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Year 2 RE > Fertility Control > Flashcards

Fertility Control Flashcards

1
Q

What is released from the hypothalamus that stimulates the pituitary gland to secrete follicular stimulating hormone (FSH) and leutenising hormone (LH)?

A
  • gonadotrophin releasing hormone (GnRH)
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2
Q

Gonadotrophin releasing hormone (GnRH) is released from the hypothalamus that stimulates the anterior pituitary gland to secrete 2 hormones that are then able to stimulate the ovaries?

A
  • follicular stimulating hormone (FSH)

- leutenising hormone (LH)

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3
Q

Gonadotrophin releasing hormone (GnRH) is released from the hypothalamus that stimulates the anterior pituitary gland to secrete follicular stimulating hormone (FSH) and leutenising hormone (LH). LH and FSH then stimulate follicles in the ovaries through to maturation. What are the 2 key hormones in the ovaries that drives the maturation of follicles?

A

1 - oestrogen

2 - progesterone

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4
Q

Estrogen is critical for stimulating follicular development through to maturation in the ovaries. What is another important function of estrogen?

A
  • negative and positive feedback to the hypothalamus
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5
Q

Although FSH and LH both have a myriad of roles, what is the main function of each of these hormones in the development and maturation of follicles?

A
  • LH = ovulation (oocyte released into fallopian tubes)

- FSH = development and maturation of follicle up to ovulation

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6
Q

Once ovulation has occurred the follicle becomes the corpus luteum. What hormone does the corpus luteum then secrete in response to this, which also then goes on to prepare the uterus for the oocyte?

A
  • progesterone
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7
Q

Once ovulation has occurred the follicle becomes the corpus luteum resulting in a peak in progesterone production and some estrogen production. What does the level of estrogen and progesterone then do to LH and FSH levels?

A
  • acts as a negative feedback

- LH and FSH levels drop significantly

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8
Q

Once ovulation has occurred the follicle becomes the corpus luteum resulting in a peak in progesterone production and some estrogen production. The levels of estrogen and progesterone then provide a negative feedback loop to LH and FSH levels, causing them to reduce. What does this then directly do to the levels of estrogen and progesterone?

A
  • both then drop as an effect
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9
Q

Synthetic estrogen is taken by females as a form of contraception. What is the main effect of synthetic estrogen on the menstrual cycle?

A
  • high oestrogen provides negative feedback to hypothalamus
  • gonadotropin releasing hormones (GnRH) is reduced
  • FSH and LH secretion is reduced
  • ovulation is inhibited
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10
Q

Although we are aware that synthetic oestrogen’s are an effective female contraceptive through:

  • providing negative feedback to the hypothalamus
  • gonadotropin releasing hormones (GnRH) is reduces
  • FSH and LH secretion is reduced
  • ovulation is inhibited

What effects can synthetic progesterone have on the menstrual cycle as an affective female contraceptive?

A
  • suppress ovulation (not as well as estrogen)
  • reduces cilia activity in the fallopian tube
  • increases volume and thickens cervical mucus
  • thins endometrium
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11
Q

What are endogenous and exogenous hormones?

A
  • endogenous = hormones produced by the body

- exogenous = synthetic prescribed hormones

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12
Q

Within the group of endogenous hormones as forms of contraception, there are 2 broad categories, what are they?

A

1 - combined hormonal contraceptives

2 - progesterone-only contraceptives

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13
Q

Within the group of endogenous hormones as forms of contraception, there are 2 broad categories:

1 - combined hormonal contraceptives
2 - progesterone-only contraceptives

What are combined contraceptives?

A
  • contraceptives that contain oestrogen and progesterone
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14
Q

Combined hormonal contraceptives are contraceptives that contain oestrogen and progesterone. In the UK what are 3 forms in which they can be administered?

A

1 - pill (combined oral contraceptive pill ‘the pill’)
2 - patch
3 - vaginal ring

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15
Q

Combined hormonal contraceptives are contraceptives that contain oestrogen and progesterone. What is the typical efficacy of this medication as an effective form of contraception?

