Contraception Flashcards

1
Q

contraception for the masses: how to make a pregnancy

A

*make an egg
*ovulate an egg
*make a sperm
*ejaculate a sperm
*get the 2 together

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2
Q

contraception for the masses: how to PREVENT a pregnancy

A

*don’t make an egg
*don’t ovulate the egg
*don’t make a sperm
*don’t ejaculate a sperm
*block them from getting together

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3
Q

egg vs. follicle

A

*medical word for egg = oocyte, which is the single cell female gamete
*an oocyte never exists alone; it is surrounded by and intimately linked to layers of granulosa cells and layers of theca cells
*the oocyte together with its surrounding granulosa and theca cells = follicle

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4
Q

how many follicles does a human ovary have?

A

*7 million follicles at 20 weeks gestation; 2 million at birth (most are primordial follicles); 400,000 at puberty; only 400 ovulated over the course of reproductive life with atresia of the others that accelerates after approx. age 35-40 until all are depleted at menopause

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5
Q

hypothalamic-pituitary-ovary axis

A

hypothalamus produces GnRH → GnRH stimulates anterior pituitary to produce and release FSH & LH → FSH & LH stimulate the ovary:
1. FSH stimulates GRANULOSA cells to produce ESTRADIOL
2. LH stimulates THECA cells after ovulation to produce PROGESTERONE

estradiol & progesterone act on the uterus (endometrium) to stimulate menstruation/bleeding

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6
Q

normal ovulatory cycle - feedback loops

A
  1. estradiol (from the granulosa cell) and all estrogens → negative feedback on FSH levels
  2. progesterone (from the theca cell) and all progestins → negative feedback on LH levels
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7
Q

underlying mechanism of oral combination estrogen-progesterone contraception: negative feedback loops

A

*giving estrogen → neg. feedback on FSH → do not recruit/make/mature the follicle

*giving progesterone → neg. feedback on LH (preventing LH surge) → do not OVULATE oocyte from the follicle

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8
Q

estrogens - definition

A

*a class of compounds that bind to the estrogen receptor; agonists
*main estrogens found naturally in humans: estradiol, estrone, estriol
*ethinyl estradiol = the estrogen found in OCPs

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9
Q

progestins - definition

A

*a class of synthetic compounds that bind to the progesterone receptor
*notably, these compounds have various affinity for estrogen, androgen, and mineralocorticoid receptors
*for contraception, your main desire is to use a progestin that is agonistic at the progesterone receptor in the hypothalamus & pituitary so that there is negative feedback on LH and no ovulation

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10
Q

estrogen & progesterone in contraception - actions

A
  1. estradiol/estrogen → negative feedback on FSH → FSH levels drop → follicles are not recruited and do not develop
  2. progesterone/progestin → negative feedback on LH → LH levels drop (no LH surge) → no ovulation
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11
Q

estrogens - effects on the endometrium

A

*proliferative effect on the endometrium
*great for sperm, work quickly, lose stability very quickly

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12
Q

progestins - effects on the endometrium

A

*stabilizing effect on the endometrium
*induces atrophy
*long term: bad for sperm / prevents sperm from getting through

note - if estrogen & progesterone are given together, PROGESTINS have the dominant effect long-term

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13
Q

estrogens - effects on cervical mucus

A

*estrogen makes cervical mucus thin, watery, stretchy, and a lovely place for sperm to thrive

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14
Q

progestins - effects on cervical mucus

A

*progestins make cervical mucus thick, sticky, and a hostile place for sperm (sperm get stuck and die)

note - if estrogen & progesterone are given together, PROGESTINS have the dominant effect long-term

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15
Q

mechanisms of progestins in contraceptives (systemic) - overall

A
  1. negative feedback on LH → prevents ovulation
  2. atrophic effect on endometrium, which is hostile to sperm, so the sperm die or become immobile (prevents oocyte & sperm from meeting)
  3. thick cervical mucus, which is hostile to sperm, so the sperm die or become immobile (prevents oocyte & sperm from meeting)
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16
Q

mechanisms of progestins in contraceptives (IUD) - overall

A

*the negative feedback on LH does NOT occur because the progestin is not absorbed systemically
*therefore, people with IUD’s still ovulate
*prevention of pregnancy is by the other 2 mechanisms: atrophy or endometrium + thickened cervical mucus

17
Q

do contraceptives affect how many follicles an ovary has?

