Contraception:
Management of adverse effects:
- Bleeding: if early in the cycle, you need higher estrogen component. If late bleeding, you need more progesterone.
- Nausea: Usually related to estrogen, take at night with food
- Acne: Usually related to progestin
Severe effects:
- Abdominal pain
- Chest pain
- Headaches: could be a stroke or blood clot
- Eye problems, blurred vision, flashing lights, could be optic neuritis, stroke, clots
- Severe leg pain could be DVT
Take a missed dose as soon as you realize you’ve missed it. If 2 pills are missed in one week, use backup method for 7 days.
Progestin-only contraception is reserved for those who cannot tolerate combined contraception. It can cause bone loss.
IUD:
Long term contraception. No estrogen. Copper can cause more monthly blood loss. There are also progestin IUDs.
Adverse effects:
- Periods late, abdominal spotting
- Abdominal pain or pain with intercourse
- Infection exposure, abnormal vaginal discharge
- Not feeling well, fever, chills
- String of IUD is missing or shorter or longer
Emergency Contraception:
- Use within 72-120 hours of intercourse
- High dose estrogen plus progestin (Yuzpe)
- Progestin-only is preferred, but it is not as effective is BMI > 25 kg/m2. Use ulipristal or copper IUD
- Ulipristal binds to progesterone receptor. It’s prescription only. Use a backup method for 7 days.
- Copper IUD – 5 days after sex, only course recommended for those >35 BMI
- RU-486 0 May use within 5 days, but it is also abortifacient
Fertility Agents:
- Clomiphene – take for five days, first line
- Letrozole or anastrozole- less risk of multiple births
- hmG – causes flu-like symptoms
- FHS – follitropin or urofollitropin
- hCG – given 36 hours before insemination
- metformin can be given with clomiphene
- Others: progesterone (maintains luteal phase), guaifenesin (thins cervical mucus), sildenafil (increases the thickness of uterus lining)