Contraception Flashcards
contraception saves lives through…
preventing unwanted or unsafe pregnancy and abortions
is contraception still a major challenge
yes
how does contraception empower women
give them the power to make their reproductive choices
how does contraception enhance economic development
women’s access to education and improved career opportunities
are fertility rates higher in developing or developed countries than in developing countries
developing countries
why are fertility rates higher in developing countries
access to contraception is more of a challenge
what effect can contraception have on developing countries
improve economic capabilities of country
main types of contraception
- oral contraceptive pill
- implants
- injections
- vaginal rings
- intrauterine devices (IUDs)
- barrier: external and internal condoms, diaphragms
- surgical: tubal ligation, vasectomy
- emergency contracpetion
what hormones can the OCP be
- progesterone only
- combined progesterone and oestrogen
which contraceptives are long acting reversible contraceptives (LARC)
- implants
- injections
- vaginal rings
which contraceptives are progestin (synthetic progesterone) based
- OCP
- implants
- injections
- vaginal rings
what are some short-term contraception methods
- OCP
- diaphragm
- condom
- withdrawal (less reliable)
__% of Australian women will use contraception at some point in their lives
80%
most common form of contraception used (2) in Aus
- OCP
- male condoms
as women get older which form of contraception is decreased in use
hormonal contraception
(male condom use remains relatively stable)
what are 2 reasons why there might be a decline in hormonal contraception use as women get older
- looking to start a family
- undesirability of side effects
how many australian women experience an unintended pregnancy
1 in 4
(despite wide access to contraception in aus)
why are LARCs recommended
- because has potential to increase effectiveness
- because does not need to be remembered on daily basis to be effective
- would reduce number and cost of unwanted pregnancies in australia
(not changing options being used; using tech we already have)
availability of technologies for reversible female but not male contraception means women generally take greater responsibility by
- carrying greater financial costs
- incur associated health burdens (side effects, unplanned baby) (even when non-female contraception)
what 2 types of contraception supported by PBS
these are combined OCP ie/ COCs
forms supported that are made from (other progestin forms exist)
- levonorgestrel (progestin) + ethinylestradiol
- norethisterone (progestin) + ethinylestradiol
what are ethinylestradiol in combined OCPs for
oestrogen decreased when using OCP as it reduces ovary’s ability to produce oestrogen => oestrogen replaced in a small dose
is there a need for better access, use, acceptance, uptake of contraception to reduce undesirable outcomes (eg/ 11% of women aged19-24 report having an unintended pregnancy)
yes
very shortly how does the OCP work
changing natural hormone cycles
what levels are similarly low both on the pill and when pregnant
gonadotrophin level (from pituitary)
nromal cycle hormone : (high gonadoptrophins?)
rising oestrogen w falling FSH, followed by LH surge which causes rise in progesterone made by corpus luteum
hormone cycle w progestin
progesterone levels stay high whilst on pill (if take sugar pill then progesterone goes low which when menstruation occurs)
but high progesterone causes low levels of gonadotrophin so cycle blocked => follicles don’t grow and mature and ovulate => oestrogen levels low and hence COCs
progesterone and oestrogen and are what hormones but are not what unlike testosterone
- sex hormones
- they are not androgens
steroid hormone signaling mechanism
- progesterone able to readily cross cell membrane
- progesterone crosses and interacts with progesterone receptor
- acted on progesterone receptor moves into nucleus and bind to DNA (progesterone receptor = DNA-binding transcription factor)
- binding to DNA activates gene expression
- include genes that act in uterus for promoting implantation
large number of steroid related transcripiton factors (receptors) & quite distinct from other steroid receptor families
which are closely and not closely related
progesterone receptor is very closely related to androgen receptor and glucocortiocoid receptor (stress response receptor)
progesterone receptor less related to oestrogen receptor
when progesterone binds to its receptor it becomes
- structure very related to structure of DNA so they bind in very specific locations
DNA recognition sequence is important because
all the closely related receptors will bind the exact same sequence
what is the significance of all the closely related receptors binding the exact same sequence
- progesterone thought of as female hormone
- testosterone thought of as male hormone
- however both hormones are present in both female and males
- progestin contraceptives are both like progesterone as well as testosterone
are the progestins (synthetic progesterone) supported by PBS in australia of norethisterone and levonorgestrel more structurally closely related to testosterone or progesterone
testosterone
what are the 3 categories for activity profiles of progestins
- progesterone-like
- androgen-like
- anti-androgen
what do anti-androgen progestins do
block testosterone action
progestins are graded into how many generations & based on what
4 - based on how progesterone or androgen like they are
3 possible side effects of progestin contraceptive agents
- depression risk
- breast cancer
- cardiovascular risk
which progestin is well associated with higher increased risk of both depression and breast cancer
levonogestrel
the increased risk of side effects from progestin contraceptives aren’t as severe as….
what increased risk of unwanted pregnancy would be
the increased risk of depression from progestin contraceptive use does associate with increased risk of _________ in users
suicide attempt
risk of suicide attempt with duration of progestin contraceptive - has a pattern of what & in what demographic
- increases most dramatically at earlier period of use, declines over longer periods of use (risk still remains increased)
- emerges mostly in young people
where else is progesterone receptor expressed (besides uterus) - list 2
- brain
- immune system
emerging evidence shows what regarding progestin contraceptives and MRI scans
- during periods of time on progestin contraceptive
- there clear changes in brain structure that can be seen on MRI
changes to brain structure from progestin contraceptives are more dramatic than the differences seen between brain of people of different sexes - T or F
true
what could these changes in brain structure due to progestin contraceptives be linked to regarding side effects
depression risk
in women on progestin contraception, immune system have changes in _____ populations that don’t occur in women not on
T cell population
people using progestin contraception have changes to immune susceptibility as what occurs
a flattening in change of immune cells that normally occur across a cycle
side effects and their risks for progestin contraceptives are variable based on
which contraceptive compound being used (progestin with oestradiol, and the dosage)
list 3 other conditions progestin contraceptives also used for
- acne
- PCOS
- endometriosis
difference between contraception and sterilisation
reversibility
by directly targeting ______ it prevents fertilisation without altering endocrine cycles
ovulation
progesterone receptor blocker is used as an __________ _____
emergency contraception
emergency contraception (progesterone receptor blocker) blocks ____
implantation
what is progesterone receptor found to be critical for
release of oocyte from ovary (ovulation)
research to look at non-hormonal contraception involving progesterone receptors by looking at
what genes are regulated by progesterone receptors in ovulation that could be blocked to prevent oocyte release
