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Female and Male Health > Contraception and Infertility > Flashcards

Contraception and Infertility Flashcards

1
Q

How long does a normal menstrual cycle range from in days?

A

23 - 25 days

average 28 day

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2
Q

In a woman’s menstrual cycle, what day is considered day 1?

A

The first day of bleeding

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3
Q

What happens during the Follicular phase?

A

A surge in estrogen causes Luteinizing hormone (LH) and FSH to increase

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4
Q

What happens during the Ovulation phase?

A

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.

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5
Q

What happens during the Luteal phase?

A

The start of ovulation begins the luteal phase which lasts about 14 days.

Progesterone is dominate in the phase.

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6
Q

What the the phases of the menstrual cycle?

A

Follicular phase -> Ovulation -> Luteal phase

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7
Q

What is the function of the Luteinizing hormone?

A

It results in the release of oocyte (egg) from the ovary into the fallopian tube.

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8
Q

When is the best time to have intercourse in order to get pregnant?

A

When Luteinizing hormone surge is detected and for the following 2 days.

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9
Q

When is Human Chorionic gonadotropin (hCG) released?

A

It is released when fertilized egg attaches to the lining of the uterus aka implantation.

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10
Q

What does pregnancy tests detect in the case of pregnancy?

A

Human Chorionic gonadotropin (hCG)

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11
Q

What are some actions which should be taken preconception?

A
  • Take folic acid
  • Stop smoking and using illicit drugs or alcohol
  • Keep vaccinations current
  • Avoid toxic chemicals
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12
Q

Which contraception method has a delay in returning to fertility once it has been discontinued?

A

Medroxyprogesterone injection

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13
Q

How do hormone contraceptives prevent pregnancy? MOA?

A
  • 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.

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14
Q

How does progestin-only pills prevent pregnancy?

A

It suppresses ovulation

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15
Q

When are progestin-only pills preferred to be used?

A
  • Primarily used in women who are lactating (breastfeeding)
    b/c estrogen decreases milk production
  • In women who are at high risk for thrombosis
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16
Q

Progestin-only pills clinical pearls

A
  • Must be taken within 3 hours of the scheduled time
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17
Q

What are other indication for combination oral contraceptive pills? (6)

A
  • Dysmenorrhea (mensural cramps)
  • Premenstrual syndrome (PMS)
  • Acne
  • Anemia
  • Polycystic ovary syndrome (to regulate menses)
  • Endometriosis
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18
Q

Xulane Contraindication?

A
  • Do not use in anyone with clotting risk factors
  • Less effective in women > 198lb
  • Do not use in women > 35 years old who smoke
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19
Q

Depot medroxyprogesterone acetate aka Depo-Provera MOA

A
  • Surpasses ovulation
  • Thickens cervical mucus
  • Causes thinning of the endometrium

Note: it is a progestin

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20
Q

How often is Depo-Provera injection given?

A

150mg IM
104mg SubCu

Every 3 months

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21
Q

How often does bleeding occur with extended cycle combination oral contraceptive pills?

A

84 days of active hormonal pill followed by 7 days of inactive or very low dose estrogen pill.

Bleeding occurs every 3 months

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22
Q

What does “Lo” mean on contraceptive pills?

A

It indicates ≤ 35mcg of estrogen e.g. Loestrin

  • To avoid or minimize ADE of estrogen
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23
Q

What does “Fe” mean on contraceptive pills?

A

It indicates an iron supplement included

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24
Q

What does “24” mean on contraceptive pills?

A

It indicated a shorter placebo time: 24 active + 4 placebo = 28 day cycle

25
Q

What are some ADE of estrogen?

A
  • Nausea
  • Breast tenderness/fullness
  • Bloating
  • Weight gain
  • Elevated blood pressure

Serious
- Thrombosis (MI, stroke and DVT/PE)

26
Q

If spotting or bleeding occurs early to mid cycle during contraceptive pill packs, what could be the cause of it?

A

Insufficient estrogen

Try increasing estrogen dose

27
Q

Contraceptive pill BBW

A
  • 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
28
Q

What are some severe and rare adverse effects of estrogen

A

ACHES

  • Abdominal pain that is severe
  • Chest pain
  • Headaches
  • Eye problems
  • Swelling or sudden leg pain (DVT)
29
Q

Which contraceptive pill are preferred for the treatment of Acne?

