polycystic Ovarian Syndrome & Functional Ovarian Cysts Using anti-androgenic effects of progestins Benign Breast Disease Progestin and estrogen-related Preserved Bone Mineral Density All estrogen doses Rheumatoid Arthritis Sex hormone effect on cellular immune response Non-contraceptive Benefits

  6. Protect Long-Term Fertility PID, TSS, Ectopic Pregnancy Thickens cervical mucus, thins the uterine lining Menstrual Migraines Monophasic & Extended cycling to minimize estrogen withdrawal period Prevent Pregnancy Special Populations Non-contraceptive Benefits

  7. Stroke Hypertension, Migraine, & Smoking Myocardial Infarction Age > 35 & Smoke Hypertension Controlled vs. Uncontrolled Venous Thromboembolic Disease Greatest documented risk with COCs Weigh risks of pregnancy Consider other VTE risk factors Adverse Effects

  8. Adverse Effects • Metabolic Disorder • Progestin and carb metabolism & insulin sensitivity • Liver Dysfunction • Oral and non-oral effects • Dyslipidemia • Estrogen- ↑HDL & Triglycerides, ↓ LDL • Progestin- ↓HDL & Triglycerides, ↑ LDL

  9. Adverse Effects • Development of Fibroids/Cysts • Incomplete H-P-O axis inhibition • Breast Cancer • ↑ detection & diagnosis, ↓ mortality & metastasis • Bone Mineral Density Loss • Progestin-only injections • Sexual Dysfunction

  10. Adverse Effects • Mood Disturbances • Weight Gain • Headache • Nausea • Irregular Bleeding Patterns • Breast Tenderness and Enlargement

  11. Adolescent to Young Adult • Initiation • Counseling-options, psychosocial aspects, limitations, expected side effects & follow-up, barrier method contraception • Adherence • Administration schedule and route • Tolerability • Safety in the population

  12. Young Adult to Perimenopause • Return to Fertility • OCP≅Patch≅Ring≅IUS/IUD≅Implant • DMPA has longer return to fertility • Breastfeeding • Progestin-only-timing is important • No further children desired • Choices similar to general female population, consider all options versus risks

  13. Perimenopause to Menopause • Pregnancy risks • Acceptance • Tolerability • Initiation • Continuation • Safety

  14. Role of the Physician Assistant • Appropriate selection • Management • Communication • Limitations • Instructions for Proper Use • Expected or Possible Adverse Effects • Follow Up Schedule • Resources