Contraceptives


Contraindication for Contraceptive use Migraine w/ Aura (increase risk of stroke) - Ortho Evra Patch is the worst
- Alternative: Copper IUD or Progesterone Only (Merina, Nexplanon, Ortho-micronor)
Other Contraindication:
- Smokers over age 35
- Severe hypertension
- Migraine with aura
- Stroke
- Valvular heart disease with complications
- Diabetes mellitus with complications
- familial tendency to form blood clots (such as familial factor V Leiden)
- Severe obesity and/or hypercholesterolemia (high cholesterol level)
- Liver tumors, hepatic adenoma or severe cirrhosis of the liver
- Cholestatic jaundice of pregnancy or jaundice with previous oral contraceptive pill use
- known or suspected breast cancer or endometrial Cancer
- Undiagnosed abnormal genital bleeding
- Systemic lupus erythematosus with antiphospholipid antibodies
 
Best contraceptives for obese women Depot medroxyprogesterone acetate
Combination contraceptive vaginal ring
Contraceptives that increase risk of Hyperkalemia Drospirenone containing OCP
Low-dose estrogen oral contraceptives - At least a 50% lower risk of subsequent epithelial ovarian cancer than women who have never used them.
- long-term benefits of oral contraceptives, including a reduced risk of postmenopausal fractures, as well as reductions in the risk of endometrial and colorectal cancers.
- Oral contraceptives do not reduce the risk of carcinoma of the breast, cervix, lung, or head and neck



 

Guidelines for Prescribing Contraceptives in Women with Comorbidities

COMORBIDITY OR RISK FACTOR METHODS TO CONSIDER METHODS TO AVOID

Depression

Combination OCPs; Depo-Provera (long-acting injectable); Implanon (single-rod implantable device); Mirena (levonorgestrel-containing intrauterine system); Nuvaring (ring); Ortho Evra (patch); progestin-only OCPs

Diabetes mellitus with complications

Depo-Provera; Implanon; Mirena; progestin-only OCPs

Combination OCPs; Nuvaring; Ortho Evra

Epilepsy treated with medications that induce hepatic enzymes:

Depo-Provera; Mirena

Combination OCPs; Implanon; Nuvaring; Ortho Evra; progestin-only OCPs

 

Carbamazepine (Tegretol); lamotrigine* (Lamictal); oxcarbazepine (Trileptal); phenobarbital; phenytoin (Dilantin); primidone (Mysoline); topiramate (Topamax; more than 200 mg per day)

Epilepsy treated with medications that do not induce hepatic enzymes:

Combination OCPs; Depo-Provera; Implanon; Mirena; Nuvaring; Ortho Evra; progestin-only OCPs

 

Acetazolamide; benzodiazepines; ethosuximide (Zarontin); gabapentin (Neurontin); levetiracetam (Keppra); pregabalin (Lyrica); tiagabine (Gabitril); valproic acid† (Depakene); vigabatrin (Sabril); zonisamide (Zonegran)

History of bariatric surgery (malabsorptive procedure)

Depo-Provera; Implanon; Mirena; Nuvaring; Ortho Evra

Combination OCPs; progestin-only OCPs

History of bariatric surgery (restrictive procedure)

Combination OCPs; Depo-Provera; Implanon; Mirena; Nuvaring; Ortho Evra; progestin-only OCPs

History of VTE/pulmonary embolism

Depo-Provera; Implanon; Mirena; progestin-only OCPs

Combination OCPs; Nuvaring; Ortho Evra

Inflammatory bowel disease (mild)‡

Combination OCPs; Depo-Provera; Implanon; Mirena; Nuvaring; Ortho Evra; progestin-only OCPs

Migraine headaches with aura

Depo-Provera; Implanon; Mirena; progestin-only OCPs

Combination OCPs; Nuvaring; Ortho Evra

Poorly controlled hypertension

Depo-Provera; Implanon; Mirena; progestin-only OCPs

Combination OCPs; Nuvaring; Ortho Evra

Rheumatoid arthritis (in patients taking immunosuppressants)

Combination OCPs; Implanon; Mirena; Nuvaring; Ortho Evra; progestin-only OCPs

Depo-Provera§

Smoking and age older than 35 years

Depo-Provera; Implanon; Mirena; progestin-only OCPs

Combination OCPs; Nuvaring; Ortho Evra

Stroke

Depo-Provera; Implanon; Mirena; progestin-only OCPs

Combination OCPs; Nuvaring; Ortho Evra

Systemic lupus erythematosus with antiphospholipid antibodies

Depo-Provera; Implanon; Mirena; progestin-only OCPs

Combination OCPs; Nuvaring; Ortho Evra

 

 

190. Which one of the following combination hormonal contraceptives is most effective in obese women?

A) The etonogestrel/ethinyl estradiol vaginal ring (NuvaRing)
B) The norelgestromin/ethinyl estradiol transdermal patch (Ortho Evra)
C) Oral norethindrone/ethinyl estradiol (Aranelle, Brevicon)
D) Oral levonorgestrel/ethinyl estradiol (Aviane, Seasonale)
E) Oral drospirenone/ethinyl estradiol (Ocella, Yaz)

ANSWER: A

 

ITE 2013, Q209. A 30-year-old female asks about her contraceptive options. She has polycystic ovary syndrome and is currently being treated with spironolactone (Aldactone) for hirsutism.
Which one of the following should be used with caution, due to an increased risk of hyperkalemia?
A) Oral drospirenone/ethinyl estradiol (Yaz, Yasmin)
B) Oral norethindrone/mestranol (Necon 1/50)
C) Oral norgestimate/ethinyl estradiol (Ortho Tri-Cyclen)
D) Transdermal norelgestromin/ethinyl estradiol (Ortho Evra)
E) Depot medroxyprogesterone acetate (Depo-Provera)

ANSWER: A

 

ITE 2013, Q 43. Which one of the following conditions presents an unacceptable health risk for combined oral contraceptive use?
A) Migraine with aura
B) Endometrial hyperplasia
C) Breastfeeding 1–6 months post partum
D) Chronic hepatitis C
E) Previous laparoscopic banding weight-loss surgery

ANSWER: A

Ref: Medical Eligibility Criteria for Contraceptive Use, ed 4. World Health Organization, 2009, pp 11-12, 16-27. 2) US
Medical Eligibility Criteria for Contraceptive Use, 2010, June 18, 2010. MMWR Recomm Rep 2010;59(RR-4):11-18.

 

ITE 2013, Q156. A 24-year-old nulligravida comes to your office for contraception counseling. She has a seizure disorder that is well controlled on carbamazepine (Tegretol). She is a nonsmoker and has no other medical problems or complaints. She is currently in a relationship and does not want to get pregnant in the next several years.
Which one of the following contraceptive options would be the most appropriate?
A) Progestin-only pills
B) Combined oral contraceptives
C) The etonogestrel/ethinyl estradiol vaginal ring (NuvaRing)
D) The norelgestromin/ethinyl estradiol contraceptive patch (Ortho Evra)
E) A levonorgestrel intrauterine device (Mirena)

ANSWER: E