Fertility, Contraception, and Sterilization

Question 1

Emergency Contraception

Which method is most effective?

Which method is progestin only?

Answer 1

Copper IUD - most effective

• -sterile inflammatory response prevents implantation
• -5-8 days post intercourse

Plan B

• -progestin only
• -72 hours post intercourse

Question 2

Combination OCPs

Reduce risk of what 2 cancers?
Effect on bones and breasts?
Effect on gallbladder, liver?
Contraindicated for what groups of women?
--re: smoking
--re: cancer

Answer 2

Combination OCPs

Reduce risk of ovarian, endometrial cancer
Increase bone density
Reduce risk of benign breast disease
Increased risk of gallbladder disease
Increased risk of benign hepatic tumors

Contraindications:

• -women over age 35 who smoke
• -women with breast or endometrial cancer

Other important sfx: breakthrough bleeding, HTN

Question 3

Elective Abortions: 1st Trimester Options

1) surgical option for pregnancies up to 7 weeks
2) surgical option for pregnancies between 7-13 weeks

3) medical option; progesterone antagonist that can be used up to 49 days post-LMP
* Name of synthetic prostaglandin subsequently used to cause uterine contractions to expel retained POC?

4) medical option; DHFR inhibitor that prevents placental villi proliferation; used up to 49 days post-LMP

Answer 3

Elective Abortions: 1st Trimester Options

1) manual vacuum aspiration

2) suction curettage (D and C)
- -safest surgical option

3) Mifepristone (RU-486)
* Misoprostol

4) Methotrexate
- -also followed by Misoprostol

Question 4

Depo-Provera (medroxyprogesterone)

1. Slow release of what hormone? leads to suppression of ovulation, thickening of cervical mucous, and unsuitability of endometrial lining.
2. Administered how often?
3. Main sfx include reversible bone demineralization, depression, weight gain, and ?
4. Reduces risk of what cancer and what disease?
5. After discontinuation, how long before normal ovulation?

Answer 4

Depo-Provera (medroxyprogesterone)

1. slow release of Progestin
2. Administered q 3 months.
3. Main side effect is irregular menstrual bleeding (spotting, irregular menses).
4. Reduces risk of endometrial cancer, PID
5. After discontinuing, 6-18 months before normal ovulation returns

Question 5

Medications Used In Treatment of Infertility

1. anti-estrogen; blocks estrogen’s negative feedback; leads to increased FSH, LH and ovulation induction
2. aromatase inhibitor; reduces androgen conversion to estrogen, stimulating follicular development for ovulatory induction
3. used to tx hypothalamic-pituitary failure

Answer 5

Infertility Tx: Medications

1. Clomiphene citrate
2. Letrozole
3. Pulsatile GnRH

Question 6

What is the preferred form of hormonal contraception in breast feeding women?

Answer 6

Progestin-only oral contraception

• Combinatioin OCPs
• -potentially decrease milk production
• -post-partum women are still hypercoaguable for several weeks to months, depending on their risk factors

Question 7

1. What form of hormonal contraception?
   - -suppress ovulation
   - -thicken cervical mucus
   - -make endometrium unsuitable for implantation
2. What form of hormonal contraction?
   - -thicken cervical mucus
   - -ovulation suppression
   - -endometrial atrophy

Answer 7

1. Combination OCP
   - -suppress ovulation; thicken cervical mucus; make endometrium unsuitable for implantation
2. Progestin-only contraception
   - -thicken cervical mucus; suppress ovulation; endometrial atrophy
   * ideal for breast-feeding mothers and women for whom estrogens are contraindicated (eg, smokers, HTN, CAD, CVD, lupus, migraines, hx of thromboembolism)