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•Continuous pills (Lybrel):
-Daily pill (no hormone free days) - ✔✔What would you recommend for
someone: Don't want them to have period, they have dysmenorrhea, anemic or
other things interfere with their daily lives
Ex: dysmenorrhea, endometriosis, anemic
estrogen - ✔✔inhibits FSH = suppress formation of dominant follicle
Progestin - ✔✔suppresses LH secretion = no LH surge = no ovulation. also
inhibits implantation by thinning endometrium and thickening cervical mucus
(making it less permeable to sperm)
Combination Oral Contraceptives - ✔✔Most effective, reversible form of birth
control
7 - ✔✔for "Sunday Start" of birth control, need to use backup method for __
days
take pill as soon as they remember - ✔✔At any point if they miss ONE pill...
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,take 2 pills when the remember, 2 pills the next day, then 1 pill/day rest of cycle
but need backup method - ✔✔if miss TWO pills during the first 2 weeks
(follicular phase)...
take 1 pill/day until day 21 & then instead of taking inert pills start a new pack
(use backup until first 7 days of new pack) - ✔✔If miss TWO pills during the 3rd
week (luteal phase)...
take 1 pill/day until day 21 & then instead of taking inert pills start a new pack
(use backup until first 7 days of new pack) - ✔✔If miss THREE or more pills...
Initiation: Within first 5 days of cycle, use 7day back method
• Placed in the vaginal for 3 weeks
Removed for 1 week to allow for withdrawal bleed (this can be skipped to allow
for continous dosing) - ✔✔Combination - Nuva Ring initiation
1 size fits all, easy to put in on own, keep in for sex, lower hormones -
✔✔Combination - Nuva Ring advantages
Do not remove for more than 3 hours, if so use backup for 7 days - ✔✔Nuva ring
rules for removal
$, foreign body, allergies/vaginitis, can be pushed out - ✔✔Nuva ring
disadvantages
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, Releases Ethinyl estradiol (EE) 15 mcg and 120mcg etonogestrol - ✔✔Combo
Nuva Ring components
• 150mg/day progestin/ 35mg/day of EE - ✔✔Combo patch components
Initiation: Anytime with 7-day back-up method. Can consider quick start. -
✔✔Combo patch initiation
doesn't go thru first pass effect, sustained level, few allergies, lighter periods -
✔✔Advantages of patch
higher exposure to estrogen compared to pills/other methods. Don't give if HX
of DVT!
-**Consider weight limitation - less effective if women is >90kg (198lbs) -
✔✔Disadvantages of patch
• Applied weekly for 3 weeks consecutively
-Leave off during period (1 week) for withdrawal bleed - ✔✔rules for patch
application/removal
4- 6 weeks, • want body time for their natural estrogen to come down (don't
want too much estrogen on board) - ✔✔Contraceptives should be started no
earlier than --weeks after delivery in non-nursing women
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