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Repro > 7. Contraception (lecture) > Flashcards

7. Contraception (lecture) Flashcards

1
Q

what is the effect of oestrogen in early / middle follicular phase (before ovulation) on HPG axis?

A

negative feedback on anterior pituitary and hypothalamus (inhibit GnRH, LH, FSH)

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2
Q

effects of oestrogen on HPG axis at ovulation?

A

positive feedback on anterior pituitary (LH surge) and hypothalamus (GnRH)

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3
Q

effect of progesterone on HPG axis at lower doses?

A

progesterone doesn’t inhibit LH surge, ovulation still likely
progesterone will THICKEN cervical mucus

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4
Q

what happens at moderate / high dose of progesterone at ovulation?

A

(corpus luteum release progesterone, HIGH oestrogen)

progesterone inhibits the positive feedback of oestrogen –> NO LH surge, NO ovulation

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5
Q

what happens at moderate / high dose of progesterone on the HPG axis at early / mi-follicular phase? (before ovulation)

A

progesterone enhances NEGATIVE feedback of natural oestrogen - reducing LH and FSH secretion
(low oestrogen, negative feedback)

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6
Q

what are common methods of contraception?

A 
natural
barrier
prevention of ovulation
inhibition of sperm transport
inhibition of implantation
sterilisation (permanent)
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7
Q

what are the natural methods of contraception?

A

fertility awareness methods

lactational amenorrhoea method

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8
Q

what is fertility awareness method of contraception? (natural)

A

use of fertility indicators to identify fertile and infertile points of the menstrual cycle. using:
cervical secretions
basal body temperature (higher post ovulation)
length of menstrual cycle (when day 14 is approx.)

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9
Q

what are the advantages of using natural methods of contraception?

A 
no hormones
no contraindications (no drug harms)
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10
Q

what are the disadvantages of using natural methods of contraception?

A

not as effective

unreliable

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11
Q

what is the lactational amenorrhoea method of contraception? (natural)

A

breastfeeding delays the return of ovulation after childbirth

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12
Q

how long is the lactational amenorrhoea method of contraception effective for? (natural)

A

only effective up to 6 months after birth

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13
Q

what are the barrier methods of contraception?

A

male / female condoms

female diaphragm / cap

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14
Q

what is the mechanism of action male / female condoms? (barrier)

A

prevents entrance of sperm into the cervix

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15
Q

what is female diaphragm / cap also used with? (barrier)

A

diaphragm / cap also used with spermicide so additional CHEMICAL barrier

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16
Q

advantages of barrier contraception?

A

can help prevent STIs

can be inserted anytime before intercourse

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17
Q

disadvantages of male condom (barrier contraception)?

A

sensitivity / allergy to latex

18
Q

disadvantages of female condom (barrier contraception)?

A

not as widely available

19
Q

what is a disadvantage of barrier contraception?

A

need to use with spermicide (can cause a local reaction)

20
Q

what are the different pills used for prevention of ovulation?

A

combined oral contraceptive pill (COCP)
progesterone depot
progesterone implant

21
Q

why do progesterone pills work as a contraception?

A

at moderate / high doses, progesterone inhibits the positive feedback of oestrogen - no LH surge, no ovulation
(lower doses progesterone thickens cervical mucus, so progesterone needs to be high enough)

22
Q

what is progestogen?

A

synthetic form of progesterone

23
Q

what is the principle action of combine oral contraceptive pill (COCP)?

A

prevents ovulation

24
Q

what are the secondary actions of COCP?

A

Reduces endometrial receptivity to inhibit implantation

Thickens cervical mucus to inhibit penetration of sperm

25
Q

what are the advantages of COCP?

A

can relieve menstrual disorders

reduces risk of ovarian cysts and cancer (compared to just oestrogen)

26
Q

disadvantage of COCP?

A

user dependent

27
Q

side effect of COCP?

A

breakthrough bleeding
breast tenderness
mood disturbance

28
Q

what can COCP lead to increased risk of?

A 
venous thromboembolism (clot in veins)
myocardial infarction
29
Q

how do you take COCP?

A

taken either 21 days followed by 7 day break
OR
taken for 21 days with 7 days of ‘dummy’ pill

30
Q

what are progesterone depot AND progesterone implant’s main mechanism of action?

A

prevents ovulation

31
Q

what are progesterone depot AND progesterone implant’s secondary actions?

A

Reduces endometrial receptivity to inhibit implantation

Thickens cervical mucus to inhibit penetration of sperm

32
Q

what are the advantages of progesterone depot?

A

convenient

can also relieve menstrual disorder

33
Q

what are the disadvantages of progesterone depot?

A

Altered and irregular bleeding is common
Delayed return of fertility for up to 1 year after stopping
Not quickly reversible
Small loss of bone mineral density and and possible increase in fracture risk

34
Q

what is progesterone depot?

A

synthetic progestogen

35
Q

how is progesterone depot administered?

A

via subcutaneous / IM injection, which is slowly released into systemic circulation

36
Q

how long does an injection of progesterone depot last for?

A

between 8-13 weeks

37
Q

what are the advantages of progesterone implant?

A

long duration of action
convenient
can also relieve menstrual disorders

38
Q

what are the disadvantages of progesterone implant?

A

small procedure required to fit and remove the implant
local adverse effects can occur
can cause changes in bleeding pattern

39
Q

how does progesterone implant work?

A

progestogen containing 4cm flexible rod implant which si inserted sub-dermally (under the skin) in the upper arm

40
Q

how long can progesterone implant last up to?

A

3 years

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