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In addition to contraception, what other advantages are conferred by taking OCPs
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Section II: Topics in Gynecology
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(mittelschmerz); regulates menses; Lessens anemia; Improves acne (with estrogen-containing pills); protects against benign breast disease, formation of new corpus luteum cysts, osteoporosis, hirsutism; may reduce fibroids (controversial); decreases risk for ovarian cancer, endometrial cancer, pelvic inflammatory disease (PID), colorectal cancer, ectopic pregnancy What are the risks of taking OCPs Increased risk of thromboembolic disease/stroke; hepatocellular adenoma; adenocarcinoma of the cervix; myocardial infarction (MI) (especially in high estrogen formulations); subarachnoid hemorrhage; hypertension; insulin dependence in diabetics Experts agree there is most likely no risk between birth control pills and breast cancer History of thromboembolic disease/ thrombophlebitis; smokers >age 35; cerebrovascular disease/coronary artery disease; congenital hyperlipidemia; history of an estrogen-dependent tumor; liver disease; pregnancy Diabetes mellitus (may need to change insulin dose) Epilepsy (can use the higher dose E2 pills if their medicines stimulate the P450 system; if their medicines do not, there is no contraindication) Gallbladder disease (although benign disease is not a contraindication) Hypertension (requires close monitoring) Use of some antibiotics Postpartum state (women may be susceptible to clots following delivery) Migraines/vascular headaches with aura Obesity
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Is there a risk of developing breast cancer when using OCPs What are the absolute contraindications to the use of estrogen-progesterone OCPs
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What are the relative contraindications to the use of estrogen-progesterone OCPs
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4: General Gynecology
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What are the possible side effects of OCPs Breakthrough bleeding (especially first 3 months) Amenorrhea Depression/mood changes Nausea Bloating Breast tenderness Headaches Acne (with some progestin-only pills) Do OCPs cause weight gain How do OCPs affect acne OCPs have not been proven to cause weight gain Progestins worsen acne by increasing sebum production whereas estrogen relieves acne Combined OCPs are used to treat acne Use of a less androgenic progesterone-only pill will lower the risk of acne Estrogen It increases the levels of clotting factors VII and X and decreases levels of antithrombin III A rare benign liver tumor associated with long-term OCP use, diagnosed by a right upper quadrant pain or a palpable mass on physical examination Rupture of the adenoma can lead to hemodynamic instability Discontinuation of OCPs is the treatment for hepatocellular adenoma Pregnancy should be avoided in patients with this diagnosis unless the tumor is surgically removed Intermenstrual bleeding that occurs because of an imbalance of estrogen and progesterone Occurs in 10 30% of women on low-dose OCPs Early occurrences usually resolve spontaneously, but if bleeding does not resolve within 4 months, the patient can be switched to a pill with increased estrogen or a lower dose
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Section II: Topics in Gynecology
progesterone Pathologic causes of abnormal bleeding should also be considered What is post-pill amenorrhea The failure to menstruate by 6 months after cessation of OCPs Most cases resolve spontaneously An endocrine workup is necessary after 6 months to rule out pregnancy and functional causes of amenorrhea (anorexia, excessive exercise) It should also include a progestin challenge test to rule out hypothalamic-pituitary dysfunction 100 mg of progesterone is administered Withdrawal bleeding should occur within a few days if ovulation is occurring OCPs are metabolized by the cytochrome P450 Drugs including anticonvulsants (phenytoin), antibiotics (isoniazid, rifampin, penicillin, tetracycline), and some antiretrovirals decrease their effectiveness by increasing their metabolism Back-up contraception should be used if the drugs are used for a short duration; however, one must seek an alternative contraceptive modality if the drugs are used for long duration One pill: take the missed dose as soon as possible and take the following dose at her regular time Two pills: take two pills immediately and then continue the following day Three or more pills: stop taking the pills in order to have menses and then restart the cycle Note: In all of the above cases, an additional contraceptive measure for the rest of that cycle is required A pregnancy test is recommended if menstruation does not occur
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