A
  • 91% is normal efficacy (due to forgotten taking of pills)

- 99% can be seen in some patients

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16
Q

Combined hormonal contraceptives are contraceptives that contain oestrogen and progesterone. Typical efficacy of this medication as an effective form of contraception is generally around 91%, although 99% can be achieved. What are 3 key things can affect the efficacy of this form of contraception?

A

1 - diarrhoea and vomiting (close to taking medication)
2 - weight (>90kg)
3 - drug interactions (enzyme inducing drugs, such as antibiotics and anti-epileptic medication can speed up enzymes acting on contraception)

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17
Q

Although combined contraception can start at any time, assuming the woman is not already pregnant. If they are taken between days 1-5 of the menstrual cycle, how quickly can their effective be seen?

A
  • immediately
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18
Q

Although combined contraception can start at any time, assuming the woman is not already pregnant. If they are taken after days 1-5 of the menstrual cycle, how quickly can their effective be seen?

A
  • at least 7 days

- if sex occurs in this time period then barrier protection should be used

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19
Q

Combined hormonal contraceptives are contraceptives that contain oestrogen and progesterone. What cancers have they been shown to reduce the risk of?

A
  • ovarian, colorectal and endometrial cancer
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20
Q

Combined hormonal contraceptives are contraceptives that contain oestrogen and progesterone. What 2 effects can the combined contraception have on bleeding and pain experienced during the menstrual cycle?

A
  • provides predictable bleeding patterns

- reduces menstrual bleeding and pain

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21
Q

Combined hormonal contraceptives (CHC) are contraceptives that contain oestrogen and progesterone. What 3 gynaecological conditions can taking the CHC pill help with?

A

1 - polycystic ovarian syndrome
2 - endometriosis
3 - premenstrual syndrome

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22
Q

What age should the combined hormonal contraceptives (CHC) not be used for?

A
  • women >50 years of age
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23
Q

Combined hormonal contraceptives (CHC) are contraceptives that contain oestrogen and progesterone. If the pill is stopped, generally how soon will fertility return to normal?

A
  • rapidly
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24
Q

Combined hormonal contraceptives (CHC) are contraceptives that contain oestrogen and progesterone. There are 6 common side effects observed in some patients that use CHC, what are they?

A 
1 - breast tenderness
2 - weight gain
3 - bloating
4 - changes in libido 
5 - changes in mood
6 - irregular bleeding
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25
Q

Combined hormonal contraceptives (CHC) are contraceptives that contain oestrogen and progesterone. What 2 cancers can CHC increase the risk of?

A

1 - breast cancer (during use and in following 5 years)

2 - cervical cancer (during use and following 10 years)

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26
Q

Combined hormonal contraceptives (CHC) are contraceptives that contain oestrogen and progesterone. What cardiovascular event is does taking CHC increase the risk of?

A
  • arterial thromboembolism (blood clot formation in an artery)
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27
Q

Combined hormonal contraceptives (CHC) are contraceptives that contain oestrogen and progesterone. Taking CHC does increase the risk of arterial thromboembolism (blood clot formation in an artery). However, is the risk higher than in a woman who is pregnant or not taking CHC?

A
  • no risk of arterial thromboembolism is higher in pregnancy and those not taking CHC
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28
Q

Combined hormonal contraceptives (CHC) are contraceptives that contain oestrogen and progesterone. There are a number of other factors that can increase the risk of thrombotic events that must be asked prior to prescribing a patient with CHC. What are some of the most common risks that must be checked?

A
  • age
  • weight (BMI >30 is cautionary contraindications)
  • smoking status (cautionary contraindications)
  • blood pressure (absolute contraindications)
  • history of thromboembolism (absolute contraindications)
  • clotting disorder (absolute contraindications)
  • migraine with aura and family history (absolute contraindications)
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29
Q

Combined hormonal contraceptives (CHC) are contraceptives that contain oestrogen and progesterone. Are CHC ok to prescribe to women postpartum (immediately following child birth) and breast feeding?

