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1st Repro > Contraception Reproductive Physiology > Flashcards

Contraception Reproductive Physiology Flashcards

1
Q

Most women have menstrual cycles lasting 24-35 days with an average of 28 days. The first day of blood flow is day 1 of the cycle. 20% of women experience irregular cycles. The normal menstrual cycle has 2 phases: The______ phase is variable lasting an average of 10-17 days while the_____ phase is more constant at 14 days.

A

follicular

luteal

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2
Q

Hypothalamic GnRH is secreted in a pulsatile fashion every 60-90 minutes and travels via the portal circulation to the anterior pituitary to produce

A

LH and FSH

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3
Q

promotes ovarian follicular growth by causing granulosa cells that line each follicle to proliferate and **produce estradiol **

A

FSH

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4
Q

promotes androgen production in theca cells adjacent to the granulosa cells

A

LH

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5
Q

The_____ diffuse from the theca cells –> granulosa cells where they are converted by the enzyme aromatase to estrogen

A

androgens

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6
Q

FSH promotes ovarian ______to proliferate and secrete estradiol resulting in follicular growth

A

granulosa cells

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7
Q

As estradiol levels rise a positive feedback loop of rising LH stimulates increased estrogen resulting in greater pituitary secretion of

A

LH >> FSH

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8
Q

About 2 days prior to ovulation secretion of___ rises 6-10 fold

LH surge causes resumption of_____ in the dominant oocyte, luteinization of granulosa cells with increased progesterone and slowed estrogen synthesis

A

LH

meiosis

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9
Q

Follicular rupture occurs 32- 44 hours after onset of _____ and 10-12 hours after _____

A

LH surge

LH peak

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10
Q

Onset of the LH surge is the most reliable predictor of _____

During the luteal phase shift is to________ dominance which suppresses new follicular growth and causes secretory changes to the endometrium

A

ovulation

progesterone

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11
Q

If pregnancy does not occur the declines 9-11 days after ovulation with a drop in ______, ______, and ______ levels with resultant shedding of the endometrial lining, rise in FSH and LH, and development of a new follicle

A

progesterone, estrogen, and inhibin

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12
Q

After ovulation the oocyte retains potential for fertilization for ________

Sperm remain viable in the reproductive tract for up to _____

A

12- 24 hours

120 hours

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13
Q

Oocyte is swept into lumen of the fallopian tube by the fimbria

Fertilization occurs in the______ portion of the tube

A

ampullary

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14
Q

After fertilization the zygote reaches the uterine cavity by day ____and implantation begins day____ when embryo is at the blastocyst stage

A

4-5

5-7

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15
Q

Combined hormonal contraceptives, contraceptive implant, contraceptive injection

A

• Prevent ovulation

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16
Q

Abstinence, fertility awareness methods, intrauterine device, progestin only pill, barrier methods, spermicides, withdrawal, sterilization

A

• Prevent fertilization

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17
Q

Estrogen PLUS Progestin

– Three formations

What is the mechanism?

A

“ The Pill”, Transdermal patch, Vaginal ring

Prevent ovulation and Thicken cervical mucous

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18
Q

Prevention of Ovulation

  • is the dominant hormone in CHC formulations
  • diminishes frequency of hypothalamic GnRH pulse frequency
  • inhibits the estrogen induced LH surge at mid-cycle
A

Progestin

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19
Q

suppresses FSH preventing selection and emergence of dominant follicle

A

Estrogen

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20
Q

OCP: Majority contain _______, few 50 mcg formulations with mestranol, one with estradiol valerate.

Progestins vary by pill formulation: Estranes - norethindrone (1st generation)

  • norgestimate, desogestrel (3rd gen) Gonanes- norgestrel, levonorgestrel (2nd gen) Spironolactone analogue- drospirenone (4th gen)
A

ethinyl estradiol

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21
Q

suppression of ovulation, Flexible ring delivers 15 mcg ethinyl estradiol and 120 mcg etonogestrel (active metabolite of desogestrel)

A

Combined Contraceptive Vaginal Ring

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22
Q

• 20 cm2 patch delivers 20 mcg of _______and________

(active metabolite of norgestimate)

  • One patch per week for 3 weeks then one patch free week.
  • Less effective in women >90 kg
A

ethinyl estradiol and norelgestromin

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23
Q

Combined Hormonal Contraceptives

  • _____ levels of pro-coagulant factors II, VII, VIII, X, and fibrinogen
  • _____ anticoagulants protein S, anti- thrombin, and tissue factor pathway inhibitor
  • Induce resistance to the natural anticoagulant activated protein C
A

