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63. Postmenopausal hormone therapy and hormonal contraceptives: Difference between revisions

63. Postmenopausal hormone therapy and hormonal contraceptives (view source)

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(Created page with "== Postmenopausal hormone replacement therapy == At menopause ovarian function decreases and oestrogen levels fall. This causes several problems, like osteoporosis, genital atrophy and increased cardiovascular risk, but also less severe problems like hot flushes, sweating, sleep problems, palpitation and mood disturbances. In theory, replacing oestrogen to postmenopausal women should eliminate all these problems. However, hormone replacement therapy is not without its ow...")
 
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Nowadays newer dosing schedules exist, where the drug is taken for longer than 21 days and with fewer and shorter drug-free periods, like 26 days with and 2 days without. This reduces the inconvenience associated with menstruation without causing any harmful effects.
Nowadays newer dosing schedules exist, where the drug is taken for longer than 21 days and with fewer and shorter drug-free periods, like 26 days with and 2 days without. This reduces the inconvenience associated with menstruation without causing any harmful effects.
[[File:Types of oral contraceptives.png|thumb|''Illustration of the monophasic and multiphasic types of oral contraceptives. The x-axis shows time. The thicker the line the higher the dose of the active ingredient.'']]
[[File:Types of oral contraceptives.png|thumb|''Illustration of the monophasic and multiphasic types of oral contraceptives. The x-axis shows time. The thicker the line the higher the dose of the active ingredient.'']]
For the combined contraceptives, monophasic and multiphasic preparations exist. In the monophasic preparations all pills in the cycle contain the same amount of active ingredients. In biphasic preparations, the pills in the latter half of the cycle contain more progestin than in the first half. Triphasic preparations also exist. Multiphasic preparations reduce the total cumulative amount of hormone taken. In theory this should reduce the number of adverse effects, however studies have not been able to demonstrate this. Thus, monophasic preparations are still preferred.
For the combined contraceptives, monophasic and multiphasic preparations exist. In the monophasic preparations all pills in the cycle contain the same amount of active ingredients. In biphasic preparations, the pills in the latter half of the cycle contain more progestin than in the first half. Triphasic preparations also exist. Multiphasic preparations reduce the total cumulative amount of hormone taken. In theory this should reduce the number of adverse effects, however studies have not been able to demonstrate this<ref>https://www.cochrane.org/CD003553/FERTILREG_birth-control-pills-with-three-phases-versus-one-phase</ref>. Thus, monophasic preparations are still preferred.


Progestin-only contraceptives should be taken continuously.
Progestin-only contraceptives should be taken continuously.
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=== Special considerations ===
=== Special considerations ===
For overweight and obese women levonorgestrel-containing emergency contraceptives do not give a significant reduction in pregnancy rate compared to when no emergency contraception is given. Ulipristal-containing emergency contraceptives are efficacious in overweight (BMI 25 – 30) women but it is 50% less efficacious in obese (BMI > 30) women.
For overweight and obese women levonorgestrel-containing emergency contraceptives do not give a significant reduction in pregnancy rate compared to when no emergency contraception is given<ref>https://www.uptodate.com/contents/emergency-contraception</ref>. Ulipristal-containing emergency contraceptives are efficacious in overweight (BMI 25 – 30) women but it is 50% less efficacious in obese (BMI > 30) women.


In these populations a copper IUD should be used as emergency contraception instead. Copped IUD is also the only emergency contraceptive which is efficacious after ovulation has occured.
In these populations a copper IUD should be used as emergency contraception instead. Copped IUD is also the only emergency contraceptive which is efficacious after ovulation has occured.
[[Category:Pharmacology 2]]
[[Category:Pharmacology 2]]