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RE > Fertility Control > Flashcards

Fertility Control Flashcards

1
Q

Contraception: Age Range:

A
  • menache to menopause
  • <18s:
  • menopause -> retrospective
    diagnosis
  • trans men + non-binary assigned
    female at birth: if no
    hysterectomy/bilateral
    oophorectomy, with risk of
    pregnancy
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2
Q

Female Physiology

A

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3
Q

Female Physiology

A

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A surge in LH leads to final egg maturation and release.
The follicle left after ovulation transforms to the corpus luteum.
The corpus luteum produces both oestrogen and progesterone which negatively feedback on FSH and LH.
If pregnancy does not occur, the corpus luteum degenerates and circulating hormone levels decline.
Sustained higher levels of oestrogen and or progesterone negatively feedback on production of FSH and or LH and in turn decrease the stimulation and or release of developing follicles.

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4
Q

Female Contraceptive Hormones: Oestrogen: Effect:

A
  • suppresses ovulation
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5
Q

Female Contraceptive Hormones: Progesterone: Effect:

A
  • suppress ovulation
  • reduces cilia activity in the
    fallopian tube
  • increases volume + thickens
    cervical mucous
  • thinning of endometrium

*progesterone creates a
hormonally driven barrier

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6
Q

Overview of Hormonal Contraceptives:

A

insert flowchart

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7
Q

Exogenous Contraception: CHC:

A
  • combined hormonal
    contraceptives
  • oestrogen and progesterone
  • effective immediately D1-5 else 7
    days
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8
Q

Exogenous Contraception: CHC: Efficacy:

A
  • highly user dependent
  • 99%-91%

Affected by:
- diarrohoea and vomiting
- weight
- drug interactions

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9
Q

Exogenous Contraception: CHC: Modes of Administration:

A
  • pill
  • patch
  • vaginal ring
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10
Q

Exogenous Contraception: CHC: Benefits:

A
  • reduces risk of ovarian,
    colorectal and endometrial
    cancer
  • predictable bleeding patterns
  • reduced menstrual bleeding and
    pain
  • management of PCOS,
    endometriosis, premenstrual
    syndrome and acne
  • reduced menopausal symptoms
  • maintains bone density in
    perimenopausal under 50
  • rapid return to fertility
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11
Q

Exogenous Contraception: CHC: Risks:

A
  • breast tenderness
  • weight gain
  • bloating
  • libido changes
  • irregular bleeding
  • increased risk of breast and
    cervical cancer
  • risk of venous and arterial
    thromboembolism: 3x
  • risk of thromboembolism lower
    than during pregnancy and
    post-partum period
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12
Q

CHC: Questions to ask:

A
  • factors increasing thrombotic
    events: age, weight, smoking,
    clotting disorder
  • not in breastfeeding women until
    after 6 weeks
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13
Q

Exogenous Contraception: CHC: Administration:

A
  • standard 21 days followed by
    hormone free interval (HFI) of 7
    days
  • tailored regimens also suitable
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14
Q

Exogenous Contraception: Progesterone-only Contraceptives:

A
  • mode of action varies according
    to mode of administration
  • alters cervical mucous and
    endometrial thickening
  • some inhibit ovulation as
    primary MoA
  • all are suitable for breastfeeding
    women
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15
Q

Exogenous Contraception: Progesterone-only Contraceptive: Modes of Administration:

A
  • pill (mini pill/POP)
  • injection
  • implant
  • interuterine system (IUS)
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16
Q

Exogenous Contraception: Progesterone-only Contraceptive: Benefits:

A
  • suitable for most, whereas
    oestrogen can be
    contraindicated
  • not associated with
    thromboembolic events
  • reduced menstrual bleeding and
    pain
  • management of gynaec conditions
17
Q

Exogenous Contraception: Progesterone-only Contraceptive: Risks:

A
  • bloating
  • headaches
  • mood changes
  • irregular bleeding
18
Q

Progesterone-only Contraceptive: Pill:

A
  • daily intake at same time with no
    HFI
  • some affect ovulation
  • efficacy: 99-91%
  • affected by: diarrhoea, vomiting,
    drug interactions
  • effective immediately D1-5, else
    2 days to become effective
  • suitable whilst breastfeeding
19
Q