Increase procoagulants

Decrease procoagulants

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24
Q

Contraindications to CHC

A

History of venous thromboembolic event (VTE), inherited or acquired thrombophilia

Postpartum – initial 3-6 weeks after delivery

History of myocardial infarction or coronary

artery disease

History of cerebrovascular accident

Cigarette smokers > age 35

Complicated diabetes, vascular disease

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25
Q

Contraindications to CHC

A

Severe hypertension BP > 160/100

Migraine with aura

Severe active liver disease, cirrhosis, history of hepatic adenoma

Personal history of breast or endometrial cancer

Undiagnosed abnormal uterine bleeding

Pregnancy

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26
Q

What three methods involve progestin only?

A
  • Pills
  • Injection
  • Subdermalimplant
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27
Q

MOA of Progestin only Pills

A

Prevention of fertilization from thickening of cervical mucus, and slowing ovum transport through decreased tubal motility

Possible prevention of implantation from thinning of the endometrium

28
Q

Profound ovulation inhibition – slow return to baseline fertility – 7-10 months

150 mg IM and 104 mg SQ formulations given every 12 weeks

A

DMPA Depot medroxyprogesterone acetate injection

29
Q

High efficacy - perfect use failure rate rate 0.3%. Typical use failure rate 3%

Unscheduled bleeding with trend toward amenorrhea with continued use

A

DMPA Depot medroxyprogesterone acetate injection

30
Q

Reversible decrease in bone density, no evidence of fracture risk

Unaffected by hepatic enzyme inducing drugs

**Decreases frequency of seizures and sickle cell crises **

A

DMPA Depot medroxyprogesterone acetate injection

31
Q

What does implant rod contain and how does it work?

How long does it work and what is the side effect?

A

Contains progestin etonogestrel and inhibits ovulation

works for 3 years and irregular bleeding most common side effect

32
Q

What enzyme medications will compete for metabolism by CYP 3A4

A

Enzyme inducing medications

Rifampin, Griseofulvin, St Johns Wort, Modafinil

Some HIV protease inhibitors

Nevirapine – non nucleoside reverse transcriptase inhibitor

33
Q

What anti-epileptics induce CYP 3A4 thus compete with estrogen and progestin?

A

Phenytoin

Carbamazepine

Phenobarbital

34
Q

Couples who do not use any method of contraception have an approximately ____ chance of experiencing a pregnancy over the course of a year.

The typical U.S. woman wants two children. To achieve this goal, she must use a contraceptive method for roughly three decades.

More than ____of women aged 15–44 who have ever had sexual intercourse have used at least one contraceptive method.

A

85%

99%

35
Q

Combination hormonal contraceptives (pill, patch, ring) – contain both estrogen and progestin - primary mechanism is

A

prevention of ovulation

36
Q

LARC Methods: Long Acting Reversible Contraceptives: Most effective forms of reversible contraception due to high typical use efficacy and high rates of continuation.

A

Implant and Intrauterine devices.

37
Q

Placed quickly and easily in the office without anesthesia

DO NOT increase risk for infertility.

Safe in nulliparous women and teens

A

Intrauterine Devices : both copper and Progestin levonorgestrel

38
Q

Mechanism of Copper IUD

A

Primary mechanism is prevention of normal fertilization

– Cu+ ions reduce motility and viability of sperm, _toxic to oocytes _

39
Q

Secondary mechanism of this method is inhibition of implantation- especially if **used for emergency contraception **

A

Copper IUD

40
Q

What is the Mechanism of Action of Levonorgestreal IUD

A

Mechanism of action: Prevention of fertilization

Thick impenetrable cervical mucus

Sterile inflammatory reaction within uterus

Impaired sperm migration

41
Q

FDA approved to treat abnormal uterine bleeding – 90% decrease in menstrual bleeding, high rates of amenorrhea

A

5 year levonorgestrel IUD

42
Q

same as 5 year LNG IUD

Smaller size of device and inserter

Contains a lower dose of levonorgestrel 13.5 mg

Designed for teens and nulliparous women

Lower rates of amenorrhea

A

3 year levonorgestrel IUD

43
Q

IUD Efficacy Rates compared to sterilization

CuT

All Sterilization

Postpartum Salpingectomy

A

CuT= 1.4

All sterilizaiton= 1.3

Postpartum Salpingectomy= 0.6

44
Q

Contraindications to IUD/IUS

A

Pregnancy

PID current or within the past 3 months

Current STI

Puerperal or postabortion sepsis current or within the past 3 months

Purulent cervicitis

Undiagnosed abnormal genital bleeding

Malignancy of the genital tract

Known uterine anomalies or fibroids distorting the cavity in a way incompatible with IUD insertion

