Contraception Flashcards
When was depo-provera introduced in the US
1992 (developed in the 1960’s in Europe)
Why does family planning fail 15-25% of the time?
Because every woman has a menstrual cycle as unique as a snowflake
How do IUD’s (intrauterine devices) work? (The most common form of contraception world wide)
- Sterile inflammation
- Destroys sperm by PMN’s
- Inhibits ovulation (when secreting progestins)
- Thickens cervical mucus
- Thins endometrial lining, decreasing menstrual volume
What are the benefits of using an IUD?
- Easy to use
- No systmeic exposure to hormones
- Light menstrual cycle
- Decreased risk of endometrial cancer?
- Can use during breast feeding (like estrogen will)
Side effects of IUDs?
- Acne (with progestin secreting forms)
- Changes in menstrual flow
- Risk of uterine performation
- Risk of pelvic infection
*Note: woman needs to be comfortable checking the string of the IUD to make sure its in place
What is Depo-Provera
It is a contraception injection given every 3 months. It is progestin only.
How does Depo-Provera work?
Progestin provides negative feedback on GnRH in the hypothalamus which causes:
- Inhibition of ovulation
- Thickening of cervical mucous
- Thinning of endometrial lining
What are some of the benefits of using Depo-Provera?
- Easy to use
- Decreases anemia
- Decreases PID
- Decreases ectopic pregancies
- Decreases endometrial cancer?
- Can use during breast feeding
what are the side effects of Depo-Provera?
- Acne
- Changes in menstrual flow
- Amenorrhea
- Mood changes
- Head ache
- Weight gain?
What are OCP’s (oral contraceptive pills)
Pill you take every day that is either a estrogen/progestin mix or just progestin
How do OCP’s work?
- Inhibits ovulatoin
- Thicken’s cervical mucous
- Disrupts tubal uterine motility
- Alters glycogen production in endometrium
Did you notice they all inhibit ovulation? Which would be the point of medication geared at preventing pregnancy. Ok good, just checking. :)
Do you get a period when on OCP? Can you make it so you don’t get a period?
Yes you can get your period (there are placebo pills that mimic a natural period for women who want to have that…) If you want, you can skip the placebo pills and start the next pack and not get your period.
Benefits of OCP’s
- Decreased menstrual flow
- Decreased PMS
- Decreased acne
- Decreased ectoptic pregnancy
- Decreased symptomatic functional cysts
- Decreased PID
- Decreased ovarian and uterine cancer
SO MANY GOOD THINGS!
Side effects of OCP’s
- Increased risk of cervical dysplasia (continue screenings for HPV)
- Increased risk of thromoembolism (estrogen effect)
- Breast tenderness (estrogen effect)
- Nausea (estrogen effect)
- Fluid retention
How does THE RING work
- Circular ring is inserted into the vagina
- Releases 15 ug of ethinyl estradiol/day
- Releases 120 ug etonogestrel/day
- Keep in for 3 weeks/1 week off
- Inhibits ovulation, thickens cervical mucous, may alter endometrial glycogen
What the benefits of the ring?
- Easy to use
- Lower hormone exposure
- Less impact on liver
- Improved menstrual cycle control
- Decreased ovarian/endometrial cancer risk?
Side effects of the ring?
- Vaginitis
- Break through bleeding
- Nausea
- Breast tenderness
- Possible increased risk of cervical dysplasia
- Increased risk of thromboembolism ?
What are two options for emergency contraception?
- Plan B (Levonorgestrel, a progestin only pill). Available OTC
- EllaOne (Ulipristal acetate, a antiprogestin pill). Available by Rx.
What is the mechanism of emergency contraception
- Alters tubal transport (but sperm get to the tube in 2 hours after intercourse so you better run to that drug store)
- Interference with corpus luteum function
- Direct interference with fertilization
- Disrupt implantation
How effective is emergency contraception based on when the woman ovulates?
Pre-ovulation: works really well
Post-ovulation: does not work very well
So it does not cause abortion, it prevents ovulation
