Contraception/family planning

Question 1

Of all the pregnancies in the U.S how many are intended and how many unintended?

Answer 1

51% intended

49% unintended
half of unintended pregnancies consists of the small proportion of women who do not use contraceptives

Question 2

Consequences of unintended pregnancy

Answer 2

1. Inadequate prenatal care
2. Tobacco and alcohol use during pregnancy
3. Low birth weight
4. Infant mortality
5. Child abuse
6. Insuff. resources for child development

Question 3

Preventing ovulation: which hormone alone will do the trick?

Answer 3

progesterone

• prevents you from ovulating
• bleeding is withdrawl every month.

*estrogen just helps

Question 4

How long can sperm last for in the female body?

Answer 4

3-6 days

Question 5

Pharm effects of progestins as contraceptives

Answer 5

1. Inhibits ovulation by suppressing fxn of HPOvarian axis
2. Modified mid-cycle surges of LH and FSH
3. Diminishes ovarian hormone production
4. Reduces activity of cilia
5. Produces endometrial changes unfavorable to embryo implantation
6. Thickens cervical mucus to impede sperm transit

Question 6

Depo provera injection MOA

Answer 6

big dose
works at all levels to suppress ovulation
- may see delay in return to fertility

Question 7

Progestin only implant

Answer 7

systemic absorption

1. inhibit ovulation
2. thickens cervical mucus
3. Decrease tubal motility
4. Atrophic endometrium

Question 8

Levonorgestrel IUD

Answer 8

Inhibits ovulation

2. decrease tubal motility
3. Atrophic endomet
4. THickens cervical mucus!!!!

Question 9

Combined hormonal contraception

Answer 9

1. Inhibits ovulation
2. Decrease tubal motlity
3. thickens mucus

*more forgiveness

Question 10

Methods that work the best?

Answer 10

Where pts dont have to do anything

1. IUD
2. Female sterilization
3. Copper IUD

Question 11

EMergency contraception

Answer 11

same as BC but higher dose

1. Disrupt follicular development
2. Block LH surge
3. Inhibits ovulation
4. Disrupts luteal phase

• NOT SAME as abortion pill
  (RU-486/mifepristone)

Question 12

Emergency contraception that works well for obese women

Answer 12

Ella

• ulipristal acetate
• progesterone receptor modulator

Question 13

Effects of estrogen

Answer 13

Contraception benefit

1. Helps stabilize uterine lining-less breakthrough bleeding
2. Added suppression of FSH less follicle development

Noncontraceptive benefits

1. Reduces SHBG –> less male effects (acne)
2. Reduces ovarian cancer, endometrial, colon cancer risk

Question 14

Physiologic risk of estrogen

Answer 14

1. Estrogen increases clotting factors
   - II, VII, X, XII, VIII, fibrinogen
2. Shift towards thrombus formation and prevention of clot dissolution
3. Great risk of venous and arterial clot formation

Question 15

Who should avoid combined hormonal contraception

Answer 15

1. smokers over 35
2. CAD / HD
3. Risk of cloths
4. Uncontrolled HTN
5. Diabetes w/ vascular changes
6. Migraines with aura
7. Active liver/gallbladder problems
8. Breast cancer
9. Prolonged immobilization after major surgery

Question 16

Diff types of EC

Answer 16

1. Yuze method
2. Plan B
3. Copper IUD
4. Ella

Question 17

Which hormone dominates in:
Follicular phase
Luteal phase

Answer 17

Follicular phase: estrogen

Luteal phase:
Progesterone