23 - Contraception

Question 1

What do contraceptives do

Answer 1

block “conception” of a fetus
work to keep sperm and ovum from being united

Question 2

What do contra-gestational agents

Answer 2

they work to keep the fertilized egg from implanting

Question 3

What do abortifacients do

Answer 3

they cause the termination of an established pregnancy

Question 4

How to prevent pregnancy at the transport of viable sperm

Answer 4

vasectomy

Question 5

How to prevent pregnancy at the deposit of sperm in vagina

Answer 5

condom or coitus interrptus

Question 6

How to prevent pregnancy at the survival of sperm in vagina

Answer 6

spermicides

Question 7

How to prevent pregnancy at the movement of sperm to uterine tubes

Answer 7

cervical cap
Diaphragm

Question 8

How to prevent pregnancy at the production of viable

Answer 8

oral contraceptives (OCs)

Question 9

How to prevent pregnancy at ovulation

Answer 9

oral contraceptives

Question 10

How to prevent pregnancy at movement of oocytes to uterine tubes

Answer 10

tubal ligation

Question 11

How to prevent pregnancy at the implantation of zygote

Answer 11

MAP, OCs, IUDs

Question 12

How to prevent pregnancy at growth of the embryo/fetus

Answer 12

abortion, surgical (D&C)
or medical (RU 486)

Question 13

What are the calendar methods of birth control

Answer 13

Rhythm Method:
- practicing abstinence from sexual intercourse (usually 3 days before and 3 days after) the likely date of ovulation

Fertility Awareness:
- relies on noticing the signs of ovulation
–> a slight drop in body temperature occurs just before ovulation and a slight increase occurs after ovulation
–> cervix produced a thin, clear, watery, and elastic mucus that shows maximal ferning
–> ovulation is associated with mittelschmerz (one-sided, cyclical abdominal pain)
–> position of cervix changes throughout the menstural cycle

Question 14

What are oral contraceptives, what do they do

Answer 14

combination pills
- combine an estrogen and a progestin
- they suppress the hypothalamic-pituitary-gonadal axis
- the estrogen and progestin inhibit the release of GnRH
- low FSH = little follicular development
- no LH surge = no ovulation

Question 15

What are the combined steroid contraceptives

Answer 15

contraceptive patches (Evra)
- work the same as pills except the delivery of steroids is transdermal
- difficult to be noncompliant with this system unless the patch falls off
- patch is put on once a week

contraceptive ring (Nuvaring)
- placed in the vagina for three weeks and removed for one
- does not provide any sort of a barrier to the movement of sperm – it is just a way of delivering steroids

Question 16

What are progestin only contraceptives

Answer 16

formulated to avoid the side effects of estrogen

do not reliably suppress ovulation but cause thick and scanty cervical mucus and prevent the movment of sperm across the cervix

endometrium is kept in a “pseudo-pregnant”/atrophic state which hinders the implantation fo the zygote

Question 17

What are the forms of progestin only contraceptives

Answer 17

mini-pills
injectable
IUD
implant

Question 18

Describe the mini pill

Answer 18

use a synthetic progesterone (progestin)

taken PO every day except for 7 days in a 28 day cycle

risk of contraceptive is failure greater than combination pills

Question 19

Describe the depo-provera

Answer 19

use of synthetic progesterone given IM to the buttock or deltoid

Question 20

What are the risks of progestin only contraceptives

Answer 20

increased risk of abnormal uterine bleeding (AUB) – iatrogenic cause

decreased libido

slightly more ectopic pregnancies

physiology centers on:
- stimulation of endometrial growth by estrogens
- stimulates estradiol conversion to estrone
- decreases estrogen production by inhibiting

Question 21

What are the postcoital contraception

Answer 21

high dose progestin (plan B)
- administered within 72 hours of coitus and two pills are taken (one right away, other within 12 hours)
- 90% effective
- appears to inhibit natural progesterone and estrogen production

Selective progesterone receptor modulator (SPRM)
- prevent ovulation
- alter endometrial physiology

Question 22

What are medical abortion

Answer 22

Mifepristone: antagonizes the effects of progesterone
- progesterone causes the uterus to be quiescent, then antagonism causes the myometrium to become active
- often a prostaglandin is often given to increase uterine contractions
=

Question 23

What is a vasectomy

Answer 23

less invasive surgery