Contraception and Infertility Flashcards
How long does a normal menstrual cycle range from in days?
23 - 25 days
average 28 day
In a woman’s menstrual cycle, what day is considered day 1?
The first day of bleeding
What happens during the Follicular phase?
A surge in estrogen causes Luteinizing hormone (LH) and FSH to increase
What happens during the Ovulation phase?
The Luteinizing hormone (LH) surge from the follicular phase triggers ovulation 24 - 36 hours later.
Ovulation is the release of egg (ova) from the ovary.
What happens during the Luteal phase?
The start of ovulation begins the luteal phase which lasts about 14 days.
Progesterone is dominate in the phase.
What the the phases of the menstrual cycle?
Follicular phase -> Ovulation -> Luteal phase
What is the function of the Luteinizing hormone?
It results in the release of oocyte (egg) from the ovary into the fallopian tube.
When is the best time to have intercourse in order to get pregnant?
When Luteinizing hormone surge is detected and for the following 2 days.
When is Human Chorionic gonadotropin (hCG) released?
It is released when fertilized egg attaches to the lining of the uterus aka implantation.
What does pregnancy tests detect in the case of pregnancy?
Human Chorionic gonadotropin (hCG)
What are some actions which should be taken preconception?
- Take folic acid
- Stop smoking and using illicit drugs or alcohol
- Keep vaccinations current
- Avoid toxic chemicals
Which contraception method has a delay in returning to fertility once it has been discontinued?
Medroxyprogesterone injection
How do hormone contraceptives prevent pregnancy? MOA?
- The inhibit the production of FSH and LH, which prevents ovulation.
- They form a mucous, which inhibits the sperm form penetrating the egg.
Work before implantations occurs.
How does progestin-only pills prevent pregnancy?
It suppresses ovulation
When are progestin-only pills preferred to be used?
- Primarily used in women who are lactating (breastfeeding)
b/c estrogen decreases milk production - In women who are at high risk for thrombosis
Progestin-only pills clinical pearls
- Must be taken within 3 hours of the scheduled time
What are other indication for combination oral contraceptive pills? (6)
- Dysmenorrhea (mensural cramps)
- Premenstrual syndrome (PMS)
- Acne
- Anemia
- Polycystic ovary syndrome (to regulate menses)
- Endometriosis
Xulane Contraindication?
- Do not use in anyone with clotting risk factors
- Less effective in women > 198lb
- Do not use in women > 35 years old who smoke
Depot medroxyprogesterone acetate aka Depo-Provera MOA
- Surpasses ovulation
- Thickens cervical mucus
- Causes thinning of the endometrium
Note: it is a progestin
How often is Depo-Provera injection given?
150mg IM
104mg SubCu
Every 3 months
How often does bleeding occur with extended cycle combination oral contraceptive pills?
84 days of active hormonal pill followed by 7 days of inactive or very low dose estrogen pill.
Bleeding occurs every 3 months
What does “Lo” mean on contraceptive pills?
It indicates ≤ 35mcg of estrogen e.g. Loestrin
- To avoid or minimize ADE of estrogen
What does “Fe” mean on contraceptive pills?
It indicates an iron supplement included
What does “24” mean on contraceptive pills?
It indicated a shorter placebo time: 24 active + 4 placebo = 28 day cycle
What are some ADE of estrogen?
- Nausea
- Breast tenderness/fullness
- Bloating
- Weight gain
- Elevated blood pressure
Serious
- Thrombosis (MI, stroke and DVT/PE)
If spotting or bleeding occurs early to mid cycle during contraceptive pill packs, what could be the cause of it?
Insufficient estrogen
Try increasing estrogen dose
Contraceptive pill BBW
- All estrogen containing pills: do not use in women > 35 years old who smoke due to risk of serious CV events
- All estrogen containing pills: Antiphospholipid syndrome or other clotting problems
- Xulane: Increased risk of DVT/PE
- Depo-Provera: Loss of bone mineral density with long-term use
What are some severe and rare adverse effects of estrogen
ACHES
- Abdominal pain that is severe
- Chest pain
- Headaches
- Eye problems
- Swelling or sudden leg pain (DVT)
Which contraceptive pill are preferred for the treatment of Acne?
