L15 Female Contraception Flashcards
World population growth projection trends are generally…
Decreasing
Name modern methods of contraception (8) and traditional or natural methods of contraception (3)
Modern: sterilization, oral hormonal pills, IUD, condoms, injectables, implants, vaginal barrier methods, emergency contraception
Traditional: rhythm (abstinence), withdrawal, lactations amenorrhea method (LAM)
Which family planning methods are permanent?
Sterilization (female and male)
What are the major components of the endocrine system
Hypothalamus (GnRH), anterior pituitary (LH, FSH), Testis/ovary (gametogenesis, gonadal hormone production)
What hormones do LH and FSH trigger in the testes and ovaries?
Testeosterone in testis
Estrogen in ovaries
What change allows puberty to are course
Hypothalamus and pituitary sensitivity to negative feedback decreases
What are the two steroid hormones produced by the ovary?
Estrogen and progesterone
TF: estrogen and progesterone send negative feedback signals to both the anterior pituitary and the hypothalamus
True
Pulsatile FSH and LH released by _ stimulate _ and _
Anterior pituitary
Maturation of ovarian follicles
Steroid synthesis
Which cells does LH act on in the ovary? What does it do
Theca cells
Increase steroid synthesis and FSH receptors
What are the effects of FSH on the ovary?
Q. Regulate follicle growth and maturation
2. Increases the activities of cholesterol side chain cleavage (progesterone synthesis by CYP11A1) and conversion of T to estradiol in granulosa cells by aromatase (FSH)
How do nuclear steroid hormone receptors work
Nuclear steroid hormone receptor has ligand binding domain and DNA binding domain
They will act to turn on transcription inside nucleus
Name the steroid receptors for progesterone and estrogen
Progesterone: hPR
Estrogen: hERalpha hERbeta
Describe the two paths for progesterone action. Which one is faster
- Nuclear receptors: activated genes (genomic) trigger biological function
- Membrane receptors (faster): secondary messengers (non genomic) trigger biological function
TF: estrogen has nuclear receptors
True
What can estrogens and progestins as drugs be used for
Fertility control: contraception and ovulation induction
Hormone replacement therapy
Cancer chemotherapy
Other
What are the relative levels of LH, FSH, progesterone and estrogen during menses
FSH>LH>estradiol>progesterone
What causes follicular rupture
LH and FSH surge (caused by estradiol surge)
When are progesterone levels highest?
When the corpus outermost is developing (peak when corpus outermost is mature)
TF: there is more progesterone during follicular phase than during luteal phase
False
TF: progesterone is secreted by corpus luteum
True
Describe the positive feedback regulation of ovulation
Estradiol surge triggers increase GnRH release, causing increase LH and FSH release
TF: both FSH and LH increase at similar levels when estradiol increases
False, there is a higher LH surge than FSH (although FSH levels do increase)
Describe the negative feedback involved in ovulation and the menstrual cycle?
Increase in estradiol and progesterone cause decreased levels of LH and FSH released from the pituitary (also negative feedback on GnRH release)
TF: progesterone acts to thicken the uterine endometrium
True
During which phase are women most fertile
Follicular phase
Days leading up to ovulation + ovulation = most fertile
TF: basal body temperature can indicate fertility
True, higher temperatures are detected during luteal phase
Why are analogs of estrogen and progestin (progesterone analog) used for oral contraceptives
They are less rapidly inactivated by enzymes
Oral contraceptives were approved by the FDA for what reasons?
To treat infertility and menstrual irregularities
What was the trend for pill dosage?
Decreasing
TF: oral contraceptive pills keep LH, FSH, Estrogen and Progesterone levels constant
True
What is the mechanism of action of contraceptive pills
LH and FSH release are inhibited (as well as GnRH and higher brain centres)
Ovulation is inhibited - no ripe follicle
What are the 3 functions of oral contraceptive pills
- Prevent ovary from releasing an egg
- Thicken cervical mucus to deter sperm from reaching egg
- Thin the lining of the uterus entering implantation of zygote
For what reason is the typical use failure rate greater than the perfect use failure rate
Poor compliance (missing pills)
Examples of P450s and antibiotics that can interact with oral contraceptives
P450s: barbiturates, phenytoin, rifampicin
Antibiotics: ampicillin, tetracycline, neomycin
Are oral contraceptives still effective after taking P450 inducers? What about antibiotics?
Inducing P450s cause increased drug metabolism while antibiotics may decrease enterohepatic circulation
What are the advantages of oral contraceptive pills (7)
Regular periods, women over 40 can use, decrease cramps and bleeding (and anemia), decrease risk of ovarian/endometrial/colorectal cancer, decrease breast tenderness and acne, increase bone density, does not interfere with sex
What are the disadvantages of oral contraceptive pills (2)
Increase risk of venous thromboembolism, slight increase in risk of breast cancer (increased in smokers)
The use of oral contraceptives in BRCA1/2 carriers appears to _
Decrease risk of ovarian cancer with no increase in breast cancer
TF: oral contraceptives thicken the blood
True
What do contraceptive patches release?
Norelgestromin (NGMN)
Ethinyl estradiol (EE)
TF: contraceptive patches are more efficient than oral contraceptives
After 6 cycles, chances of getting pregnant are half that of oral contraceptive users
Patch compliance better than OC: unaffected by age (though lower in younger subjects)
*compliance is if the subject is using it correctly and regularly
Less efficacious in overweight women
What steroids are usually found in implants
Levonorgestrel (progesterone analog)
TF: implants of progesterone analogs work by decreasing the LH surge
True
What are the two kinds of IUD (intra-uterine devices) and their differences?
Hormonal (levonorgestrel) and copper
Copper IUD lasts 10 years while hormonal IUD last 3-5 years
What hormones does the plan b pill release
Levonorgesterol (progesterone analog)
There is also: Selective progesterone receptor modulator (uliprostal acetate)
How does plan B work?
Temporarily blocks ovulation and fertilization
TF: plan B can induce withdrawal bleed
True
TF: plan B can be taken up to 7 days after unprotected sex
False, it is 5 days
What is used for medical termination of pregnancy
Mifepristone (progesterone receptor antagonist) + misoprostal (prostaglandin analog)
What does misoprostal do?
It is used in combination with mifepristone for medical termination of pregnancy, it dilates the cervix and induces uterine contractions
