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
- 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.
Long term contraception. No estrogen. Copper can cause more monthly blood loss. There are also progestin IUDs.
- 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
- 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
- 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)