Oral Contraceptives (OCPs):
Types: monophasic vs multiphasic/ ...

Oral Contraceptives (OCPs):

Types: monophasic vs multiphasic/ triphasic; combined (estrogen + progestin) vs progestin-only

OCP selection:

 • 2nd generation progestin-containing (levonorgestrel, norethindrone): ↓ VTE risk

 • 3rd generation progestin-containing (norgestimate, desogestrel): ↓ androgenic SE, higher VTE risk

 • Progestin-only (norethindrone 0.35 mg): if contraindication to estrogen, if ♀ lactating

Switching OCPs due to SEs:

 • HA, nausea, breast tenderness → 2/2 estrogen excess → decrease estrogen dosing, change to QHS

 • Weight gain, acne, hirsutism, ↓ libido, mood Δ → 2/2 androgen or progestin excess → change to 3rd gen progestin

 • Breakthrough bleeding → increase estrogen dosing if early cycle bleeding; increase progestin or change to triphasic if late

 • Amenorrhea → rule out pregnancy, otherwise continue with same pill

#Oral #Contraceptives #OCPs #contraception #selection #management #gynecology
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MGH White Book Manual
Account created for the MGH Internal Medicine Housestaff Manual "White Book" - https://stk10.github.io/MGH-Docs/WhiteBook-2019-2020.pdf
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