021315 contraception Flashcards
what does LH surge cause?
resumption of meiosis in dominant oocyte
when does follicular rupture occur after onset of LH surge?
32-44 hours after
most reliable predictor of ovulation
onset of LH surge
sperm are viable in the reproductive tract for up to how long
5 days
3 forms of contraception
prevent ovulation
prevent fertilization
prevent implantation
three formations for combined hormonal methods
pill
patch
vaginal ring
MOA of combined hormonal methods
prevent ovulation
thicken cervical mucous
combined contraceptive vaginal ring
single ring placed in vagina for 3 wks
removed for one week to allow withdrawal bleed
combined transdermal patch
one patch per wk for 3 weeks then 1 week patch-free
less effective in women w BMI over 30
combined hormonal contraceptives’ other effects
increase levels of pro-coagulant factors
decrease anticoagulant proteins
contraindications to combined hormonal contraceptive
history of venous thromboembolic event postpartum history of coronary artery dis cigarette smokers complicated diabetes severe HTN migraine (risk of ischemic stroke) severe active liver dis (the hormones are metabolized by liver) breast or endometrial cancer undiagnosed abnormal uterine bleeding pregnancy
post hysterectomy, what postmenopausal hormone therapy should you give
estrogen only
MOA of progestin only pills
- suppress ovulation in 50% of cycles
- prevent fertilization by thickening cervical mucus and slowing ovum transport through decreased tubal motility
DMPA
depot medroxyprogresteron acetate injection
- profound ovulation inhibition (slow return to baseline fertility)
- given every 3 months
decreases frequency of seizures and sickle cell crises
DMPA
contraceptive implant
MOA-inhibts ovulation
contains progestin etonogestrel
works for 3 years
two types of IUDs
copper progestin levonnorgestrel (5 yr and 3 yr)
do IUDs increase risk for inferility?
no
MOA of copper IUD
prevents normal fertilization (copper ions reduce motility and viability of sperm and is toxic to oocytes)
SECONDARY mechanism-inhibition of implantation esp if used for emergency contraception
MOA of 5 yr levonorgestrel IUD
prevents fertilization by creating thick impenetrable cervical mucus, a sterile inflammatory rxn within uterus, and impaired sperm migration
3 yr vs 5 yr levonorgestrel IUD
3 yr has lower dose of levonorgestrel and is designed for teens and nulliparous women
has lower rates of amenorrhea compared to 5 yr
contraindications to IUD use
pregnancy pelvic inflam dis current STI undiagnosed abnormal genital bleeding malignancy of genital tract etc
nonoxynol-9
spermicide
used ideally with a barrier method
sponge
nonoxynol-9 impregnated
diaphragm
used with spermicide
cervical cap
use with spermicide
hormonal emergency contraception
levonorgestrel
ulipristal acetate
copper IUD
methods of sterilization
laparoscopy (tubal ligation)
mini laparotomy post partum (tubal ligation)
hysterocopy
progestins at high doses can
inhibit LH surge and thus prevent ovulation
most effective forms of reversible contraception
implant and IUDs
