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patient factors to consider
medical conditions
medications
allergies
age
BMI
preferance/lifestyle
smoking
ae
indication for contraceptive
medical conditions requiring referal
Hx of breast cancer
severe liver disease
liver cancer
active viral hepatitis
at high risk of MI/stroke
SLE
undiagnosed vaginal bleeding
medical conditions requiring Rx for POP or LARC
diabetes with microvascular disease OR >20yrs
htn uncontrolled with SBP >160mmHg or DBP >/=100mHg
hypertension with vascular disease
medical conditions requiring Rx for POP, DMPA, LARC (not COC)
migraine w/ aura, DVT/PE risk, complicated valvular disease
medication factors to consider
CYP3A4 inducers and substrates (prob shouldn’t prescribe)
BMI factors to consider
risk with the batch BMI >30
efficacy with implant >30% IBW
smoking factors to consider
age plus # of cigs
age factors to consider
under 12 refer
implant, patch and vaginal ring not for <18
depo for <18
indications to consider
contraception, dysmenorrhea, acne, menstrual regulation, non contraceptive benefits
preferences to consider
route of admin, adherence, return to pregnancy, cost, coverage, accesibility
CHC recommendation post partum
not recommended before 6mo PP in women who are breastfeeding
**<21 days regardless of BF- not recommended
if someone has acne after being put on contraception what to do
switch to higher EE dose or progestin with less androgenic activity
if someone has bloating after being put on contraception what to do
switch progestin to dropsirenone which has weak potassium sparing diuretic effects
if someone has breast tenderness after being put on contraception what to do
switch to lower EE dose or progestin with less progestin activity
if someone has weight gain after being put on contraception what to do
switch to lower EE dose or progestin with less androgenic activity
if someone has headache after being put on contraception what to do
switch to lower EE dose or progestin with less progestin activity
if migraines develop or worsen on contraception what to do
if migraines develop or worsen, switch to progestin only
if nausea occurs as SE on contraception what to do
switch to lower estrogen dose
if someone is having early cycle breakthrough bleeding on CHC after 3mo trial what to do
switch to higher estrogen dose
if someone is having late cycle breakthrough bleeding on CHC after 3mo trial what to do
switch to a higher dose progestin or progestin which has higher progestin activity
if someone is having break through bleeding on progestin only contraception what to do
switch to low dose COCs x 1-3 cycles
add estrogen x 10-20 days (oral conjugated estrogen or estradiol)
add NSAIDs x 5-7 days
add tranexamic acid: 2-3 tabs, 3-4x a day for several days- routine use is not recommended
too much estrogen effects
nausea, breast tenderness, headache, bloating, increased BP, melasma (facial gray-brown patches)
too little estrogen effects
spotting, breakthrough bleeding early and mid cycle
too much progestin effects
breast tenderness, headache, fatigue, mood changes
too little progestin effects
breakthrough bleeding late cycle
too much androgen effects
weight gain, acne, hirsutism, increased LDL, decreased HDL
norethindrone progesterone/androgen effects
progesterone: ++
androgen: ++
ethynodiol diacetate progesterone and androgen effects
progesterone: +++
androgen: +
norgestrel progesterone and androgen effects
progesterone: +++
androgen: +++
levonorgestrel progesterone and androgen effects
progesterone: ++++
androgen: ++++
norgestimate progesterone and androgen effects
progesterone: ++
androgen: ++
desogestrel progesterone and androgen effects
progesterone: ++++
androgen: ++
drospirenone progesterone and androgen effects
progesterone: ±
POP side effects
headache
androgenic SE
menstrual cycle disturbance
IM progestin side effects
headache
acne, decreased libido, mood, nausea, breast tenderness, abdominal pain or discomfort, nervousness, dizziness and asthenia
patch side effects
breast symptoms, headache, nausea, application site reactions
ring side effects
headache, vaginitis, leukorrhea
IUD side effects
irregular bleeding or changes in amount of menstrual bleeding
implant side effects
mood swings
weight gain
headache
acne
breast pain
abdominal pain
cholasama
Note
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