Fertility / Obstetric

 
Oral Contraceptives

 

Drug interactions:

Efficacy of OCP’s reduced by penicillins, tetracyclines, rifampin, ibuprofen, phenytoin, barbiturates, sulfonamides

OCP’s reduce efficacy of folates, anticoagulants, insulin, hypoglycemics, methyldopa, phenothiazides, TCA’s

Contraindicated: see estrogen

           

Ethinyl estradiol        

mestranol is cleaved to EE by the liver / oral contraceptives

 

19-nor progestins (medroxyprogesterone, MPA)

variable effect on ovulation / impair transport and implantation

Side effects: edema, weight gain, HA, menstrual irregularities / ? avoid w/ liver disease

 

Intrauterine device (IUD)

very effective in preventing pregnancy, can be used in nulliparous women

           

Clomiphene (Clomid)

induces ovulation / competitive ER antagonist in pituitary / used to achieve ovulation in PCOD (given with GnRH? to induce FSH, LH surge) / Side effects: hot flashes, multiple gestation (usually twins)

 

Aromatase inhibitors

block conversion of androgens to estrogens

 

Mifepristone/RU-486

anti-progestin / given with prostaglandin to terminate pregnancy