Exam 2 - Contraception Flashcards
All female hormonal contraception contains —- which acts by…
progestogen
contraceptive effect
acts independently on the cervix, ovary, hypothalamic-pituitary axis, endometrium, and fallopian tube
have variable androgenic properties - for example, some are anti-androgenic and can prevent acne
Some female hormonal contraception contains — which acts by…
estrogen (always ethinyl estradiol, the orally available form of estradiol)
better cycle control/bleeding regularity
What are the main contraceptive actions/advantages of progestogen?
hostile cervical mucus:
- decrease volume and increase viscosity
- immediate but short lived effect
- considered the first line of defense - occurs at a lower dose than other effects
decrease pulses of GnRH to a point where FSH and LH both decline:
- decrease FSH inhibits follicle development
- decrease LH prevents surge/ovulation
What are the disadvantages of progestogen?
slows ovum/zygote transport by reducing the number of ciliated cells and the intensity/frequency of cilia action
this can increase the rate of ectopic pregnancy (embryo implants somewhere other than the uterus)
What are the advantages of estrogen?
inhibit follicular development and prevent ovulation by suppressing FSH and LH
better cycle control (bleeding regularity)
What are the disadvantages of estrogen?
increase water retention (breast tenderness and bloating)
increases risk of venous thromboembolism (blood clots in an intact vein)
What is the bleeding that happens while taking a hormonal contraceptive? Why does it occur?
it is not a menstrual period
it is an expected result of the drop in hormone levels when hormones are stopped (placebo week, etc.)
normally the endometrium sees only estrogen for 14 days before progesterone starts being involved, but hormonal contraceptives have progesterone constantly, causing a thinner and disordered endometrium (low proliferation, low secretory activity, not much of it to be shed)
when hormones are stopped, this can weaken the lining just enough for some bleeding to occur
What is breakthrough bleeding?
bleeding while taking hormones
dose of estrogen and progesterone may be inadequate for individual patient, which may cause the uterine lining to become excessively thin
What are some examples of combination contraceptives?
combined oral contraceptive, transdermal patch, nuva ring or annovera
An adequate amount of estrogen/progestogen from oral contraceptives only remains in the blood for about how long?
24 hours - that’s why you have to take it every day
How does daily dose correlate with exposure?
they don’t correlate - low daily dose doesn’t necessarily mean low exposure
What are some progestogen-only contraceptives?
progestin only pill, depo-provera, nexplanon, and the hormonal IUD
How does a copper IUD work?
copper ions are toxic to sperm and embryos, but they do not interfere with follicular development or ovulation
produces a low grade inflammatory response (leukocyte infiltration of endometrium, increase uterine prostaglandin production, may prevent implantation but not the primary mechanism of action
10 year lifespan
How does a hormonal IUD work?
suppresses gonadotropin secretion (FSH and LH) but doesn’t always prevent ovulation
local effect on cervix and oviduct which creates an environment unsuitable for sperm survival and fertilization
local, low grade inflammatory response
3-7 year lifespan depending on the brand
How does a hormonal IUD work?
suppresses gonadotropin secretion (FSH and LH) but doesn’t always prevent ovulation
local effect on the cervix and oviduct which creates an environment unsuitable for sperm survival and fertilization
the local, low-grade inflammatory response
3-7 year lifespan depending on the brand
