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Reproduction > Lec5 Fertility Control > Flashcards

Lec5 Fertility Control Flashcards

1
Q

What is progesterone’s role in pregnancy?

A

Progesterone supports potential pregnancy

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2
Q

What happens when progesterone drops?

A

Labour is induced

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3
Q

How is temporary, reversible infertility brought about?

A

Need to stop/prevent ovulation

Suppression of LH surge - to prevent ovulation by giving progesterone - this works by negative feedback

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4
Q

How do female contraceptives work?

A

Prevent ovulation
Thicken cervical mucus
Hostile endometrium

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5
Q

What effect does progesterone have on the LH surge?

A

Prevents the LH surge - so ovulation cannot happen

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6
Q

What effect does progesterone have on cervical mucus?

A

Thickens cervical mucus so that sperm cannot get in

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7
Q

When are progestogens given?

A

They are given at the start of the menstrual cycle so that the endometrium stays thin - it’s a hostile environment and will not support a fertilised ovum

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8
Q

What does giving oestrogen do?

A

Suppresses FSH - so the ovum doesn’t develop

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9
Q

What is the combined oral contraceptive pill?

A

It is oestrogen and progesterone given together

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10
Q

What effect does the combined oral contraceptive pill have?

A

It reliably suppresses ovulation, thickens cervical mucus and thins endometrium to make it hostile

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11
Q

What is the pregnancy rate of progesterone only pill?

A

5% out of 100 women having regular unprotected sex for a year

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12
Q

What is the pregnancy rate of combined contraceptive oral pill?

A

3 in 10,000 women in a year

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13
Q

In Brighton why is it 5 pregnancies per 100 in a year?

A

Because they don’t take it properly

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14
Q

How many days do you take the tablets for and how many non tablet days are there with the oral combined contraceptive pill?

A

21 days tablets

7 days no tablet

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15
Q

What happens during the 7 day tablet free period?

A

Withdrawal bleed

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16
Q

What are the fears about the endometrium?

A

Fears that if you don’t get rid of the endometrial lining regularly, it can increase the chances of endometrial thickening and endometrial cancers

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17
Q

What happens if a woman has diarrhoea or vomiting?

A

They may not have absorbed the pill and should take an additional pill

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18
Q

Contraindications of the combined oral contraceptive pill?

A

Antibiotics wipe out the gut bacteria

Some minor evidence that taking antibiotics and taking the pill increases the chances of pregnancy

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19
Q

What happens when people take the pills in the wrong order - up and down rather than left to right?

A

Dramatically increased failure rate of the pill

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20
Q

What happens if you miss a pill every three days with the COCP?

A

Nothing really happens - won’t make much difference

21
Q

What happens if you miss days at the start of the menstrual cycle?

A

It renders it ineffective - extends the number of drug free days and increases chances of pregnancy

22
Q

If you have 9-10 drug free days, what is likely to happen?

A

An ovum will develop and there is a risk of ovulation

23
Q

Give an example of the progesterone only contraceptive pill and describe how it works.

A

Levonorgestrel
Progesterone suppresses the LH surge - preventing ovulation
Thickens cervical mucus
Renders endometrium ‘hostile’

24
Q

What is the standard dose of the progesterone only contraceptive pill?

A

350mcg 1 tablet daily

25
Q

What are the adverse effects of the progesterone only pill?

A 
Menstrual irregularity
Nausea
Vomiting 
Headache 
Breast discomfort 
Weight changes 
Changes in libido
26
Q

How long does this pill use contraception for and how late can you be in taking it?

A

22 hours/day

Can be late by 12 hours in taking it but no more than that

27
Q

What is the combined oral contraceptive pill and how does it work?

A

Combination of oestrogen - usually ethinyloestrodiol and progesterone - norethisterone
The progesterone inhibits LH surge - so prevents ovulation and thickens cervical mucus
Oestrogen inhibits FSH release and therefore development of the ovum

28
Q

What is the standard dose of the COCP?

A

1 tablet for 21 days - oestrogen 20-35mcg ethinyloestrodiol & 500-1000mcg norethisterone
7 days drug free

29
Q

What are the adverse effects of the COCP?

A

Nausea, vomiting, abdominal cramps, fluid retention, changes in body weight, hepatic impairment, cardiovascular changes including DVT, breast tenderness, cervical erosion
Exacerbation of migraine
Chloamsa
Mood changes

30
Q

What other forms of female contraception are there?

A

Intrauterine
Implants
Vaginal

31
Q

What other symptoms are contraceptives used to treat?

A

Painful periods - dysmenorrhoea
Heavy menstrual bleeding (HMB)
The progesterone thins the endometrium - so reduces bleeding and reduces pain

32
Q

What are IUDs and how do they work?

A

Solid plastic rod inserted into the uterus
Causes a local sterile inflammatory response
No infection
A fertilised ovum can’t implant into the uterus

33
Q

Why are IUDs recommendable?

A

Because IUDs are the most effective form of contraception

34
Q

What is an IUS?

A

IntraUterine System - an IUD that releases low dose of progestogen - this suppresses ovulation

35
Q

What are implants and how do they work?

A 
Solid ring subdermally inserted 
Releases progesterone over 3 years 
Constant release- no drug free period
Total lack of withdrawal bleed
Very reliable 
Some women report irregular bleeding - appears that the endometrium is thin but breaks down suddenly even with the implant in place
36
Q

How do vaginal contraceptives work?

A

Progesterone is inserted vaginally by a silicone ring - effective absorption by the vaginal mucosa

37
Q

Name two drugs used for emergency contraception “morning after pill”.

A

Levonorgestrel

Ulipristal

38
Q

How effective are these emergency contraceptives?

A

Levo-norgestrel - 70-80%

Ulipristal is more effective than levonorgestrel

39
Q

How does ulipristal work?

A

It is a progesterone analogue - partial agonist
Blocks the progesterone receptor - progesterone can’t bind - endometrium collapses/ won’t support the pregnancy/implantation

40
Q

Why can’t ulipristal be used long term?

A

Not as effective as the oral contraceptive pills

41
Q

What can go wrong with ulipristal use?

A

If ovulation has already occurred then it is too late for it to work but ulipristal may disrupt implantation

42
Q

What drug is used for induced abortion and how does it work?

A

Mifepristone - a progesteron antagonist
Progesterone supports pregnancy
Progesterone antagonist causes progesterone to be unable to bind- drop in progesterone - endometrium lining to collapse
Induces abortion and terminates a pregnancy

43
Q

How do male contraceptives work?

A

By blocking sperm production

FSH causes sperm production so by blocking FSH

44
Q

Why not give oestrogen/progesterone to men, seeing as it blocks LH (so blocks secretion of testosterone) and FSH (blocks sperm production)?

A

Because it takes 3 months to make sperm
Very slow onset of action b
But also by giving progesterone and blocking endogenous testosterone, they were losing male secondary characteristics

45
Q

What is a better option to block sperm production?

A

Giving testosterone - blocks endogenous testosterone production but continue giving testosterone so they still have secondary male characteristics

46
Q

How effective are male contraceptives?

A

They are just as effective as female contraceptives in clinical trials

47
Q

Why haven’t male contraceptives taken off?

A

Because of the market
Women are the ones that get pregnant
Who would trust a man that said he was on a contraceptive to take it properly etc

48
Q

Why is testosterone not given orally?

A

Because it would cause hepatotoxicity

49
Q

What is menopause caused by?

A

It is a hypothalamic event - not caused by eggs running out

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