Allergy to any component of the IUD or Wilson’s disease (for copper IUD)

45
Q

Perfect fail rate for condoms 1st year:

Typical use rate first year:

Benefits of condom use

A

3%

18%

decrease risk of STI transmission

*has 3-5% breakage or slippage rate thus consider backup use

46
Q
  • Nitrile sheath with 2 flexible polyurethane rings lined with silicone
  • Protection against STI’s
  • Single use only
  • Do not use with male condom
  • Typical first year failure rate 21%
A

Female Condom

47
Q

Available as creams, gels, film, foam, and suppositories containing nonoxynol-9

Used alone or ideally with a barrier method

Typical one year failure rate 28%

A

Spermicide

48
Q

Nonoxynol-9 impregnated polyurethane sponge

Should be removed after 24-30 hours due to increased risk of irritation and TSS

Typical failure rate 24% for multiparous and 12% for nulliparous women

A

Sponge

49
Q

Prevention of fertilization

Used with spermicide

Multiple sizes

Typical one year failure rate 12%

New silicone diaphragm Older latex diaphragm

discontinued in the US

A

Diaphragm

50
Q

• Silicone cap with outward flared rim

One year typical failure rate 15%

Use with spermicide

Leave in at least 8 hours after intercourse

Do not leave in longer than 48 hours

A

Cervical Cap

51
Q

Describe using the calander method for fertility

A

– Subtract 18 days from shortest cycle and 11 days from longest cycle to calculate fertile window

52
Q

Standard Days Method

– Must have regular ____ days cycle – 80% of women

– Days___are fertile days

– Cumulative probability of pregnancy was 4.75% over 13 cycles with correct use and 12% probability under typical use.

A

26-32

8-19

53
Q

Cervical Mucus Ovulation Detection Method

– Abstinence or use barrier with onset of cervical secretions until _________(clear, stretchy, egg white) consistency

• Two Day Method
– Abstain or use barrier if detect cervical secretions of any type ______

A

4th day after last day of peak ovulatory secretions

TODAY and YESTERDAY

54
Q

Sympto-thermal Method

– Fertile interval begins with ______ and ends with sustained increase in basal body temperature of ______ degrees for 3 consecutive days following 6 days of lower temperatures

A

cervical secretions

at least 0.4

55
Q

Sympto-hormonal Method (Marquette Method)

– Combines cervical secretion check and detection of urine LH with ovulation predictor device: how does it work?

A

Fertile period onset of cervical secretions until 3 days after PEAK LH reading

56
Q

– FDA approved for use 72 hrs after unprotected intercourse. Can use for up to 120 hrs

– Less effective in women with BMI >30

A

Levonorgestrel 1.5 mg tab

57
Q

When must you take Levonorgestrel 1.5 mg tab for it to be effective in preventing pregnancy?

A

Effective only if taken 2-3 days prior to LH peak

58
Q

– Selective progesterone receptor modulator

– FDA approved for use 120 hrs after unprotected intercourse.

A

Ulipristal

59
Q

How does Ulipristal work as an emergency contraceptive?

A

– Prevents follicular rupture 100% if taken just prior to LH surge

– Prevents follicular rupture for 24-48 hours if taken on day of LH peak

60
Q

99% effective if placed within 5 days after unprotected intercourse

A

Copper IUD

61
Q

MOA of copper IUD in emergency contraception

A

Copper ions toxic effect on sperm as well as negative effects on oocycte, zygote-morula- blastocyst, and endometrium

62
Q

Methods of Sterilization

A

Sterilization

– Female
• Laparoscopy
• Mini-laparotomy post partum • Hysteroscopy

– Male
• Outpatient office procedure

63
Q

MOA of Hysteroscopic sterilization

A

Expandable outer coil – Alloy of nickel and titanium, polyester fibers

Stainless steel inner coil that expands to fit contour of tube

Over 3 months tissue grows into the device occluding the tube

0.3% failure rate at 5 years

64
Q

at high doses inhibit the LH surge thus preventing ovulation and result in thick viscous cervical mucus that is “hostile” to sperm

A

Progestins

65
Q

The ovum is fertilizable for ____ hours and sperm are viable for______– hence a woman is fertile for 6 days per cycle

A

12-24

up to 5 days

66
Q

are the most effective forms of reversible contraception

A

The implant and IUDs

1st Repro (16 decks)

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