A
  • postpartum = yes

- breastfeeding = after 6 weeks

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30
Q

Combined hormonal contraceptives (CHC) are contraceptives that contain oestrogen and progesterone. What is the standard CHC administration?

A
  • 21 days use

- 7 days of hormone free interval (HFI)

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31
Q

The standard treatment with combined hormonal contraceptives (CHC) is generally 21 days of using the CHC, followed by a 7 day hormone free interval (HFI). This can be tailored and amended though. What time period can the HFI period be changed to?

A
  • generally 4 days

- can increase the risk of unscheduled bleeding

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32
Q

Combined hormonal contraceptives (CHC) are contraceptives that contain oestrogen and progesterone. The standard CHC administration is 21 days use, following by 7 days of hormone free interval (HFI). Any deviation from this increases the risk of what?

A
  • unpredictable bleeding
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33
Q

Within the group of endogenous hormones as forms of contraception, there are 2 broad categories:

1 - combined hormonal contraceptives
2 - progesterone-only contraceptives (POC)

POC as the name suggests is when the contraception contains only progesterone. There are 4 type os POC used in the UK, what are they?

A

1 - pill (oral contraceptive pill - ‘the mini pill’ or POP)
2 - injection (‘the depo injection’)
3 - implant
4 - interuterine system (IUS)

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34
Q

There are 4 types of progesterone-only contraceptives (POC) used in the UK:

1 - pill (oral contraceptive pill - ‘the mini pill’ or POP)
2 - injection (‘the depo injection’)
3 - implant
4 - interuterine system (IUS)

Although they all have a unique mechanisms, they are ALL able to do what to the cervix and uterus?

A
  • cervix = increase mucous thickening

- uterus = thin endometrial layer (not good for oocyte implantation)

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35
Q

Are progesterone-only contraceptives (POC) suitable for postpartum women and those women breast feeding?

A
  • yes
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36
Q

If a women is unable to take the combined contraception as oestrogen is a contraindication to them, what form of contraception will they be able to take?

A
  • progesterone only contraception
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37
Q

Progesterone-only contraceptives (POC) have a number of benefits. Do they increase the risk of arterial thromboembolism?

A
  • no
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38
Q

Progesterone-only contraceptives (POC) have a number of benefits. What benefits can POCs have on the menstrual cycle, specifically the uterus?

A
  • thinning the uterus so less and more consistent bleeding patterns
  • reduced pain during bleeding
39
Q

Progesterone-only contraceptives (POC) have a number of benefits, however, there are also some common side effects, what are they?

A
  • bloating
  • headaches
  • mood changes
  • irregular bleeding
40
Q

There are 4 types of progesterone-only contraceptives (POC) used in the UK:

1 - pill (oral contraceptive pill - ‘the mini pill’ or POP)
2 - injection (‘the depo injection’)
3 - implant
4 - interuterine system (IUS)

When taking the pill form of POC, how would this be administered?

A
  • taken daily at the same time

- no hormone free intervals like in the combined contraception

41
Q

There are 4 types of progesterone-only contraceptives (POC) used in the UK:

1 - pill (oral contraceptive pill - ‘the mini pill’ or POP)
2 - injection (‘the depo injection’)
3 - implant
4 - interuterine system (IUS)

When taking the pill form of POC, some are able to inhibit ovulation in 97% of patients taking this form of POC. What is the active ingredient that contributes to inhibition of ovulation?

A
  • desogestrel

- form of progesterone

42
Q

There are 4 types of progesterone-only contraceptives (POC) used in the UK:

1 - pill (oral contraceptive pill - ‘the mini pill’ or POP)
2 - injection (‘the depo injection’)
3 - implant
4 - interuterine system (IUS)

When taking the pill form of POC, what are the efficacy rates?

A
  • 99% if manufactures guidelines are followed

- 91% typically due to patients forgetting to take the pills

43
Q

What 2 common aspects can affect the efficacy of the progesterone-only contraceptives (POC) pill?

