0521779407-C03 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:54
400 Contraception for the Internist➣Progestin-only pills
➣Combination estrogen/progestin: monophasics, multiphasics
➣Progestins used: norethindrone, norethindrone acetate, deso-
gestrel, norgestrel, levonegestrel, norgestimate
➣Estrogens used: ethinyl estradiol, mestranol
■Benefits:
➣Protective effect against endometrial cancers
➣Protection against benign breast disease, salpingitis, ectopic
pregnancy, dysmenorrhea and iron deficiency anemia
➣Fewer menstrual disorders
➣No overall increased risk of breast cancer for OC users up to age
55 y
➣OCs containing norgestimate, levonorgestrel, gestodene, and
desogestrel may improve acne
■Side Effects
➣Nausea, vomiting, abdominal cramps, bloating, breakthrough
bleeding, altered menstrual flow, breast tenderness, edema,
headaches, weight changes, rash, acne, depressive symptoms in
some women (reaction to progestin component)
■Contraindications
➣Pregnancy, migraines with aura, vaginal bleeding of unknown
cause, breast, endometrial or hepatic cancer, thromboembolic
disorders, smokers >35 y, CAD, CVD, documented history of sen-
sitivity to progestins, history of depression
■Complications
➣Thromboembolism, MI, hypertension, hepatic adenoma, stroke,
depression
■Special Situations
➣Smokers at increased risk of MI and CVD, esp >35 y
➣Drugs that decrease efficacy of OCs: rifampin griseofulvin, and
anticonvulsants (phenobarbital, phenytoin, carbamazepine,
primidone, ethosuximide)
➣OCs may potentiate corticosteroids, theophylline, amino-
phylline, metoprolol, cyclosporin action, whereas they decrease
efficacy of cyclopenthazide, guanethidine
■Prognosis
➣With perfect use: progestin-only OCs: failure rate 0.5%; combi-
nation OCs: failure rate 0.1%
■Injectable contraception:
➣Medroxyprogesterone acetate IM q 12 wks
➣Side Effects