Family Planning

Question 1

Percentage of pregnancies that are unintended

Answer 1

49% (22% result in birth, 20% abortion, 7% fetal loss)

The 7% of women not using contraceptives account for 47% of unintended pregnancies

Question 2

Consequences of unintended pregnancy

Answer 2

• inadequate prenatal care
• tobacco and alcohol use during pregnancy
• low birth weight
• infant mortality
• child abuse
• insufficient resources for child development

Question 3

Which hormone dominates in follicular phase? luteal phase?

Answer 3

Follicular phase: estrogen dominates (follicle grows, uterine lining grows–proliferative phase)

Luteal phase: progesterone dominates (corpus luteum, uterine lining matures (secretory phase) to allow for implantation)

Question 4

Contraceptive methods for stopping sperm production

Answer 4

• male hormonal contraception

- vasectomy

Question 5

Blocking entry of sperm into/past cervix

Answer 5

-Male barrier methods:
male condom
-Female barrier methods:
female condom
diaphragm
cervical cap
sponge
\+/- spermicide
-copper intrauterine device

Question 6

Contraceptives that thicken cervical mucus

Answer 6

Progestin methods:

• pills (Micronor)
• depot medroxyprogesterone acetate(Depo-provera)
• implant (Implanon)
• progestin IUD

Question 7

Female sterilization

Answer 7

ligate/occlude/remove fallopian tube

Removal = salpingectomy

Question 8

Contraceptives that prevent ovulation

Answer 8

a.) Progestin alone
i. Progestin only pills Micronor®
ii. Depot medroxyprogesterone
acetate (Depo-provera®)
iii. Implant (Implanon®)
iv. Progestin IUD (Mirena®)

b) Estrogen & progestin
i. Oral contraceptive pills
ii. Transdermal patch
iii. Transvaginal ring

Question 9

Natural family planning methods (and concerns)

Answer 9

• Billings ovulation method: recognize signs of fertility
• Symptothermal method: basal body temp rise after ovulation
• LH predictor kits

Concerns:

• sperm can last for 3-6 days
• variable cycles
• often retrospective

Question 10

Methods that thin the endometrium

Answer 10

Progestin thins endometrium

Estrogen stabilizes endometrium= less bleeding

Question 11

Pharm effects of progestins as contraceptives

Answer 11

-Inhibits ovulation by suppressing function
of hypothalamic-pituitary-ovarian axis
-Modifies mid-cycle surges of LH and FSH
-Diminishes ovarian hormone production
-Reduces activity of cilia
-Produces endometrial changes unfavorable to embryo implantation
-Thickens cervical mucus to impede
sperm transit

Question 12

MOA Progestin only pills

Answer 12

• inhibits ovulation
• atrophic endometrium
• thickens cervical mucus

(Plasma level drops by 24 hrs, thickened mucus lasts 27 hrs; woman at risk if miss pill by greater than 3 hrs)

Question 13

MOA Depo Provera injection

Answer 13

inhibits ovulation
atrophic endometrium
thickens cervical mucus

(Same 3 actions for Levonorgestrel IUD, but mucus even more thick; and for Progestin only pills)

Question 14

MOA progestin only implant

Answer 14

inhibits ovulation
atrophic endometrium
thickens cervical mucus
decreases tubal mobility

Question 15

MOA Combined hormonal contraception (pill, patch, ring)

Answer 15

inhibits ovulation
decreased tubal motility
thickens mucus

Question 16

MOA copper IUD

Answer 16

• creates inflammatory rxn in uterus

- copper acts as spermicide

Question 17

What impacts failure rates?

Answer 17

lower failure rate = less user dependent
From least to most failures:
Levonergestrel IUD
female sterilization
Copper IUD
injection
oral contraceptive
vaginal ring
patch
condom
diaphragm
fertility awareness
spermicide
no method

Question 18

Effects of estrogen: contraceptive and noncontraceptive benefits

Answer 18

Contraceptive benefit
▪ Helps stabilize uterine lining- less breakthrough
bleeding
▪ Added suppression of FSH- less follicle
development

Noncontraceptive benefits
▪ Reduces SHBG
so less male effects (i.e. acne)
▪ Reduces ovarian cancer, endometrial, colon cancer risks

Question 19

Emergency contraception

Answer 19

-MOA is same as other methods, but higher dose:
Disrupts follicular development
▪ Blocks LH surge
▪ Inhibits ovulation
▪ Disrupts luteal phase
• Not the same as abortion pill (RU-
486/mifepristone)

Examples:

• Yuzpe Method (Combined OCPs)
• Plan B: Levonorgesterol
• Copper IUD
• Ella (Ulipristal acetate= progesterone receptor modulator)