Female Contraception

Question 1

All female hormonal contraception includes…

Answer 1

progestogen

Question 2

Progestogens include…

Answer 2

Natural progesterone and synthetic (progestin) compounds

Question 3

Progestogens have variable androgenic properties and act independently on…

Answer 3

• Cervix
• Ovary
• Hypothalamic-pituitary axis
• Endometrium
• Fallopian tube

Question 4

How does progestogen create a hostile cervical mucus

Answer 4

Decreases volume and increases viscosity preventing sperm movement

Question 5

How does progestogen act on GnRH to prevent ovulation?

Answer 5

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

Question 6

How does progestogen slow the rate of ovum/zygote transport in the oviduct?

Answer 6

• Decreases the number of ciliated cells lining the oviduct
• Decreases the intensity of cilia action

Question 7

Ectopic pregnancy

Answer 7

Embryo implants in location other than the uterus

Question 8

Females using progestogen-only birth control have a ______ rate of ectopic pregnancy

Answer 8

higher

Question 9

Why do we combine estrogen with progestogen in birth control?

Answer 9

Estrogen inhibits follicular development and ovulation as well. Together they provide a better suppression of FSH and LH.

Question 10

Why does estrogen cause breast tenderness and bloating?

Answer 10

It increases water retention

Question 11

Estrogen comes with the primary risk of…

Answer 11

venous thromboembolism (blood clotting within a vein)

Question 12

Explain withdrawal bleeding

Answer 12

Bleeding resulting from a drop in hormone levels causing uterine lining to weaken

Question 13

Explain breakthrough bleeding

Answer 13

• Bleeding while taking hormones.
• NOT normal
• Result of inadequate estrogen/progestogen dosage causing the uterine lining to be excessively thin

Question 14

Cycle control

Answer 14

Described if a female has an intended bleeding pattern when on hormonal contraception

Question 15

How can cycle control be improved?

Answer 15

Adding estrogen to a contraceptive

Question 16

Combined contraceptives and frequency of use

Answer 16

• Combined oral (1x daily)
• Nuvaring (3-4 weeks)
• Transdermal patch (1x a week)

Question 17

Progestogen-only contraceptives and frequency of use

Answer 17

• Progestin-only pill (1x daily)
• Depo-provera shot (every 3 months)
• Nexplanon implants (every 3 years)
• Hormonal IUD (3-7 years)

Question 18

Mechanism of action for the copper IUD

Answer 18

-Copper ions are toxic to sperm and embryos
- Produces local low-grade inflammatory response as leukocytes infiltrate endometrium increasing prostaglandin production.

Question 19

Mechanism of action for hormonal IUD

Answer 19

• 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

Question 20

Arguments against monthly menstruation

Answer 20

• Painful
• PMS, anemia, and endometriosis
• Planning and supplies
• Decreases productivity

Question 21

Arguments in favor of monthly menstruation

Answer 21

• Natural
• Not a sickness

Question 22

Does monthly shedding of endometrium protect against cancer?

Answer 22

Only the top layer is shed not the basal layer where cancer starts

Question 23

Define progestogen compared to progestin

Answer 23

Progestogen can be natural progesterone or synthetic progestin

Question 24

Explain why birth control pills need to be taken every 24 hours.

Answer 24

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.