Contraception

Question 1

FSH promotes _______ by causing ______ that line each ______ to ________ and _______

Answer 1

ovarian follicular growth; granulosa cells; follicle; proliferate; produce estradiol

Question 2

LH promotes _______ production in _____ cells adjacent to _____ cells

Answer 2

androgen; theca; granulosa

Question 3

menstrual cycle: LH surge causes _______, ______ with increased _______ and slowed _______ synthesis

Answer 3

resumption of meiosis in the dominant oocyte; luteinization of granulosa cells; progesterone; estrogen

Question 4

most reliable predictor of ovulation is what occurrence?

Answer 4

onset of LH surge

Question 5

menstrual cycle: during the luteal phase, shift is to ____ dominance which _______ and causes ______ changes to the endometrium

Answer 5

progesterone; suppresses new follicular growth; secretory

Question 6

menstrual cycle: if pregnancy does not occur the corpus luteum declines ____ days after ovulation with a drop in __________ with resultant shedding of the endometrial lining, _______, and ________

Answer 6

9-11; progesterone, estrogen, and inhibin levels; rise in FSH and LH; development of a new follicle

Question 7

after ovulation the oocyte retains potential for fertilization for ______. sperm remain viable in the reproductive tract for up to _____.

Answer 7

12-24 hours; 120 hours

Question 8

combined hormonal methods: mechanism of action

Answer 8

estrogen PLUS progestin; prevent ovulation, thicken cervical mucus

Question 9

_____ is the dominant hormone in combined hormonal contraceptive formulations.

Answer 9

progestin

Question 10

what is the mechanism of action of progestin in combined hormonal contraceptive formulations? what about estrogen?

Answer 10

progestin diminishes frequency of hypothalamic GnRH pulse frequency, inhibits estrogen-induced LH surge at mic-cycle
estrogen suppresses FSH preventing selection and emergence of dominant follicle

Question 11

combined contraceptive vaginal ring: mode of action, what does it contain

Answer 11

suppression of ovulation; ethylene vinyl acetate

Question 12

combined transdermal patch: drawback compared to oral contraceptive pill

Answer 12

higher rate of venous thromboembolism

Question 13

combined hormonal contraceptive effects on coagulation cascade

Answer 13

1. increase levels of procoagulant factors 2, 7, 8, 10 and fibrinogen
2. decrease anticoagulant protein S, antithrombin, and tissue factor pathway inhibitor
3. induce resistance to natural anticoagulant activated protein C

Question 14

contraindications to combined hormonal contraceptives

Answer 14

1. smokers > 35 years old (increased risk of cardiovascular events)
2. history of thromboembolism and stroke
3. history of estrogen-dependent tumor
4. postpartum: 3-6 weeks after delivery (hypercoagulable state)

Question 15

progestin only pills: mechanism of action

Answer 15

prevents fertilization from thickening of cervical mucus and slowing ovum transport through decreased tubal motility

Question 16

best method of contraception for patients who experience seizures

Answer 16

DMPA depot medroxyprogesterone acetate injection

Question 17

DMPA depot medroxyprogesterone acetate injection decreases frequency of what conditions not related to pregnancy?

Answer 17

seizures and sickle cell crises

Question 18

what is the most effective reversible method of contraception and what is the mechanism of action

Answer 18

contraceptive implant; contains progestin etonogestrel –> inhibits ovulation

Question 19

which anti-epileptics induce hepatic cytochrome p450 3A4 (the same enzyme that metabolizes estrogens and progestins)

Answer 19

phenytoin, carbamazepine, phenobarbital

Question 20

IUDs: two types

Answer 20

copper, progestin levonorgestrel

Question 21

copper IUD: mechanism of action

Answer 21

primary: prevention of normal fertilization; copper ions reduce motility and viability of sperm, toxic to oocytes
secondary: inhibition of implantation, especially if used for emergency contraception