Class 7 & 8: Female Hormonal Contraception/Emergency

Question 1

COC

Answer 1

Combined oral contraceptive containing both progestin and estrogen. Estrogen was added to decrease the side effect of breakthrough bleeding from progestin only pills. Function by suppressing endogenous gonadotropins, preventing LH surge and ovulation.

Question 2

POP

Answer 2

Progestin only pill. Function by disrupting the reproductive environment. Thicken cervical mucus and perturb endometrium receptivity to embryo.

Question 3

Agonist:

Answer 3

Promotes action; a hormone agonist specifically is a molecule that binds to a hormone’s receptor and induces the post-receptor events leading to a biological effect.

Question 4

Antagonist

Answer 4

Inhibits action; a hormone antagonist specifically is a molecule that binds to a hormone’s receptor and blocks binding of Hormone agonist (or original hormone) resulting in inhibition of post-receptor events/biologic response.

Question 5

• Suppression of endogenous gonadotropins:

Answer 5

No LH surge, no ovulation.

Question 6

Emergency contraception methods, actions:

Answer 6

“Morning after pill.” Provide a very high dose of progestin. In pre or peri ovulation stage can delay or inhibit ovulation and thicken cervical mucus (delays/inhibits sperm transport.) In post ovulation - delay/inhibit embryo transport, perturb endometrial receptivity (inhibit embryo implantation.)

Question 7

Function of COC

Answer 7

Suppress endogenous gonadotropins - prevent LH surge and ovulation.

Question 8

Function of POP

Answer 8

Disrupt the reproductive environment → thicken cervical mucus, perturb endometrium receptivity to embryo. (LH is not suppressed and egg is still released.)

Question 9

Function of E+P vaginal ring

Answer 9

Suppress endogenous gonadotropins - prevent LH surge and ovulation.

Question 10

Function of Shot (Depo-provera)

Answer 10

(Depo-provera) Suppress endogenous gonadotropins - prevent LH surge and ovulation. Dose high enough to provide negative feedback.

Question 11

The fertilization of human eggs most commonly occurs in what part of the female reproductive system?

Answer 11

Oviduct

Question 12

New IUD’s (not available in the U.S. yet) have low amounts of progesterone in them. What effect might this have on the cervix that enhances the IUD’s ability to prevent pregnancy?

Answer 12

Thickened cervical mucus → blocking or slowing sperm to keep sperm from joining with egg.

Question 13

Explain why would a progesterone-containing IUD have this effect on the cervix?

Answer 13

Steady state of progesterone creates an inhospitable environment for implantation, unable to complete natural cycle of hormones, unsupportive for implantation.

Question 14

what is the active ingredient in ella is and how it works

Answer 14

Ella provides protection for up to 120 hours (5 days) after unprotected intercourse.
Ella is a SPRM (selective progesterone receptor modulator)
Delays ovulation for up to 5 days and can be effective in preventing pregnancy even after the LH surge has begun by preventing or delaying follicular rupture
May also prevent implantation by disrupting the implantation environment

Question 15

partial agonistic as well as antagonistic effects on the progesterone receptor” This action makes the ingredient in ella a —

Answer 15

SPRM (selective progesterone receptor modulator)__

Question 16

“In a [1997] phase I clinical trial, ella was reported to inhibit endometrial development in women in a dose-dependent manner.”

This action suggests that ella acts as a _____in the uterus/endometrium.

Answer 16

progesterone antagonist

Question 17

Proteome

Answer 17

the collection of all the proteins present in a given cell

Question 18

COX-2

Answer 18

enzyme involved in a key step in the synthesis of prostaglandins. Prostaglandins are lipids involved in cellular signalling. COX-2 is primarily responsible for increase prostaglandin production during inflammatory responses → pain.
Cox-2 is responsible for production of prostoglandins which produce proteases that “eat” through the follicle membrane resulting in the follicle rupture & ovulation. If a Cox-2 inhibitor is present then the follicle would not rupture and no egg ovulated.
Granulosa cells in periovulatory follicles express COX-2. Prostaglandin amounts increase in the fluid in the follicle (antrum) with time after chorionic gonadotropin.
Potential link shown between women taking COX-2 inhibitors and difficulty conceiving
The work on COX-2 inhibitors and prostaglandins in ovulation points to another potential way to interfere with ovulation.