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Block 5 > Contraception, Fertility and Menopause > Flashcards

Contraception, Fertility and Menopause Flashcards

1
Q

What things need to be considered in a contraceptive consultation?

A

Health

Age

Desire for fertility

Social/religious/ethical

Education

Compliance

Cost

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2
Q

List the 4 broad contraceptive methods

A

Natural/physiological

Barrier

Hormonal

Surgical

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3
Q

List the 3 natural/physiological forms of contraception

A

Rhythm method

Coitus interruptus

Lactation

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4
Q

Give some advantages and disadvantages of the rhythm method

A

No STI protection

Cheap

No side effects

No religious/ethical barriers

Limits sexual activity

Failure rate

Education

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5
Q

Discuss the lactation method of contraception

A

Regular and exclusive breastfeeding

Prevent ovulation

Prolactin inhibits secretion of FSH - no ovulation

Only works in theory for 6 months

High failure rate?

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6
Q

Discuss the coitus interruptus method of contraception

A

Penile withdrawal before ejaculation

Prevent sperm/egg interaction

No STI protection

Significant failure rate

Cheap

Education

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7
Q

List the 4 barrier methods of contraception

A

Condom

Diaphragm

Cervical cap

+/- spermicide

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8
Q

Give advantages and disadvantages to condom use

A

STI protection

Cheap and readily available

Latex allergies

Loss of sensation

Accidents

Education

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9
Q

Give advantages and disadvantages to diaphragm and cap use

A

Needs professional fitting

Education

Use with spermicides

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10
Q

Discuss the copper IUD

A

Long-acting reversible contraception

Releases copper which is a spermicide and mechanically prevents implantation

Long term

Can be used as emergency contraception if implanted within 5 days of unprotected sex

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11
Q

Give advantages and disadvantages to the copper coil

A

No interruption to sexual activity

No artificial hormones

Amenorrhea

Partner unaware

Decreased libido

Irregular bleeding

Cost

Invasive

No STI protection

Expulsion

Perforation

Infection (PID)

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12
Q

Discuss methods of termination of pregnancy

A

Legal to 34/40

Medical
- mifepristone/misoprostol (9/40)

Surgical

  • vacuum (15/40)
  • dilation and curettage (>15/40)
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13
Q

Discuss surgical methods of contraception

A

Surgical interruption of sperm and egg interaction

Tubual ligation (FR 0.5%)
Vasectomy (FR 0.05%)

Consider irreversible

Counselling

Cost

Invasive

Failures

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14
Q

What is ‘the pill’?

A

Synthetic steroid hormones that mimic the functions of oestrogen and progesterone

Combined or progesterone only pills

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15
Q

Discuss the molecular MoA of oral contraceptives

A

Act upon oestrogen and progesterone receptors which are intracellular transcription factors

Steroid hormones diffuse across the cell membrane

Binding with receptor activates the receptor via dissociation from HSP90

Active receptor dimers then influence extensive gene expression

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16
Q

Name the oestrogen intracellular receptors

A

ERalpha

ERbeta

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17
Q

Name the progesterone intracellular receptors

A

PR-A

PR-B

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18
Q

How is oral contraceptive progesterone different?

A

Usually a synthetic analogue of progesterone

19
Q

What is the primary outcome of oral contraceptives?

A

Suppression of ovulation

20
Q

Discuss how progesterone inhibits ovulation

It which emergency can progesterone be used?

A

Progesterone acts on AP and hypothalamus in -ve feedback the suppresses FSH and LH synthesis

High progesterone early in follicular phase lowers FSH and LH synthesis/activity - ovulation is inhibited

Emergency contraception when oestrogen-derived complications/risk occur

21
Q

Give some effects of progesterone on the endometrium

A

Inhibits endometrial gland development - makes implantation less favourable

Thickens cervical mucus - inhibits sperm motility

22
Q

Which hormone is in an IUS?

A

Progesterone

23
Q

List some common side effects to oral contraceptives

A

Breakthrough bleeding

Nausea

Depression

Increased risk of stroke, DVT, HTN

Slight increase in breast cancer risk in long term use

24
Q

Give some benefits beyond contraception of the pill

A

Relieves symptoms of endometriosis

Dysmenorrhoea

Menorrhagia

Relieves acne

Progesterones reduce risk of endometrial cancer

25
Q

List the 5 stages of menopause

A

Pre-menopause

Premature menopause/primary ovary failure (POF)

Peri-menopause

Menopause

Post-menopause

26
Q

Describe the endocrine changes at menopause

A

Declining oocyte numbers

Ovaries can not respond to increased LH and FSH from AP

Oestrogen + inhibin drop

Which leads to an increase in FSH

27
Q

What is the mean age of onset of the menopause?

A

51 years

45-60 years

28
Q

What is the classic symptom triad of menopause?

A

Hot flushes

Sweats

Vaginal dryness

29
Q

List some other non-specific symptoms of the menopause

A

Headaches

Migranes

Palpitations

Disturbed sleep

Joint and muscle ache

30
Q

List some urogenital symptoms of menopause

A

Vaginall dryness

Cystitis

Urinary frequency

Urinary incontinence

31
Q

List some psychological symptoms of menopause

A

Loss of concentration

Poor memory

Irritability

Loss of libido

Panic attack

32
Q

List some symptoms of menopause caused by atrophy of connective tissue

A

Skin thinning

Hair loss

Brittle nails

Aches and pains

Osteoporosis

33
Q

If a woman is having symptoms of menopause <40yo, what hormone would you test for?

A

FSH is used as a marker of early menopause

34
Q

How is menopause usually diagnosed?

A

Age

Symptoms

Signs

35
Q

Discuss premature menopause

A

Premature ovarian failure before 40 years old

POF doesn’t necessarily mean lack of viable follicles

Risks include

  • premature death
  • neuro diseases
  • psychosexual function
  • mood disorders
  • osteoporosis
  • infertility
36
Q

What are the causes of POF?

A

Idiopathic

Familiar tendency

Autoimmune

Genetic - fragile X, Turner’s

Infections - viral

Surgical menopause - oophrectomy, total hysterectomy

37
Q

How is menopause diagnosed?

A

Amennorhea >12 months

38
Q

When is perimenopause?

A

Menopause +/- 5 years

39
Q

Discuss HRT

A

Administration of oestrogen relieves menopausal symptoms

Preparations use natural oestrogen at lower doses than the pill

Combination with progesterone avoids cystic endometrial hyperplasia

40
Q

What routes of administration are available for HRT?

A

PO

Transdermal patches lasting 2 weeks

Subcut oestrogen implants lasts 6 months, + PO progesterone to avoid uterine symptoms (hysterectomy)

Topical oestrogen creams - urogential symptoms (atrophy and dyspareunia)

41
Q

Give some benefits of HRT

A

Improves vasomotor symptoms (hot flushes, night sweats)

Improves urogenital symptoms (vaginal atrophy, vulvovaginitis)

Reduces # risk and osteoporosis

Reduces osteoclast proliferation

42
Q

List some adverse effects of HRT

A

Stroke, thromboembolism

Breakthrough bleeding

Breast tenderness

Increased risk of breast CA

?Increased risk of dementia

43
Q

What 2 other drugs are available to treat menopausal symptoms?

A

Raloxifene

  • selective oestrogen receptor modulator
  • osteoporosis, acts on ER in bone but not breast or uterus

Tibolone
- synthetic steroid with metabolites possessing oestrogenic and preogestogenic activities

Block 5 (6 decks)

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