Contraception Flashcards
Names of the phases for
- Follicles
- Uterine lining
- Follicular, luteal
2. Menstrual/atretic, proliferative, secretory
Histology of the endometrium in the proliferative phase
Endometrial stroma thickens
Glands elongate
No crowding
More stroma than glands
Histology of the endometrium in the secretory phase
Endometrial stroma becomes loose and edematous
Blood vessels become thickened and twisted
Endometrial glands become tortuous
More glands than stroma
4 Natural methods of contraception
Withdrawal
Fertility awareness
Basal body temperature
Cervical mucus
Fertility awareness method of contraception
Using cycle length and signs of ovulation to predict and avoid intercourse on fertile days so egg and sperm never meet
Basal body temp method of contraception
Increase in body temperature follows the LH surge as progesterone levels rise
Elevation in temperature restrospectively predicts ovulation and signifies the end of the fertile period
Chart this over time, and avoid intercourse just before temp increases
Cervical mucus methods of contraception
Prior to ovulation, estradiol causes cervical secretions that favor sperm motility, passage through the cervical canal and sperm maturation (these are copious, thin, stretchy, clear mucus)
Post ovulation, progesterone results in mucus that impedes sperm motility (scant, thick, tenacious mucus)
4 places in the female repro system that contraception can work
Ovulation
Fallopian tube
Implantation
Entry of semen
Tubal ligation
Sterilization process that blocks the fallopian tube patency so that sperm and egg never meet
Salpingectomy (removal of tubes) is not reversible but does reduce risk of ovarian cancer
Vasectomy
Prevents the entry of semen
Interruption of the vas deferens
Sperm and egg never meet
What stage do barrier methods work at?
Prevent the entry of semen
What stages do combined hormonal contraception work at?
All of them! Ovulation (main one) Fallopian tube Implantation Entry of semen
What is the MOA of combined hormonal contraceptives (general)
Inhibits gonadotropin secretion via negative feedback on pituitary and hypothalamus
MOA of
1. Ethinyl estradiol (1)
2. Progesterone (4)
in the combined hormonal contraceptives
- Inhibits FSH release (inhibits FSH follicular recruitment and prevents ovulation)
- Primarily suppresses LH release (prevents ovulation), endometrium not receptive to ovum, cervical mucus thick and impervious, reduced tubal peristalsis
Function of
- High levels of progesterone
- Continuous levels of progesterone
- Stabilizes/causes the thickening of the endometrium
2. Prevents endometrial growth
Combined hormonal contraceptives can come in what 3 forms?
Oral contraceptive pills
Transdermal patch
Vaginal ring
Where do progesterone only hormonal contraceptives work?
All 4 sites again Ovulation (less prominent) Fallopian tube Implantation Entry of semen
4 MOAs for progesterone contraceptives
Suppresses LH release (prevents ovulation about 40% of the time)
Endometrium not receptive to ovum
Cervical mucus thick and impervious
Reduced tubal peristalsis
Intrauterine device MOA
Chronic inflammatory changes within endometrium and fallopian tubes
Become toxic to sperm and ova (prevents fertilization, discourages implantation)
Levonorgestrel releasing IUD MOA
Progesterone IUD
Changes in cervical mucus
Thinning and glandular trophy of endometrium
Prevents ovulation
What contraceptions work at
- Ovulation
- Fallopian tube
- Implantation
- Entry of semen
- Hormonal contraception
- Tubal ligation, hormonal contraception
- Hormonal contraception, IUD
- Barrier methods, vasectomy, hormonal contraception, coitus interruptus
2 hormonal forms of emergency contraception
Levonorgestrel (ex: PlanB - use within 5 days, effectiveness decreased if BMI over 25) Ulipristal acetate (ex: Ella - use within 5 days, effectiveness decreased if BMI over 30)
What is the most effective form of emergency contraception?
Copper T IUD
Use within 7 days of unprotected intercourse
First line is BMI over 30
Levonorgestrel
Emergency contraception Multifactorial MOA (interferes with ovulation, affects fallopian tube contractility, inhibits sperm binding to zona pellucida)
Ulipristal acetate
Emergency contraception Multifactorial MOA (interferes with follicle rupture) No effect on endometrium
Copper IUD
Most effective form of emergency contraception
Copper ions are toxic to sperm and ova
Affects fallopian tube and myometrial contractility
Inhibits implantation IF a blastocyst reaches the uterus
