Contraception Flashcards
What are the three types of estrogen, in order of potency?
Estradiol (ovary)
Estrone (fat?)
Estriole (placenta)
What percent of estrogen is protein bound?
70% to SHBG: sex hormone binding globulin
What does estrogen administration do to free androgens? How?
Estrogen increases SHBG
More SHBG lowers FREE androgens
What transports progesterone? This also carries what?
Transcortin (which also carries cortisol)
How does Estrogen work?
nuclear receptors ERalpha (female repro tract, elsewhere( ERbeta (prostate and ovary) HRE nucleus
What is the action of Estrogen overview?
HDL up, LDL down Breast grows Osteoclast inhibited Bones grow Uterus grow Increase liver action: clotting and bining globulins Close episeal plates in both seces Tumor growth
What is a precursor to adrenal steroids?
Progesterone
Where is progesterone made?
Ovary, adrenal, testes, placenta
What does progesterone do to breasts?
Increase secretory units development
What does progesterone do?
Modulate estrogen actions Secretory uterus Thick mucus cervix Pregnancy maintenance Increase body temp in luteal phase Depressant/hypnotic effects possible
What are E/P given for?
Fertility control Hormone replacement Uterine bleeding Luteal phase dysfunction Ovulation induction
What is given to increase LH/FSH from the hypothalamus? How?
Clomiphene
Fulvestrant
by blocking ER receptors in hypothalamus
What are the AEs of Estrogen?
Cancer: endometrial, breast, uterus, bone, kidney, testes
Stroke: DVT by increased clotting factors
GI, menstrual disorders, mastalgia, HTN, decreased lactation
What is the AE of DES?
Women whose mothers took it while pregnant have higher risk of clear cell carcinoma of vagina
What are the AEs of Progesterone?
Breast cancer!
LDL up, HDL down
GI
Menstrual disorder
What are the most effective birth controls? Least effective?
Most; IUD and sterilization
Least: barrier and calendar
What are the benefits of contraception?
No babies
Decrease lifetime risk ovary/endometrial cancer
Decrease free androgens: less acne
What causes contraception failure?
Antibiotics! Rifampin Anti-retrovirals Anticonvulsants St. John's wort
What are estrogen drugs?
Ethinyl estradiol
Mestranol
What are progesterone drugs?
Norgestrel
Levonorgestrel
Progestin can lead to what skin problem?
acne
Estogen does what to breasts?
Enlargement
What are contraindications to E/P OCP?
Thromboembolic state CVD MI CAD Hyperlipidemia Breast cancer Endometrial cancer
How does progestin only pill work?
Thickens cervical mucus
Alters endometrium
Only blocks 70% of ovulations
What is a good birth control pill for breast feeding or smoking women?
Progesterone only! (Norgestrel, levonorgestrel)
What is the parch?
Combo P/E
How long do you take the patch?
One new one every week, 3 weeks
One week off
What is the patch less effective in?
Obesity
What is advantageous about the ring?
Rapid return to fertility after removal
What is injected? How often and how long does it last?
Progesterone only (Medroxyprogesterone) Every 3 months. 2 yrs of injections, then another 6-12 months until return to fertlity
What is in the implant? how long does it last?
Progesterone only.
3 years.
What are the two types of IUD? How long do they last?
Copper: 15-20 years
Progestin: 5 years
How long are spermicides effective?
1 hour
How long do you leave sponges in vagina?
6 hours
What are emergency contraceptives, “plan B pills”? What time window is there to take it?
Progesterone high dose:
levonorgestrel 2 doses separated by 12 hours
72 hours: sooner the better
What drugs are used for termination after 72 hours?
Mifeprisone
Onapristone
Within 7 weeks
What is the action of mifepristone and onapristone?
Progestin receptor antagonists:
Prevent action of progesterone
Inhabitable uterus
