Oral Contraceptives (FETT)

Contraceptives

ETHINYLOESTRADIOL/ LEVONORGESTREL

• Activation of estrogen receptors

• Hormone replacement therapy

• Combined oral contraception

• Hypogonadism

• Endometrial cancer

• Thromboembolic events

• Vaginal clear cell adenocarcinoma (in patients exposed to DES in utero)

• ↑ Risk of cardiovascular conditions (e.g., myocardial infarction, hypertension)

• Hypothalamus: suppresses release of GnRH

• Pituitary: suppresses release of gonadotropins

  • Decreased LH production and release leads to inhibition of ovulation.

  • Decreased FSH level prevents ovarian folliculogenesis.

• Venous thromboembolism (VTE): increased rate due to estrogen-mediated coagulopathy

• Cardiovascular events

• Hypertension: increased risk in patients with a history of HTN during pregnancy and/or family history of HTN

• Headaches

• Hepatic adenoma development

• Mastopathy and mastodynia

• Nausea, GERD

• Cardiovascular

  • Thromboembolism

  • Coagulopathy, antiphospholipid antibodies

  • Coronary heart disease

  • Stroke

  • Arterial hypertension (> 160/95 mm Hg)

  • Heart defects

• Metabolic

  • Pronounced hypertriglyceridemia

  • Metabolic disorders of the liver

  • Insulin-dependent diabetes mellitus with vascular complications or duration greater than 20 years

• Oncologic

  • Hepatic tumors

  • Estrogen-dependent tumors (e.g., breast cancer)

• Inflammatory

  • Acute pancreatitis

  • Lupus erythematosus

  • Vasculitis

  • After herpes gestationis

• Other

  • Smoking > 35 years of age (due to significant increase in the risk of VTE)

  • Genital bleeding of unknown cause

  • Pregnancy

  • Migraine with aura

• Cardiovascular

  • Superficial venous thrombosis

  • Thrombophlebitis

  • Severe varicosis

• Metabolic

  • Hypercholesterolemia

  • Morbid obesity

  • Diabetes mellitus

• Other

  • Age > 40 years

  • Migraines

  • Uterine leiomyomas (especially intracavitary)

  • Epilepsy

  • Smoking

  • Lactation (progestin-only preparations permitted): otherwise ↑ risk of thromboembolism due to estrogen excess

  • Ulcerative colitis

Oral emergenxy contraception medication —> progestin

• Activate progesterone receptors

• Contraception (alone or in combination with estrogens)

• Abnormal uterine bleeding

• Progesterone challenge test

• Endometrial cancer

• Endometriosis

• Breakthrough bleeding

• Venous thromboembolism

• Dizziness

• Bloating

• Weight gain