A

Use contraceptive pill with lower androgenic activity (e.g. Ortho-Cyclen)

OR

no androgenic activity (e.g. Yaz, Yasmin)

30
Q

Which contraceptive pill are preferred in women breastfeeding?

A

Progestin only

31
Q

Which contraceptive pill are preferred for the treatment for Migraines?

A

If with aura, use progestin only

If with no aura, use any contraceptive pill

32
Q

Which contraceptive pill are preferred for the treatment of Menorrhagia (heavy menstrual bleeding)?

A
  • Natazia

- Levonorgestrel-releasing IUD: Mirena

33
Q

What are the 3 versions of progestin found in contraceptive pill?

A
  • Norethindrone
  • Levonorgestrel
  • Drospirenone
34
Q

What drugs decreases the effectiveness of contraceptive pill?

A
  • Antibiotics (Rifampin, Rifabutin and Rifapentine)
  • Anticonvulsants
  • St. John’s wort
  • Tobacco
35
Q

Drospirenone ADE

A

Hyperkalemia

36
Q

In general, how long does it take for combination contraceptive pill to be effective?

A

7 days

Use a backup method for those 7 days

37
Q

When is a back up method not required when starting contraceptive pill?

A

If contraceptive pill is started within 5 days after the start of the period

38
Q

In general, how long does it take for progestin only contraceptive pill to be effective?

A

start at anytime and use backup method for 48 hours

39
Q

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?

A

If patient misses ≥2 pills.

Use back up method for 7 days

40
Q

Missing pill direction…. 1 late or missing pill of combination contraceptive pill

A

Take missed pill as soon as possible and take next dose on schedule even if that makes 2 pills in 1 day

41
Q

Missing pill direction…. ≥ 2 late or missing pill of combination contraceptive pill

A

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

42
Q

Missing pill direction…. if > 3 hours past scheduled time of progestin only contraceptive pill

A

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

43
Q

Which IUDs have hormone in them?

A

Intrauterine devices such as Mirena

44
Q

How long is Mirena good for?

A

Can be used for up to 5 years

45
Q

True or False:

Copper-T IUD can be used for emergency contraception and/or birth control.

A

True

46
Q

How long is copper IUD good for?

A

Can be used for up to 10 years

47
Q

Copper IUD ADE

A

Can cause heavy bleeding and cramping

48
Q

What is Nexplanon

A

It is a plastic rod that is placed subdermally (in the arm) and releases the progestin etonogestrel for 3 years

49
Q

What is the most effective emergency contraceptive available?

A

Copper IUD if inserted within 5 days

50
Q

What are the 2 types of oral emergency contraceptives?

A 
Levonorgestel (Plan B) 1.5mg
Ulipristal acetate (Ella)
51
Q

MOA Levonorgestel (Plan B)

A

Primarily works by preventing or delaying ovulation
and
thicken cervical mucus

52
Q

MOA Ulipristal acetate (Ella)

A

Delays ovulation

53
Q

Infertility definition

A

the inability to get pregnant after trying for 1 year with unprotected sex

54
Q

What is the 1st line treatment for infertility?

A

Clomiphen

55
Q

Clomiphen Class? MOA?

A

Class: SERM
MOA: Act as estrogen agonist in some tissues and estrogen antagonist in other tissues and increases LH and FSH which triggers ovulation

56
Q

Clomiphen ADE

A

Hot flashes

Clotting risk

57
Q

What is the 2nd line treatment for infertility?

A

Gonadotropins

58
Q

Gonadotropins MOA

A

Trigger ovulation by acting similarly to the endogenous gonadotropins LH, FSH and hCG

59
Q

What are some Gonadotropins agents?

A

Generic names include:

  • Chorionic Gonadotropin-Recombinante
  • Follicle Stimulating Hormone-Recombinante
  • Human Chorionic Gonadotropin-Recombinant
  • Menotropin

Brand names include:

  • REPROduce
  • FOLLicle
  • GONadotropins
  • PREGnancy
  • OVary

Female and Male Health (6 decks)

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