A
  • diarrhoea and vomiting

- medications that induce enzymatic activity (antibiotics)

44
Q

Although progesterone-only contraceptives (POC) pills can start at any time, assuming the woman is not already pregnant. If they are taken between days 1-5 and following day 5 of the menstrual cycle, how quickly can their effective be seen?

A
  • days 1-5 = immediately

- days >5 need barrier protection until it becomes effective

45
Q

What are long acting reversible contraception (LARCS) progesterone only injections?

A
  • a progesterone only containing injection that is normally injected into the bottom
  • removes problems with adherence and remembering to take medication
46
Q

Long acting reversible contraception (LARCS) progesterone only injections are normally injected into the bottom, that removes problems with adherence and remembering to take medication. What is the mechanism of action of this treatment?

A
  • inhibits ovulation
  • reduces endometrium thickness
  • thickens cervix mucus plug
47
Q

What is the efficacy of long acting reversible contraception (LARCS) progesterone only injections?

A
  • 99% if manufactures guidelines are followed

- typically 94%

48
Q

Are long acting reversible contraception (LARCS) progesterone only injections affected by vomiting, diarrhoea, weight of the patient and enzyme inducing medication?

A
  • no
49
Q

Although long acting reversible contraception (LARCS) progesterone only injections can start at any time, assuming the woman is not already pregnant. If they are taken between days 1-5 and following day 5 of the menstrual cycle, how quickly can their effective be seen?

A
  • days 1-5 = effective immediately

- days >5 = effective after 7 days so barrier protection is needed

50
Q

What effect do long acting reversible contraception (LARCS) progesterone only injections have on bone mineral density (BMD)?

A
  • reduce BMD

- not prescribed to teenage women, or checked every 2 years

51
Q

What effect do long acting reversible contraception (LARCS) progesterone only injections have on fertility once the LARCs have been stopped?

A
  • can affect fertility for up to 1 year

- wouldn’t be good if considering getting pregnant

52
Q

What are long acting reversible contraception (LARCS) progesterone only implants?

A
  • sub dermal implant normally placed under the arm

- lasts for up to 3 years

53
Q

What are long acting reversible contraception (LARCS) progesterone only implants are sub dermal implants. What is the mechanism of action of this form of LARCs?

A
  • inhibits ovulation
  • increase cervical mucus thickness
  • thins the endometrium
54
Q

What is the efficacy of long acting reversible contraception (LARCS) progesterone only implants?

A
  • 99%
55
Q

The efficacy of long acting reversible contraception (LARCS) progesterone only implants is 99%, but what can affect the efficacy of this form of LARCs?

A
  • enzyme inducing drugs
56
Q

Although long acting reversible contraception (LARCS) progesterone only implants can start at any time, assuming the woman is not already pregnant. If they are taken between days 1-5 and following day 5 of the menstrual cycle, how quickly can their effective be seen?

A
  • days 1-5 = immediately

- days >5 = 7 days before effective so barrier protection would be required

57
Q

What effect do long acting reversible contraception (LARCS) progesterone only implants have on fertility once the LARCs have been stopped?

A
  • fertility returns immediately
58
Q

What effect do long acting reversible contraception (LARCS) progesterone only implants have on menstrual cycle once the LARCs have been stopped?

A
  • increased risk of amenorrhea (absence of periods)
59
Q

Can long acting reversible contraception (LARCS) progesterone only implants be used immediately postpartum?

A
  • yes
60
Q

Although long acting reversible contraception (LARCS) progesterone only implants are generally safe, what are some common side effects?

A
  • risk of inflammation and infection at site of insertion

- risk of migration

61
Q

Intrauterine system (IUS) is an example of a long-acting reversible contraception (LARC) progesterone only form of contraception. What is this?

A
  • T-shaped plastic device that’s put into your uterus by a doctor or nurse
  • secretes progesterone
62
Q

Intrauterine system (IUS) is an example of a long-acting reversible contraception (LARC) progesterone only contraceptive. What is the mechanism of action of this form of LARC?

