Fertility Control Flashcards
These are locally active devices preventing entry of sperm in through the cervix, thus preventing pregnancy.
BARRIER-SPERMICIDAL METHODS
BARRIER-SPERMICIDAL METHODS Advanatges
Barrier methods become increasingly effective with advancing age and the associated natural decline in fertility.
They do protect against some STDs.
They do not have systemic
side effects.
Failure rate of BARRIER-SPERMICIDAL METHODS
approaches 20%.
They are the most common barrier contraceptive method used.
Condoms
This is a dome-shaped device placed in the anterior and posterior vaginal fornices holding spermicidal jelly against the cervix. It can be placed an hour before intercourse.
Vaginal diaphragm
Disadv of Vaginal diaphragm
Individual fitting is required. If too large a size is used, it can result in urinary retention.
The active ingredient is nonoxynol-9, a surface-active agent that disrupts
cell membranes, thus the possible side effect of genital membrane irritation
Spermicides.
These include inhibition of the midcycle luteinizing hormone (LH) surge, thus preventing ovulation;
alteration of cervical mucus making it thick and viscid, thus retarding sperm penetration; and alteration of endometrium inhibiting blastocyst implantation
STEROID CONTRACEPTION
Mechanism of Action of Steroid Contraception
Pituitary _____
Ovary_______
Endometrium_____
Cervix ______
↓ LH surge
↓ ovulation
Atrophy
Hostile mucus
Estrogen effect of steroid hormones
1 2 3 4 5
fluid retention from decreased sodium
excretion;
accelerated development of cholelithiasis;
increase in hepatic protein production
healthy lipid profile changes
and increased venous and arterial thrombosis
What hepatic proteins are increased with estrogenic effects of steroid hormones
(e.g., coagulation factors, carrier proteins, angiotensinogen);
Lipid changes of estrogen
(increase in high-density lipoproteins [HDL]; decrease in low-density lipoproteins [LDL]);
Progestin-Mediated Metabolic Effects of steroid hormones
These include mood changes and depression from decreased serotonin levels; androgenic effects (e.g., weight gain, acne); and unhealthy lipid profile changes (decreased HDL, increased LDL).
Absolute Contraindications of steroid hormones
acute liver disease; history of vascular
disease cerebrovascular accident
[CVA], systemic lupus erythematosus [SLE]); hormonally dependent cancer (e.g., breast);
smoker ≥35; uncontrolled hypertension; migraines with aura; diabetes mellitus with vascular disease; and known thrombophilias
Relative Contraindications of steroid hormones.
These include migraine headaches, depression, diabetes mellitus,
chronic hypertension, and hyperlipidemia
Noncontraceptive Benefits of steroid hormones
These include decreased ovarian and endometrial cancer; decreased dysmenorrhea and dysfunctional uterine bleeding; and decreased PID and ectopic
pregnancy.
Noncontraceptive Benefits of steroid hormones usually from what component
Mostly Progestin Component
These contain both an estrogen and a progestin. They are administered
most commonly in one of two ways: daily with 21 days on and 7 days off or daily 24 days on
and 4 days off
Combination OCPs
COCP
When “off” the hormones, _____will occur
withdrawal bleeding
COCP failure rate
Failure rate is 2% with ideal use.
A unique combination of OCP (YAZ) reduces severe PMDD symptoms by 50%. It contains______ and a new progestin, _____. The dosing is 24 days of active pills then 4 days of placebo, rather than the traditional 21 days
ethynyl estradiol
drospirenone
Marketed under the trade name of NuvaRing, this device, inserted into the vagina, contains both an estrogen and a progestin. It is removed after 3 weeks for 1 week to allow for a withdrawal bleed.
Combination Vaginal Ring
Combination Vaginal Ring failure rate
2%
Marketed under the trade name of Ortho Evra, this patch contains both an estrogen and a progestin. A patch is replaced every week for 3 weeks then removed for 1
week to allow for a withdrawal bleed.
Transdermal Skin Patch
They contain only progestins and are sometimes called the “minipill.”
They need to be taken daily and continuously.
A frequent side effect is break-through bleeding.
POP
POP failure rate
Failure rate is 3% with ideal use.
