Contraception Flashcards
fertile days of cycle
8-19
two types of IUD
Copper
progestin levonorgestrel (3 and 5 year(
LH surge ___ days before ovulation
dominant follicle develops on day ___
Lh surge 2 days before ovulation (tiggers meiosis)
dominant follicle on 5-7days
Depot Caveats and side effects
unscheduled bleeding and ammenorrhea with continued use
reversible decrease in bone density (no fracture risk)
unaffected by hepatic enzyme inducing drugs
decreases siezure threshold and sickle cell crisis
trasndermal patch caveats
less effective in body weight >90kgs
higher rate of VTE
enzyme inducing anti-epileptics
phenytoin
carbamazepine
phenobarbital
primodone
topiramate (>200mg)
felbamate
vigabatron
after ovulation oocyte retains potential for fertilization for
spem viable in tract for
12-24 hours
sperm viable for 120 hours
hormonal emergency contraceptives + mechanistic requirements
Levonorgestrel - 72-120hours, effective only if 2-3d prior to LH peak
Ulipristal acetate - 120hrs - preventsfolciular rupture if before LH surge, delays follicular rupture for 24-48hr if taken on day of LH peak
Copper IUD
mechanism of action for combined hormonal methods (estrogen + progestin)
prevent ovulaiton
thicken cervical mucus
mechanism progestin only methods
ovulation suppressed in 50% of cycles
thickening of cervical mucus
possilbe prevention of implantation via thinning of endometrium
enzyme inducing general medications (p450 3A4)
rifampin
griseofulvin
St johns wort
modafinil
some HIV protease inhibitors
Nevirapine (non-nucleoside reverse transcriptase inhibitor)
caveats, progestin only pills
time dependent - daily dose consitency needed
unscheduled bleeding or spotting
hematologic effets combined hormonal contraceptives
Increase 2 7 8 10 fibrinogen
decrease anticoag Protein S, anti-thrombin, tissue factor pathway inhibitor
induce resistance to activated protein C
most reliable predictor of ovulation
LH surge
Progestin mechanism of ovulation prevention
estrogen mechanism
progesstin: diminishs frequency of hypothalamic GnRH pulse frequency
inibits estrogen induced LH surge
estrogen supresses FSH preventing selection and emergence of dominant follicle
transdermal patch mechanism
combined hormonal BC
ethinyl estradiol
norelegesstromin (active metabolite of norgestimate)
Combined oral contraception formulations
estranes (norethinidrone-1stgen) (Norgestimate, Nesogestrel 2nd gen)
Gonanes - borgestrel, levonorgestrel (2nd gen)
sprironolactone analogue - drosprienone
LH surge causes lutenization of ___ cells resulting in
luteinization of granulosa cells with increased progesterone and slowed estrogen synthesis
LH promotes androgen production in the ___ cells
theca cells
copper IUD mechanism
Cu ions reduce motility and viability of sperm
toxic to oocyte
prevent implantation (useful for emergency contraception)
progestin only methods
Pills
Injection
implant
androgens converted to estrogen by aromatase in _____ cells
granulosa cells
vaginal ring mechanism
combined hormonal contraception
estradiol and etonogestrel (active metabolite of desogestrel)
contradictions to IUD
pregnancy
PID within past 3 months
peurperal or post-partum sepsis within 3 months
Purulent cervicitis
undx abnormal bleeding
malignacy
Known uterine morphologic abnls
contraindications to CHC
Hx of VTE, inherited or acquired thrombophilia
postpartum - 3-6wks
Hx of MI or CAD
Hx of cerebrovacular accident
smokers > 35
complicated diabetes or vascular disesase
severe HTN BP >160/100
MIgrane with aura
Liver disease
Hx
breast or endometrial cancer