Use contraceptive pill with lower androgenic activity (e.g. Ortho-Cyclen)
OR
no androgenic activity (e.g. Yaz, Yasmin)
Which contraceptive pill are preferred in women breastfeeding?
Progestin only
Which contraceptive pill are preferred for the treatment for Migraines?
If with aura, use progestin only
If with no aura, use any contraceptive pill
Which contraceptive pill are preferred for the treatment of Menorrhagia (heavy menstrual bleeding)?
- Natazia
- Levonorgestrel-releasing IUD: Mirena
What are the 3 versions of progestin found in contraceptive pill?
- Norethindrone
- Levonorgestrel
- Drospirenone
What drugs decreases the effectiveness of contraceptive pill?
- Antibiotics (Rifampin, Rifabutin and Rifapentine)
- Anticonvulsants
- St. John’s wort
- Tobacco
Drospirenone ADE
Hyperkalemia
In general, how long does it take for combination contraceptive pill to be effective?
7 days
Use a backup method for those 7 days
When is a back up method not required when starting contraceptive pill?
If contraceptive pill is started within 5 days after the start of the period
In general, how long does it take for progestin only contraceptive pill to be effective?
start at anytime and use backup method for 48 hours
If a patient misses how many days of contraceptive pill does she need to start using backup methods? And for how long should the back up method be used?
If patient misses ≥2 pills.
Use back up method for 7 days
Missing pill direction…. 1 late or missing pill of combination contraceptive pill
Take missed pill as soon as possible and take next dose on schedule even if that makes 2 pills in 1 day
Missing pill direction…. ≥ 2 late or missing pill of combination contraceptive pill
Take most recent missed pill as soon as possible and take next dose on schedule even if that makes 2 pills in 1 day.
Discard the other missing pills
Use back up method for 7 days
Consider EC if unprotected sex in the last 5 days
Missing pill direction…. if > 3 hours past scheduled time of progestin only contraceptive pill
Take pill as soon as possible and take next dose on schedule
Use back up method for 48 hours
Consider EC if unprotected sex in the last 5 days
Which IUDs have hormone in them?
Intrauterine devices such as Mirena
How long is Mirena good for?
Can be used for up to 5 years
True or False:
Copper-T IUD can be used for emergency contraception and/or birth control.
True
How long is copper IUD good for?
Can be used for up to 10 years
Copper IUD ADE
Can cause heavy bleeding and cramping
What is Nexplanon
It is a plastic rod that is placed subdermally (in the arm) and releases the progestin etonogestrel for 3 years
What is the most effective emergency contraceptive available?
Copper IUD if inserted within 5 days
What are the 2 types of oral emergency contraceptives?
Levonorgestel (Plan B) 1.5mg Ulipristal acetate (Ella)
MOA Levonorgestel (Plan B)
Primarily works by preventing or delaying ovulation
and
thicken cervical mucus
MOA Ulipristal acetate (Ella)
Delays ovulation
Infertility definition
the inability to get pregnant after trying for 1 year with unprotected sex
What is the 1st line treatment for infertility?
Clomiphen
Clomiphen Class? MOA?
Class: SERM
MOA: Act as estrogen agonist in some tissues and estrogen antagonist in other tissues and increases LH and FSH which triggers ovulation
Clomiphen ADE
Hot flashes
Clotting risk
What is the 2nd line treatment for infertility?
Gonadotropins
Gonadotropins MOA
Trigger ovulation by acting similarly to the endogenous gonadotropins LH, FSH and hCG
What are some Gonadotropins agents?
Generic names include:
- Chorionic Gonadotropin-Recombinante
- Follicle Stimulating Hormone-Recombinante
- Human Chorionic Gonadotropin-Recombinant
- Menotropin
Brand names include:
- REPROduce
- FOLLicle
- GONadotropins
- PREGnancy
- OVary
