CONTRACEPTION Flashcards by Qúophy Calbert

Reversible contraceptives

Short acting reversible contraceptives(SARC)
Long acting reversible contraceptives (LARC)
Emergency contraceptive
Fertility awareness based method(FABM)
Barrier methods
Hormonal contraception
IUCD

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Permanent methods of contraception

Female sterilization
vasectomy

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Hormonal methods

OCTs
Injections
Implants
Dermal patch
Vaginal rig
IUD
Emergency contraception

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Injections

Depo-provera
NET-EN
Norigynon

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Mechanisms of hormonal contraception

Inhibits ovulation
Thins uterine lining
Thickens cervical mucus

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Implants

Jadelle
Implanon

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Progestogens in OCT

Drospirenone-DRSP
Levonorgestrel-LNG

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Which estrogen is present only during pregnancy

Estetrol E4

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Which androgen are estrogens synnthesised from

Androstenedione
Testosterone

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Combined contraceptives

Progesin and Estrogen

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Three endogenous estrogens

Estrone-E1
Estradiol-E2
Estriol-E3

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Enzyme that synthesizes estrogens

Aromatase

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Most potent and prevalent estrogen during reproductive life.

Estriol-E3

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Hormone that stimulates estrogen production

Follicle stimulating hormone (FSH)

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Which cells produce estrogen in the gonads

Granulosa cells and Corpora lutea

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Where does ovarian synthesis of estrogen begin

Theca cells and ends in Granulosa cells

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Androstenedione is converted to ———- by aromatase

Estrone

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Testosterone is converted to ———- by aromatase

Estradiol

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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

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Why is EE(ethinylestradiol) more potent that E2

EE does not bind to sex hormone-binding globulin (SHBG)

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Migrogynon, Secure

Levonorgestrel 150mcg
Ethinylestradiol 30mcg

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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

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Yasmin

Drospirenone 3mg
Ethinylestradiol 30mcg

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How is norethindrone gotten from ethisterone

removal of the 19-carbon from ethisterone

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Typical use failure rate in 1st year for combined contraceptives

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.