CONTRACEPTION Flashcards
Reversible contraceptives
Short acting reversible contraceptives(SARC)
Long acting reversible contraceptives (LARC)
Emergency contraceptive
Fertility awareness based method(FABM)
Barrier methods
Hormonal contraception
IUCD
Permanent methods of contraception
Female sterilization
vasectomy
Hormonal methods
OCTs
Injections
Implants
Dermal patch
Vaginal rig
IUD
Emergency contraception
Injections
Depo-provera
NET-EN
Norigynon
Mechanisms of hormonal contraception
Inhibits ovulation
Thins uterine lining
Thickens cervical mucus
Implants
Jadelle
Implanon
Progestogens in OCT
Drospirenone-DRSP
Levonorgestrel-LNG
Which estrogen is present only during pregnancy
Estetrol E4
Which androgen are estrogens synnthesised from
Androstenedione
Testosterone
Combined contraceptives
Progesin and Estrogen
Three endogenous estrogens
Estrone-E1
Estradiol-E2
Estriol-E3
Enzyme that synthesizes estrogens
Aromatase
Most potent and prevalent estrogen during reproductive life.
Estriol-E3
Hormone that stimulates estrogen production
Follicle stimulating hormone (FSH)
Which cells produce estrogen in the gonads
Granulosa cells and Corpora lutea
Where does ovarian synthesis of estrogen begin
Theca cells and ends in Granulosa cells
Androstenedione is converted to ———- by aromatase
Estrone
Testosterone is converted to ———- by aromatase
Estradiol
Why ethinyl group is added to exogenous estradiol
Increases oral bioavailability
Makes it more potent
Resistant to enzymatic degradation by 17-beta-hydroxylase
Higher affinity for the estrogen receptor
Why is EE(ethinylestradiol) more potent that E2
EE does not bind to sex hormone-binding globulin (SHBG)
Migrogynon, Secure
Levonorgestrel 150mcg
Ethinylestradiol 30mcg
Why is mestranol weaker than ehinylestradiol
Mestranol would have to be converted to ethinyl estradiol in the body.
Mestranol will not bind to the cellular estrogen receptors
Yasmin
Drospirenone 3mg
Ethinylestradiol 30mcg
How is norethindrone gotten from ethisterone
removal of the 19-carbon from ethisterone
Typical use failure rate in 1st year for combined contraceptives
8%
Mestranol
3-methyl ester of ethinylestradiol
Perfect use failure rate in 1st year for combined contraceptives
0.3%
Effectiveness of combined contraceptives
92-99%
Who produced norethindrone from ethisterone
Carl Djerassi
Lydia, Diane 35
Cyprotene acetate 2mg
Ethinylestradiol 35mcg
Progeistin only contraceptives are good for…………….
Breastfeeding
Older women
Smokers who cannot used combined pill
Example of progestin only contraceptives (PILLS)
Micronor-Norethindrone
Ovrette-Norgestrel
Contraindications of estrogens
breastfeeding
cardiovascular disease
migraine
Side effects of combined contraceptives
Vomiting
Nausea
Headache
Bloating
Contraindications of progestin only contraceptives
Breast cancer
How is dermal patch used
For three consecutive weeks, followed by 1 patch-free week per cycle.
Dermal patch content
Estrogen
Progestin
Vaginal ring use
New ring inserted every month, removed after 3 weeks
Example of vaginal ring
NuvaRing
When is emergency contraception used
condom breakage, slippage, or incorrect use
3 or more consecutively missed combined oral contraceptive pills
mini-pill taken more than two hours late (or more than 12 hours late if taking a 0.75mg desogestrel-containing pill
Effectiveness of oral contraceptives
reduce the chance of a pregnancy by 75% if taken within 72 hours of unprotected sex
Effectiveness of contraceptives
Extremely effective (>99%) - Male/Female sterilisation/IUD/IUS/Implants/Abstinence
Very effective (92%)- Pills, Injectables, Ring, Patch
Moderately effective (80) - Condom, Sponge, Withdrawal, Diaphragm
Effective (75%)- Fertility awaremeness
Cervical cap
Spermicide
This is approved for use up to 120 hours after sex
Ulipristal acetate (ella)
The risk of these cancers can be reduced by oral contraceptives
Ovarian
Endometrial
Coloreactal
Extended hormonal contraceptives
COCs
Transdermal patch
Vaginal ring
Benefits of oral contraceptives on menstrual cycle
Irregular cycles
Dysmenorrhea
Menorrhagia
Anemia
Functional ovarian cysts
Complications of OCTs
CVS
DVT
Myocardial infarction
Stroke
OCTs can be used to treat
Acne
Hirsutism
Perimenopausal symptoms
Absolute contraindications of oral contraceptives
History of vascular disease (thromboembolism)
Systemic diseases (affect vascular system) SLE , DM with retinopathy or nephropathy
Undiagnosed uterine bleeding
Increase serum TGs
Heart failure rare
Smoking in female more than 35y
OCTs can prevent
Bone loss
Fibrocystic/benign breast disease.
Ectopic pregnancy
Relative contraindications of OCTs
Migraine headache
Undiagnosed amenorrhea and depression
Smoking in female less than 35 y
Endometrial cancer and contraceptives
protection related to duration of use
Ovarian caner and contraceptives
decrease risk, duration related
Pituitary adenoma and contraceptives
mask symptoms produced by prolactinoma amenorrhea and galactorrhea (hyperprolactinemia)
Colorectal cancer and contraceptives
protection
Example of a spermicide
Nonoxynol
Benzalkonium chloride
Chlorhexidine
Menfegol
Octoxynol-9
Sodium docusate
Barrier methods
Spermicides
Male Condom
Female Condom
Diaphragm
Cervical Cap
Dental Dams
What is used to make male condoms
latex, polyurethane, or lamb skin
Most used spermicide
Nonoxynol
Postpartum contraception
initiation and use of contraceptives during the first year after delivery.
Post abortion contraception
initiation and use of family planning methods after treatment for abortion - within 48 hours, or before fertility returns.
