Contraception

Question 1

What is a contraceptive?

Answer 1

Something that blocks the conception of a fetus; keeps egg and sperm apart

Question 2

What is a contragestational agent?

Answer 2

Something that works to keep a fertilized egg (zygote) from implanting

Question 3

What is an abortifacient?

Answer 3

Something that causes the termination of an established pregnancy

Question 4

What is a vasectomy?

Answer 4

Cutting of the vas deferens

Question 5

What is tubal ligation?

Answer 5

Cutting of the uterine tubes

Question 6

What does a morning after pill do?

Answer 6

Keeps a fertilized egg from implanting

Fertilized eggs are less likely to implant with OCs (makes a hostile endometrium)

Question 7

How does an IUD work?

Answer 7

Makes the uterus (endometrium) hostile for a fertilized zygote

Does this by releasing progesterone & making the endometrium thin

Question 8

Physical signs of ovulation (x4)

Answer 8

1. Drop in body temperature
2. Production of thin, clear + watery cervical mucus
3. Mittelschmerz: one-sided, cyclical abdominal pain associated with ovulation)
4. Position of the cervix (elevated, softer + wetter cervix = more fertile)

Question 9

Fertile vs infertile mucus

Answer 9

Fertile mucus has lots of K+ and Na+ (crystallizes on a plate)

Infertile mucus looks like goo

Question 10

What is a combination pill? What does it do?

Answer 10

Combination of estrogen + progestin to create a pseudopregnancy

These hormones inhibit the release of GnRH

Low FSH –> little follicle development

No LH surge –> no ovulation

Creates: thick cervical mucus (inhibits sperm movement) & thin endometrium

Question 11

Contraceptive patch (Evra)

Answer 11

Works the same as combination pills except its transdermal

Allows for the drugs to enter the system slowly

Doesn’t allow for uncompliance really

Question 12

Contraceptive (Nuva) ring

Answer 12

Form of combined steroid contraceptive

Delivers estrogen + progesterone

Question 13

Characteristics of progestin-only contraception

Answer 13

Formulated to avoid the side effects of estrogen (vomiting, nausea, tender breasts, deep vein thrombosis)

Do not reliably suppress ovulation –> thick, scanty mucus

Endometrium stays in a “pregnant” state –> doesn’t allow for zygote implantation

Question 14

The mini pill

Answer 14

Progestin only

Missing a dose of this pill by hours –> leads to ovulation + pregnancy

Higher risk of contraceptive failure than combination pill

Question 15

Progestin injections

Answer 15

Leaks out in high amounts

Question 16

Progestin injections

Answer 16

Leaks out in high amounts

Question 17

Risks with progestin-only injections

Answer 17

Dysfunctional uterine bleedings (DUB)

Weight gain

Decrease in libido (due to less estrogen)

Question 18

Physiology of progestin-only injections (x4)

Answer 18

1. Stimulation of endometrial growth by estrogen
2. Inhibitory effect of progestins on endometrium (stimulate secretion by glands)
3. Stimulates estradiol conversion to estrone (less potent)
4. Decreases estrogen production by inhibiting pituitary-hypothalamo-gonadal axis

Question 19

Long-acting reversible contraceptives (LARCs)

Answer 19

Contraceptive implants & IUDs

Very reliable, no problems with compliance & easy return to fertility

Question 20

Progestin implants

Answer 20

Amount of progestin released decreases steadily after placement

Not available in Canada

Question 21

Risks with progestin implants

Answer 21

Subdermal insertion is key (implant can migrate + cause damage)

Insertion & removal requires training

Depressed mood –> suicidal

Question 22

Plan B (high dose progestin)

Answer 22

Inhibits natural progesterone and estrogen production and ovulation

Administered ASAP

Question 23

Selective progesterone receptor modulator (SPRM)

Answer 23

Blocking of the progesterone receptors –> inhibits ovulation for days

Question 24

Mifepristone

Answer 24

Antagonizes the effects of progesterone –> active myometrium

Causes endometrium to fall off

Misoprostol (PG) is given to increase uterine contractions as well

Question 25

Why is making male birth control tricky?

Answer 25

Anything that interferes with testosterone causes impotence

Question 26

Role of LH and FSH in males

Answer 26

FSH is responsible for sperm production

LH is responsible for testosterone production

Question 27

Novel male contraceptives (x3)

Answer 27

1. Something that inhibits gonadotrophin & testosterone for replacement of male androgen
2. Injection of a gel into vas deferens –> blocks sperm movement
3. Sperm cannot develop without RAR-alpha activation (block this)

Question 28

What is a vasectomy?

Answer 28

Cutting of the vas deferens on both sides