A
  • inhibits ovulation in some women (25%)
  • increases cervical mucus
  • thins endometrium
  • foreign body effect
63
Q

Intrauterine system (IUS) is an example of a long-acting reversible contraception (LARC) progesterone only contraceptive. What is the efficacy of this form of LARC?

A
  • > 99% if given in days 1-5 of menstrual cycle

- effective 7 days after administration if given outside of days 1-5, so barrier protection would be needed for 7 days

64
Q

Intrauterine system (IUS) is an example of a long-acting reversible contraception (LARC) progesterone only contraceptive. How long can this last and what age would it it generally get removed?

A
  • effective for over 5 years

- removed if patient is >45 years

65
Q

Intrauterine system (IUS) is an example of a long-acting reversible contraception (LARC) progesterone only contraceptive. How soon can this form of contraception be administered following delivery?

A
  • <48 hours following delivery
66
Q

Intrauterine system (IUS) is an example of a long-acting reversible contraception (LARC) progesterone only contraceptive. In addition to acting as a contraceptive, what else has this form of LARC being licences for the use of?

A
  • hormone replacement therapy

- can last for up to 4 years

67
Q

Intrauterine system (IUS) is an example of a long-acting reversible contraception (LARC) progesterone only contraceptive. What affect does the LARC have on ffertility once the LARCs have been stopped?

A
  • returns immediately
68
Q

Although intrauterine system (IUS) is an example of a long-acting reversible contraception (LARC) progesterone only contraceptive are generally safe, what are some common side effects?

A
  • risk of perforation, migration and infection
69
Q

intrauterine system (IUS) is an example of a long-acting reversible contraception (LARC) progesterone only contraceptive. What is a contraindication for the use of this form of contraception?

A
  • breast cancer
70
Q

intrauterine system (IUS) is an example of a long-acting reversible contraception (LARC) progesterone only contraceptive. Although this reduces the risk of pregnancy, what can this form of contraction increase the risk of in terms of pregnancy?

A
  • ectopic pregnancy
71
Q

What is the first and second line progesterone only emergency contraception?

A
  • 1st line = ulipristal acetate a hormonal emergency contraceptive
  • 2nd line = progesterone only is the intrauterine device (IUD) a long-acting reversible contraception (LARC) progesterone-only contraception
72
Q

What is the first line emergency contraception that is offered in the UK?

A
  • Intrauterine device (IUD) a Long-acting reversible contraception (LARC) copper coil device
73
Q

Intrauterine device (IUS) a Long-acting reversible contraception (LARC) progesterone only contraception is the first line emergency contraception that is offered in the UK. How soon should it be offered to patients?

A
  • as soon as possible after unprotected intercourse
74
Q

Intrauterine system (IUS) a Long-acting reversible contraception (LARC) progesterone only contraception is the first line emergency contraception that is offered in the UK as soon as possible following unprotected intercourse. What drug is used for this?

A
  • Levonorgestrel
75
Q

Intrauterine system (IUS) a Long-acting reversible contraception (LARC) progesterone-only contraception is the first line emergency contraception that is offered in the UK as soon as possible following unprotected intercourse. Levonorgestrel is the drug that is used for this. What is the window where it is most effective following unprotected sex?

A
  • 72 hours

- double the dose if patient has a BMI >30kg/m2

76
Q

Intrauterine system (IUS) a Long-acting reversible contraception (LARC) progesterone-only contraception is the first line emergency contraception that is offered in the UK as soon as possible following unprotected intercourse. Levonorgestrel is the drug that is used for this and it is most effective if taken with 72 hours. What is its mechanism of action?

A
  • delay or prevents follicular rupture and ovulation
77
Q

Intrauterine system (IUS) a Long-acting reversible contraception (LARC) progesterone-only contraception is the first line emergency contraception that is offered in the UK as soon as possible following unprotected intercourse. Levonorgestrel is the drug that is used for this and it is most effective if taken with 72 hours. In addition to Levonorgestrel, what is the alternative drug that can be taken that acts on progesterone receptors?