Marketed under the trade name of Depo-Provera, this is an IM injection of depo-medroxyprogesterone acetate (DMPA). The slow release allows administration
only every 3 months.
Progestin-Only Injectable
SE of DMPA
A frequent side effect is break-through bleeding. Other side effects are prolonged time for fertility return and decreased bone mineral density
Failure rate of DMPA
Failure rate is <1%.
Progestin-Only Subcutaneous Implant. Marketed under the trade name of Nexplanon, this uses _______ as the active ingredient
etonogestrel
Progestin-Only Subcutaneous Implant contains small amount of _____ making
it visible on x-ray.
barium,
Progestin-Only Subcutaneous Implant
The continuous release continues for ____
3 years
Progestin-Only Subcutaneous Implant
failure rate
Failure rate is <1%.
“Morning-After” Pill. Marketed under the trade name of “Plan B,” it uses ______
levonorgestrel tablets.
“Morning-After” Pill failure rate
Failure rate is <1%.
Mechanisms of Action of IUD 1 2 3 4 5
inhibition of sperm transport;
increased tubal motility causing failure of implantation of immature zygote;
inhibition of implantation secondary to
endometrial inflammation;
phagocytic destruction of sperm and blastocyst;
and alteration of cervical mucus
alteration of cervical mucus only for
only progesterone IUSs).
Absolute Contraindications for IUD include a
1
2
3
confirmed or suspected pregnancy;
known or suspected pelvic malignancy;
undiagnosed vaginal bleeding; and
known or suspected salpingitis
Relative Contraindications for IUD
abnormal uterine size or shape; medical condition (e.g., corticosteroid
therapy, valvular heart disease, or any instance of immune suppression increasing the risk of infection); nulligravidity; abnormal Pap smears; and history of ectopic pregnancy
IUD
The LNG-containing IUS is effective for ______years, the copper T-380A is effective for ____ years, making it potentially the
least expensive contraceptive available.
5
10
This patient’s recent _______ is a significant risk factor for IUS use. Most of the increased risk of infection actually attributable to IUS use is within 20 days after infection
chlamydia infection
_______ could also be a relative contraindication because they
alter the shape of the endometrial cavity or cause heavy bleeding
Uterine fibroids
Ectopic pregnancy in IUD
The IUS does not increase ectopic pregnancies. However, with
pregnancy from failed IUS, the likelihood of it being ectopic is higher because primarily,
intrauterine pregnancies are prevente
A levonorgestrel-impregnated (LNG) IUS that releases the hormone gradually over 5 years.
Bleeding and cramping may be decreased. Failure rate is <1%.
“Mirena.”
______. A smaller (LNG) IUS similar to Mirena but effective for only 3 years. Failure rate
is <1%.
Skyla
________ Marketed under the trade name “Paraguard,” this copper-banded
IUS releases copper gradually over 10 years. Bleeding and cramping may be increased
Copper T-380A IUS.
Disadv of coitus interuptus
High failure rates. No protection against STDs. High degree of discipline
required. Semen can enter vagina and cervical mucus prior to ejaculation.
plain water, vinegar and other products are used immediately after
orgasm to theoretically flush semen out of the vagina. It has a long history of use in the
United States.
With vaginal douche,
With lactation, elevated_____ with exclusive breastfeeding inhibit pulsatile secretion
of GnRH from the hypothalamus
prolactin levels
Effectiveness of LAM
Effectiveness is dependent on the frequency (at least every 4-6 hours day & night) and intensity (infant suckling rather than pumping) of milk removal.
Disadvantages of LAM:
High failure rate if not exclusively breastfeeding. Reliable for only up to
6 months. No protection against STDs.
Tubal Ligation
Destruction or removal of a segment of the oviduct is performed in an operating
room through a transabdominal approach usually using a
laparoscopy or minilaparotom
Failure rate of Tubal Ligation
Failure rate is 1 in 200
Destruction or removal of a segment of vas deferens is performed as an outpatient
procedure using local anesthesia
Vasectomy.
Vasectomy failure rate
Failure rate is 1 in 500
A successful Vasectomy can be
confirmed by
absence of sperm on a semen specimen obtained 12 ejaculations after the surgery.
Sperm antibodies can be found in _____ of vasectomized patients.
50%