A

*NO - you are born with all the follicles you will ever have
*what a contraceptive CAN do is simply change how many you go on to mature or ovulate
*contraceptives also do not alter the rate of follicular atresia

18
Q

contraceptive failure rates

A

*perfect use effectiveness: rate of effectiveness when the contraceptive method is always used consistently & correctly
*typical use effectiveness: rate of effectiveness in all couples using a method, both consistently and inconsistently
*Pearl Index = number of pregnancies that would occur per 100 women in 1 year

19
Q

methods of contraception: withdrawal

A

*method of preventing pregnancy; prevent the egg & sperm from getting together
*perfect use 4% failure; typical use 22% failure rate

20
Q

methods of contraception: rhythm method, natural family planning, fertility awareness

A

*method of preventing pregnancy; prevent the egg and sperm from getting together
*basal body temperature, cervical mucus method, sympothermal method
*requires a great amount of motivation and training
*requires regular menses

21
Q

methods of contraception: Phexxi

A

*nonhormonal vaginal gel
*mechanism: maintains vaginal acidic pH, which immobilizes sperm
*NOT a spermicide
*must apply before intercourse, lasts for 1 hour
*expensive

22
Q

methods of contraception: spermicides

A

*foams, creams, suppositories
*active ingredient: Nonoxyl 9, a surfactant that immobilizes sperm on contact by destroying cell membrane
*also a mechanical barrier
*need to be placed in vagina before each act of coitus
*may increase risk of viral transmission (HIV)

23
Q

methods of contraception: contraceptive sponge

A

*traps & absorbs sperm
*sperm death: continuously releases spermicide to kill sperm
*physical barrier: covers the cervix so that sperm can’t reach the egg
*issues: UTIs, irritation, efficacy, cost

24
Q

methods of contraception: cervical cap & diaphragm

A

*mechanism: physical barrier to sperm and spermicidal (spermicide use required)
*both diaphragm and cap require fitting an a prescription
*timing issues (insert before, leave in for minimum time post-intercourse)
*issues: UTIs, irritation, need for repeat spermicide, damaging effect of oil based lubricants

25
methods of contraception: male condom
*latex, polyurethane, or animal skin *good barrier to STD *failure: 2% with perfect us, 18% with typical use *correct application important & overlooked *care taken not to spill ejaculate on withdrawal of condom
26
methods of contraception: female condom
*typical use failure rate estimated to be 21%, 5% with perfect use *polyurethane: impenetrable by viruses *less likely to rupture than male condom *can be left in place longer after ejaculation *better protection than male condom against STDs, esp. HSV
27
methods of contraception: combination hormonal contraceptives
*combination OCPs, patch, vaginal ring *contain systemic estrogen & progestin
28
methods of contraception: progestin-only contraceptives
1. progestin-only pills (POPs) - systemic progestin (no estrogen); prevents ovulation; must be taken at exactly same time each day within a 3 hour window 2. shot (depo-provera): systemic progestin
29
non-contraceptive benefits of hormonal contraceptives
*lower rates of endometrial cancer *less menstrual blood loss *lower rate functional ovarian cysts *DMPA: benefits for sickle cell pts and epilepsy *less pain with periods *treatment for endometriosis *reduces PID risk
30
methods of contraception: progestin implant (the rod)
*progestin only mechanism *left in place for up to 3 years (effective for up to 5) *return to fertility after removal is within days to weeks
31
methods of contraception: copper IUD
*non-hormonal *prefertilization: copper is toxic to sperm, so there is inhibition of sperm migration & viability; also makes the endometrium inflammatory due to foreign body effect, which is also hostile to sperm
32
methods of contraception: levonorgestrel IUD
*hormonal *prefertilization: hostile thick cervical mucus & atrophic hostile endometrium, with inhibition of sperm migration and viability *does NOT prevent ovulation because the progestin is a local effect in the uterus and not systemic
33
intrauterine devices (IUDs) - benefits
*IUDs are associated with a reduction in uterine cancer risk *progestin IUD reduces measured blood loss *note - do NOT cause PID
34
methods of contraception: female surgical sterilization - bilateral tubal ligation (BTL)
*different names depending on when it's done: -post partum tubal ligation: done immediately after vaginal delivery -intraoperative tubal ligation: done during a C-section -interval tubal ligation: not done in relation to any pregnancy *mechanism: cut, burn, clip, band, remove a tubal segment; result = occlusion of tubal lumen so you physically block the egg and sperm from getting together
35
pros and cons of bilateral tubal ligation
*pros: permanent, high efficacy, hormone free, no need to take any meds, esp. easy if done at time of c-section *cons: irreversible (regret), surgical risks, failure rate is slightly higher than IUDs/implants
36
methods of contraception: male surgical sterilization - vasectomy
*must confirm azoospermic semen specimen postoperatively ~3 months post-procedure *methods: conventional incision, no scalpel method, percutaneous method, local anesthetic in office