Contraception Flashcards
Which hormone is required for contraceptive purposes?
Progestin
How do contraceptives work?
Exogenous progestin and estrogen decrease endogenous production of LH and FSH which suppresses the HPO function, stopping ovulation and endometrium prep
What are some advantages to barrier methods?
- STD protection
- Good for occasional intercourse
- Avoid hormonal methods
- OTC
What are some disadvantages to barrier methods?
- Not as effective
- Depends how you use them
- May require fitting by healthcare provider
- Many require concomitant use of spermicide
What are the two components of spermicides?
- Spermicidal chemical (nonoxynol-9–>surfactant that disrupts sperm membrane)
- A delivery base
What are some advantages to the copper IUD?
- > 99% effective
- Effective up to 5 days after intercourse
- Well tolerated
- 12 Years
- Immediately reversible
What are some disadvantages to the Cu IUD?
- Req healthcare professional to insert
2. Bleeding changes
How do we do male sterilization?
No-scalpel vasectomy is the standard of care. A small opening is made in the skin of the scrotal sac to deliver vas deferens. Ligate. No scalpel or sutures required
What are 3 methods of female sterilization?
- ligating
- blocking with clips/rings
- cauterizing
What % of women have sterilization regret
20% of women 30y/o
What is tubal occulusion?
It is non surgical where micro-inserts are placed into proximal fallopian tubes. Brand name=Essure
What is the combination pill
Is emergency contraceptive with estrodiol and progestin. 2 doses 12 hours apart, first within 120 hours of sex
What % of unwanted preg does the combo pill prevent?
Prevents 75% of unintended pregnancies
What are some disadvantages of the combo pill?
- High estrogen=inc side effects
2. Nausea, vomiting
What is the progestin only EC?
1 dose within 120 hours of sex (“plan B”)
What are some advantages and disadvantages to progestin only EC?
- More effective than combo
- Better tolerated
- Single dose
No disadvantages, mild nausea
What is ulipristal acetate/ella?
A progesterone receptor modulator that inhibits/delays ovulation
What are some advantages of Ella?
- Single dose
2. FDA approved 120hrs after sex, but isn’t time sensitive so works just as well on day 5 as day 1
What are some disadvantages of Ella?
- Mild side effects (nausea)
2. Req prescription, few pharmacies carry it
List the 2 purposes of the menstrual cycle
- Transport gametes to site of fertilization
2. Provide a suitable site for implantation
What 4 things does exogenous progestin do to prevent pregnancy?
- It inhibits the LH surge which inhibits ovulation
- It thickens the cervical mucus impeding sperm travel
- Decreases estrogen driven cell proliferation in the endometrium inhibiting egg implantation
- Converts reproductive tissues from proliferative modes to functional modes (ie endometrial atrophy?)
also causes ovarian inhibition
What 4 things does exogenous estrogen effect?
- Inhibits FSH surge and subsequent follicle development
- MAY inhibit ovulation
- Thins the cervical mucus (so you need more progestin than estrogen in your pill)
- Increases endometrial proliferation
Where do we make endogenous estrogen and progestin?
Ovaries!
What is the most common form of synthetic estrogen?
ethinyl estradiol (EE)
Describe the bioavailability of progestin
It differs widely between different exogenous progestins. High=reduced doses, but mg to mg comparisons lack meaning
Describe the half life of progestin
It differs widely as well. Longer half life=stays in body longer. So missing a pill isnt as big of a deal
What is depot medroxyprogesterone acetate?
An injectible BC that uses medroxyprogesterone acetate. Inject every 3 mo
What are some advantages of depot medroxyprogesterone acetate?
- Effective
- 3 mo
- Private
- No estrogen
- less endometrial cancer
- menstrual changes
What hormone causes the side effects of contraceptives?
Estrogen
What are some disadvantages of depot medroxyprogesterone acetate?
- Menstrual changes
- Injection
- Weight gain
Why do people discontinue depot medroxyprogesterone acetate?
irregular bleeding, prolonged menses or amenorrhea
What is a combo pill’s effect on dose?
Lower dose since they have synergistic effects
What are the pharmacologic effects of progestins in combo OCs?
- Inhibits ovulation by suppressing HPO function
- Diminish ovarian hormone production
- Produce endometrial change unfavorable for ovum implantation
- Thicken cervical mucus
- Inhibit sperm action
Effects of combo OCs on androgen pathways
- Both directly increase amount of serum sex hormone binding globulin, which binds testosterone. This dec amt of free testosterone in blood
- LH and FSH suppression causes ovary suppression further decreasing the amount of free testosterone in blood (since ovaries make testosterone)
- Leads to reduction in acne and facial hair
What are the clinical effects of hormonal contraception?
- Contraception!
- Dec menstrual symptoms
- Improved anemia
- Suppressed functional ovarian cysts
- Decreased acne/hirsuitsm (facial hair)
- Cancer protection
What kind of bleeding you have have on contraceptives?
Withdrawal bleeding, not a period since you didn’t ovulate
What are some advantages to levonogestrel IUD?
- Effective
- 5 years
- Private
- Less bleeding
What are some disadvantages to levonogestrel IUD?
- Professional insertion and removal
2. Changes bleeding pattern
What is Implanon/Nexplanon
Progestin implant that is effective immediately, rapid return of fertility (within 3 mo), 3 years of protection
Pregnancy vs OCP health hazards
Pregnancy incidence of all things OCP inc risk for=worse
What cancers do OCPs reduce the risk of?
Ovarian cancer and wnsomwreiL Xnxwe
How many pregnancies in the US are unintended?
Nearly 50%!
What determines the effectiveness of contraception?
Compliance!
Advantages and disadvantages of the contraceptive patch
Adv:
- OCP efficacy same
- Weekly application
Dis:
- Site reaction where applied
- > 198lbs=not effective
- Breast pain
- Visible on skin
- Not as well studied as OCPs
Adv and dis of vaginal ring
Adv.
1: effective as OCP
2. less spotting
3. 3 weeks before removal
4. private
Dis:
- req insertion and removal
- comes out, feel it
