Female Contraception Flashcards
All female hormonal contraception includes…
progestogen
Progestogens include…
Natural progesterone and synthetic (progestin) compounds
Progestogens have variable androgenic properties and act independently on…
- Cervix
- Ovary
- Hypothalamic-pituitary axis
- Endometrium
- Fallopian tube
How does progestogen create a hostile cervical mucus
Decreases volume and increases viscosity preventing sperm movement
How does progestogen act on GnRH to prevent ovulation?
Decreases GnRH to the point there is a decline in LH and FSH.
- Decreased FSH inhibit antral follicle development
- Decreased LH may prevent LH surge and therefore ovulation
How does progestogen slow the rate of ovum/zygote transport in the oviduct?
- Decreases the number of ciliated cells lining the oviduct
- Decreases the intensity of cilia action
Ectopic pregnancy
Embryo implants in location other than the uterus
Females using progestogen-only birth control have a ______ rate of ectopic pregnancy
higher
Why do we combine estrogen with progestogen in birth control?
Estrogen inhibits follicular development and ovulation as well. Together they provide a better suppression of FSH and LH.
Why does estrogen cause breast tenderness and bloating?
It increases water retention
Estrogen comes with the primary risk of…
venous thromboembolism (blood clotting within a vein)
Explain withdrawal bleeding
Bleeding resulting from a drop in hormone levels causing uterine lining to weaken
Explain breakthrough bleeding
- Bleeding while taking hormones.
- NOT normal
- Result of inadequate estrogen/progestogen dosage causing the uterine lining to be excessively thin
Cycle control
Described if a female has an intended bleeding pattern when on hormonal contraception
How can cycle control be improved?
Adding estrogen to a contraceptive
Combined contraceptives and frequency of use
- Combined oral (1x daily)
- Nuvaring (3-4 weeks)
- Transdermal patch (1x a week)
Progestogen-only contraceptives and frequency of use
- Progestin-only pill (1x daily)
- Depo-provera shot (every 3 months)
- Nexplanon implants (every 3 years)
- Hormonal IUD (3-7 years)
Mechanism of action for the copper IUD
-Copper ions are toxic to sperm and embryos
- Produces local low-grade inflammatory response as leukocytes infiltrate endometrium increasing prostaglandin production.
Mechanism of action for hormonal IUD
- Acts by same mechanism as other modes of progestogen-only contraception.
- Suppresses gonadotropin secretion (FSH and LH)
- Local effect on cervix and oviduct which creates environment unsuitable for sperm survival and fertilization.
- Local low-grade inflammatory response
Arguments against monthly menstruation
- Painful
- PMS, anemia, and endometriosis
- Planning and supplies
- Decreases productivity
Arguments in favor of monthly menstruation
- Natural
- Not a sickness
Does monthly shedding of endometrium protect against cancer?
Only the top layer is shed not the basal layer where cancer starts
Define progestogen compared to progestin
Progestogen can be natural progesterone or synthetic progestin
Explain why birth control pills need to be taken every 24 hours.
Birth control pills need to be taken every 24 hours, since progestogen (and estrogen, if also included in the pills) have a very short half life of less than 24 hours in the body. To maintain effects of pills, must be taken every 24 hours.