A
  • ulipristal acetate
78
Q

Intrauterine system (IUS) a Long-acting reversible contraception (LARC) progesterone-only contraception is the first line emergency contraception that is offered in the UK as soon as possible following unprotected intercourse. Levonorgestrel is the drug that is used for this and it is most effective if taken with 72 hours. In addition to Levonorgestrel, ulipristal acetate is the alternative drug that can be taken that acts on progesterone receptors?. What is the mechanism of action of this drug?

A
  • delays ovulation by up to 5 days, including following the LH surge
79
Q

Ulipristal acetate is the alternative drug that can be taken that acts on progesterone receptors and is the first line hormonal emergency contraception. How long is this drug licensed for use?

A
  • 120 hours
80
Q

What is the lactational amenorrhea method (LAM)?

A
  • a temporary postnatal infertility that occurs when a person is amenorrheic (not menstruating) and fully breastfeeding
81
Q

What hormone is produced by the anterior pituitary gland that increases milk production?

A
  • prolactin
82
Q

The lactational amenorrhea method (LAM) is a temporary postnatal infertility that occurs when a person is amenorrheic (not menstruating) and fully breastfeeding. What causes this temporary postnatal infertility?

A
  • prolactin is secreted by anterior pituitary gland in response to breast feeding
  • prolactin provides negative feedback loop to the hypothalamus
  • gonadotrophin releasing hormone (GnRH) from hypothalamus is reduced
  • reduced GnRH reduces LH and FSH secretion from anterior pituitary gland
  • low FH and FSH inhibits follicular maturation and ovulation
83
Q

The lactational amenorrhea method (LAM) is a temporary postnatal infertility that occurs when a person is amenorrheic (not menstruating) and fully breastfeeding. In order for this method to be effective, what are the 3 criteria that must be met by the mum?

A

1 - <6 months postpartum
2 - amenorrheic (suppression of menstrual cycle)
3 - fully breastfed baby

84
Q

The lactational amenorrhea method (LAM) is a temporary postnatal infertility that occurs when a person is amenorrheic (not menstruating) and fully breastfeeding. How effective is this method as a contraceptive method?

A
  • 98%
85
Q

What are the non-hormonal forms of contraception for males?

A
  • condoms
86
Q

In male sterilisation, what is cut in order to stop sperm reaching the penis?

A
  • vas deferens
87
Q

In male sterilisation, the vas deferens must be cut in order to stop sperm reaching the penis. How effective is this method?

A
  • 99%

- not immediate can take 8-12 weeks to be effective

88
Q

In male sterilisation, the vas deferens must be cut in order to stop sperm reaching the penis. Is this process permanent?

A
  • no

can be reversed in 45% of patients if <10 years from procedure

89
Q

What is the difference between the Intrauterine system (IUS) and the Intrauterine device (IUD)?

A
  • IUS secretes the hormone progesterone

- IUD secretes copper

90
Q

What is the first line non-hormonal emergency medication that can be prescribed to a patient if they have had unprotected sex?

1 - Progesterone-only: Intrauterine system (IUS)
2 - Progesterone only: Levonorgestrel
3 - Progesterone only: Ulipristal acetate
4 - Intrauterine device (IUD)

A

4 - Intrauterine device (IUD)

91
Q

The first line non-hormonal emergency medication that can be prescribed to a patient if they have had unprotected sex is the intrauterine device (IUD). What is the mechanism of action of the IUD?

A
  • copper coil secretes copper

- increases cervical mucus thickness and foreign body affect

92
Q

The first line non-hormonal emergency medication that can be prescribed to a patient if they have had unprotected sex is the intrauterine device (IUD). How quickly can fertility return once the IUD is removed?

A
  • immediately
93
Q

The first line non-hormonal emergency medication that can be prescribed to a patient if they have had unprotected sex is the intrauterine device (IUD). The IUD can last between 5-10 years. When is it normally taken out?

A
  • when not needed or if patient is above 40 years old

Year 2 RE (53 decks)

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