Contraception

Question 0

Between vasectomy (male) and tubal sterilization (female) which is less risky/invasive?

Answer 0

Vasectomy is less risky and invasive.

Question 1

What’s the most effective form of emergency contraception (EC)?

Answer 1

Copper T IUD

Question 2

What’s a non-surgical form of tubal sterilization?

Answer 2

Nonsurgical Tubal Occlusion: Coil is inserted into fallopian tubes. Induces occlusion of tube, confirmed by hysterosalpingogram.

Question 3

What is the Yuzpze Regimen for emergency contraception (EC)? What’s the major disadvantage?

Answer 3

2 doses of ethinyl estradiol + norgesteral, 12 hours apart.

High dose estrogen causes nausea and vomiting.

Question 4

What is “Plan B”? Time frame? How does its effectiveness compare to the Yupze Regimen?

Answer 4

Levonorgestrol only, single dose EC. Must be taken within 120 hours of unprotected sex - sooner is better.
It’s more effective, and has fewer side effects.

Question 5

What is “Ella”? Time frame? Disadvantages?

Answer 5

Progesterone receptor inhibitor that delays / inhibits ovulation. Used for EC. Can be used up to 120 hrs have unprotected sex.
Causes nausea/vomiting, not easily available.

Question 6

4 effects of progestins in oral contraceptives (OCs)?

Answer 6

Inhibits LH surge, preventing ovulation.
Reduces proliferation of endometrial tissue.
Thickens cervical mucus.
Converts reproductive tissues from “proliferative” to “functional.”
(may also affect sperm motility)

Question 7

4 effects of estrogens in OCs?

Answer 7

Inhibits FSH surge, and thus follicle development.
May help inhibit ovulation.
Thins cervical mucus. (bad for contraception)
Increases endometrial proliferation.

Question 8

What are 4 types of synthetic progestins?

Answer 8

Testosterone derivatives (estranes, gonanes)
Progesterone derivatives (pregnanes)
Spironolactones
Anti-progestins

Question 9

What’s medroxyprogesterone acetate (MDPA)?

Answer 9

aka. DepoProvera, it’s an injectable progestin for long-acting contraception.

Question 10

3 disadvantages of MDPA?

Answer 10

Menstrual changes
Requires injection every 3mo.
Weight gain

Question 11

Significance of bioavailability? What’s one OC hormone with particularly high bioavailability?

Answer 11

Can give less drug, may mean less variation in dosage between patients.
Levonorgestrel has bioavailability of about 90%.

Question 12

Does a longer serum half-life correlate with higher efficacy of OC?

Answer 12

Yep.

Question 13

What effects do combined OCs have on androgens?

Answer 13

They increase levels of androgen-binding proteins in serum, decreasing levels of free T. This has anti-verilizing effects (including less acne and facial hair).

Question 14

5 things combined OCs are good for other than contraception?

Answer 14

Reduced menstrual flow/symptoms.
Decreased anemia.
Suppresses ovarian cyst activity.
Good for acne / facial hair.
Protective against cancer.

Question 15

What’s the deal with withdrawal bleeding while taking OCs?

Answer 15

It’s non-ovulatory, it’s from the loss of endometrium-sustaining hormones. There’s no harm in not having it.

Question 16

How has dosing of OCs changed over time?

Answer 16

It has decreased a lot. People realized that they work synergistically.

Question 17

How different are the patch / vaginal ring different from OCPs?

Answer 17

They’re not, really. The dosing is similar - it’s just different sites of absorption.

Question 18

What do Mirena and Implanon have in them?

Answer 18

Progestin-only.

Question 19

How are progestin IUDs thought to work?

Answer 19

Mainly by local activity of progestins thickening cervical mucus and decreasing endometrial proliferation.
Note that it does not commonly suppress ovulation.

Question 20

Significant risks of hormonal contraceptives?

Answer 20

Clotting / CV mortality: But this may be more due to smoking / synergy with smoking.

Question 21

Does the estrogen or the progestin in OCs seem to play more of a role increasing risk for VTE? How does the increased risk from OCs compare to the increased risk from pregnancy?

Answer 21

Estrogen.

Pregnancy makes women have wayyy more estrogen than does OCs, and consistently, the risk for VTE is much higher.

Question 22

Overall, how you should you use / not use hormonal contraceptives in women with conditions predisposing them to clots?

Answer 22

You should be more aggressive with the contraceptives, because pregnancy is all the more dangerous in these patients.

Question 23

2 specific cancer that OCs reduce the risk for?

Answer 23

Ovarian and endometrial cancer.