12 - Contraception Flashcards
What part of the gonad differentiates to become the ovary and the testes?
Cortex - female ovary
Medulla - male testes
One that doesn’t differentiate regresses
Where do primordial germ cells migrate from?
Yolk sac along retroperitoneum to the gonad at the urogenital ridge
Weight loss due to excess cortisol
What effects does oestrogen have on the female reproductive tract in the proliferative phase?
What effects does progesterone have on the female reproductive tract in the secretory phase?
Which cells release b-hCG?
Syncytiotrophoblasts
What are some causes of primary and secondary amenorrhoea?
How can you tell where the issue is in primary amennorhoea?
Measure blood FSH
- Low: hypothalamus/pituitary
- High: ovary
How can you have female secondary sexual characteristics in androgen insensitivity?
Testosterone converted to oestrogen
What is contraception?
Always important to balance patient safety and patient preference
What are the different groups of contraception?
Can be short acting or long acting
What are the different types of natural contraception, and the advantages/disadvantages of both?
How does the fertility awareness method work?
- Measure basal body temperature, cervical secretions and menstrual cycle length
- Avoid sex or use further protection dyring ovulation
How does lactational amenorrhoea work as a contraceptive method?
- Breastfeeding delays return of ovulation
- Suckling stimulus stops GnRH release
- Need to exclusively breast feed with no top up, amenorrheic and only effective for 6 months
What is barrier contraception and the advantages and disadvantages?
- Prevent sperm entering the cervix
- Male condoms, female condoms, diaphragms/caps with spermicide
What are the different hormonal contraceptives?
What are the advantages and disadvantages of short acting hormonal contraception and how do they work?
What are the rules with missing a hormonal contraceptive pill?
- If one pill missed take the pill when you release and take the rest of the pack normally
- Take last pull missed and leave any earlier pills. Continue taking the rest of the pack but use condoms for the next 7 days. If less than 7 pills left don’t take a break and start next pack
What are some cases where you should not prescribe the COCP?
- High BMI
- Migraines aura as risk of stroke
- Previous breast cancer
- Smoking
- Over 35
- Diabetes
- High altitude
Thromboembolic so use progesterone contraception
What are the advantages and disadvantages of long acting reversible contraception and how do they work?
What happens to stop fertility at different doses of progesterone?
What contraceptive methods work by inhibiting implantation and what are the advantages and disadvantages?
IUD has no effect on endometrial lining so not effective in menorrhagia so heavy painful periods
What are irreversible forms of contraception?
- Have to be 100% sure
- Vasectomy: clip vas def under local anaesthetic to stop sperm entering ejaculate. High success rate but need samples after to ensure effective
- Tubal Ligation: clip fallopian tube to stop ovum entering uterus, general or local anaesthetic but higher failure rate
What is some types of emergency contraception?
- IUD up to five days after event
- Hormonal pill within 3-5 dayd
What guidelines should a GP use when deciding what type of contraception a woman should use?
- UKMEC
- Safe to prescribe if 1 or 2
- Compromise between safety and preference
What are some causes of erectile dyfunction in a young man?
- Antihypertensives
- Smoking
- Tear in TA
- Psychological
- Diabetes
How can we measure if ovulation has taken place?
Progesterone blood test on day 21, will be high if ovulation
How do you test tubal patency?
Hysterosalpingogram
How does clomiphene work to increase fertility levels?
- Given for first 5 days of menstrual cycle
- Binds to oestrogen receptors so no negative feedback on the GnRH so LH and FSH can continue to rise
- When receptors come back, oestrogen concentration is high enough to cause a positive feedback and an LH surge
What would happen to the fertility of a woman if you gave her metoclopramide?
- Would decrease as this is a dopamine antagonist so more prolactin made. Prolactin inhibits GnRH
Will a woman with an IUS continue to ovulate?
Yes - release of progesterone is just local and thins lining of endometrium
How does the COCP work?
Stops ovulation primarily and then inhibits endometrial lining from thickening and thickens mucus lining