Progesterone-only Contraceptive: Injection:

A
  • LARC: Long-acting reversible
    contraception
  • inhibits ovulation, alters cervical
    mucous, endometrium
  • every 12 -13 weeks via IM
  • 99-91%
  • not affected by enzyme inducing
    drugs or weight
  • effective immediately D1-5, else
    7 days
  • *decreased bone mineral density
  • *delayed fertility for upto 1 year
20
Q

Progesterone-only Contraceptive: Implant:

A
  • LARC: Long-acting reversible
    contraception
  • inhibits ovulation, alters cervical
    mucous and endometrium
  • subdermal injection every 3
    years
  • efficacy >99%
  • affected by enzyme inducing
    drugs
  • effective immediately D1-5, else
    7 days
  • suitable immediately after
    delivery
  • rapid return to fertility
  • local reactions/risk of migration
21
Q

Progesterone-only Contraceptive: IUS:

A
  • LARC: Long-acting reversible
    contraception
  • inhibits ovulation in 25%, affects
    cervical mucous and endometrial
    thickness
  • foreign body effect
  • efficacy>99%
  • effective for 8 years/until no
    longer required if inserted in
    >45yrs
  • 48 hrs after delivery
  • part of HRT for 4 years
  • rapid return to fertility
  • risk of perforation, migration and
    infection
  • increased risk of ectopic
    pregnancy but overall risk
    decreased due to lower
    pregnancy risk
22
Q

Progesterone-only: Emergency Contraception:

A
  • second line to IUD

Levonorgestrel:
- delay/prevents follicular rupture and
ovulation
- licensed within 72 hours, efficacy reduces
with time
- body weight>70kh/BMI>26 recommend
double dose or another agent

Ulipristal acetate:
- selective progesterone receptor modulator
- delays ovulation by up to 5 days, including
after the start of LH surge
- first line hormonal emergency
contraceptive
- licensed for use within 120 hours

23
Q

Lactational Amenorrhea Method (LAM):

A
  • ovarian activity can resume by 21 days
  • suckling suppresses resumption of ovarian
    activity
  • breastfeeding as a contraceptive requires:
    - less than 6months post partum
    - amenorrheic
    - fully breastfed
  • efficacy >98%
  • one of many post natal contraceptive
    options
  • important to discuss contraception
    antenatally, offer early postpartum
    contraception and STI protection; not to
    wait until postnatal checks typically done 6
    weeks after delivery
  • postpartum contraception including LAM
    should be initiated immediately if
    medically eligible
24
Q

LAM

A

insert diagram

25
Q

Condoms:

A
  • male and female condoms
  • latex and polyurethane
  • protects against STIs
  • 98%-85% efficacy
  • no contraindications
  • can split, come off or be damaged with oil
    based lubricants
26
Q

IUDs:

A
  • intrauterine devices
  • LARC: Long-acting reversible contraception
  • copper coil
  • affects cervical mucus and foreign body
    effect
  • > 99%
  • effective immediately
  • first choice for emergency contraception
  • 5-10 years
  • rapid return to fertility
  • risk of perforation, migration and infection
  • increased risk of ectopic pregnancy, overall
    decreased risk due to unlikely pregnancy
27
Q

IUDs are hormonal contraceptive devices?

A

Non-hormonal contraceptive devices
non-hormonal emergency contraception
reversible

28
Q

Male Contraception:

A
  • condoms
  • male sterilisation: bilateral cut/seal of vas
    deferens
  • efficacy >99%
  • not effective immediate
  • 45% reversal succes <10 years later
29
Q

Male Physiology

A

insert diagram

30
Q

Male Hormonal Contraception:

A
  • maintenance of androgen dependent
    function
  • testosterone is effective at suppressing
    sperm concentration
  • GnRH antagonists are effective in
    suppressing spermatogenesis
  • testosterone only side effects: acne,
    altered libido, night sweats, increased
    weight and mood changes
  • combination regimes allow a reduction in
    testosterone and associated side effects
31
Q

Comparative Efficacy:

A

insert table

32
Q

Potential mechanisms for male contraception:

A
  • condoms/sterilisation
  • testosterone only regimens
  • GnRH antagonists
  • androgen must be part of the
    contraceptive regime

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