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Gynaecology > Menstrual Cycle & Contraception > Flashcards

Menstrual Cycle & Contraception Flashcards

1
Q

Outline the name of the stages in the menstrual cycle

A
  1. Menstruation
  2. Proliferation phase
  3. Luteal/ secretory phase
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2
Q

Outline the 1st stage of the menstrual cycle

A

Day 1-4 - menstruation

  • Endometrium is shed as its hormonal support is withdrawn
  • Myometrial contraction can be painful
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3
Q

Outline the 2nd stage of the menstrual cycle

A

Day 5-13 - proliferative phase

  • Gonadotrophin-releasing hormone (GnRH) pulses released from Hypothalamus
  • GnRH stimulates FSH & LH release from Ant. Pituitary
  • FSH & LH induce Follicular growth
  • Follicles produce Oestradiol & Inhibin
    • Inhibit FSH
    • Stim. LH
      • Leads to LH surge stim. ovulation 36hrs later
    • Oestradiol stim. stromal cell proliferation & gland elongation (a ‘proliferative endometrium’)
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4
Q

Outline the 3rd stage of the menstrual cycle

A

Day 14-28 - luteal/ secretory phase

  • Follicle from which egg released become Corpus Leuteum (CL)
    • Releasing Oestradiol & Progesterone
      • More P released relatively
  • P peaks 7 days later (~21) inducing Secretory changes in endometrium
    • Stromal cells enlarge
    • Glands swell
    • Blood supply increases
  • No fertilisation
    • CL fails and O&P withdrawn
    • Cycle restarts
  • Fertilisation
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5
Q

How is the efficacy of contraception measured?

A
  • Using the Pearl Index (PI)
    • PI of 2 = out of 100 women using it for 1 year, 2 will be pregnent
  • Efficacy is variable in user-dependant contraceptives (ie the pill, condoms)
    • Higher with perfect use
    • Lower with typical use
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6
Q

Outline the categories of hormonal contraception

A
  1. Progestogen only pill (mini-pill)
  2. Progestogen as depot
    • Nexplanon
    • Depo-Provera & Noristerat
    • Levonorgestrel-containing intrauterine system (IUS)
  3. Combined hormonal contraception (CHC) (progestogen & oestrogen)
    • Combined oral contraception (the pill, COC, mono/bi/tri phasic)
    • Transdermal patch
    • Vaginal ring
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7
Q

COC pill: mechanism of action

A

Contains oestrogen & progestogen

  • -ve feedback on gonadotrophin release, inhibiting ovulation
  • thins endometrium
  • thicken cervical mucus
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8
Q

What are the types of COC pill?

Outline how they are taken.

A

All contrain oestrogen & progestogen.

  1. Ethinyloestradiol +
    • 3wks on, 1wk off
    • monophasic 20-40ug
  2. Oestradio Valerate (metabolised to Oestradiol)
      • Dienogest (natural progestogen)
    • 4 phases over 26d, 2d off
    • Lower lipid & haemostatic effects
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9
Q

What is the efficacy of COC pill?

A

PI = 0.2

lower dose = higher dose

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10
Q

Outline progestogenic side effects?

A
  • Mastalgia
  • Weight gain
  • Depression/ PMT-like symptoms
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11
Q

Outline oestrogenic side effects?

A
  • Nausea
  • Headaches
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12
Q

What are the risk factors of taking COC pill?

A

Major

  • DVT (particularly 3rd gen)
  • MI
  • CVA
  • Migraine
  • Hypertension
  • Carcinoma
    • Breast & Cervical

Risk factors are multiplied by;

  • Smoking
  • Inc age
  • Obesity
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13
Q

What are the relative & absolute contradinations for COC pill?

A

Relative

  • BMI 35-39

Absolute

  • 4 wks pre-surgery
  • BMI >40
  • Age >35
  • Smoker >15
  • First 6wks breastfeeding
  • History of any of the major risk factors
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14
Q

Outline the specific thromboembolic risks for;

  • Normal women
  • Pregnant
  • Old 30ug COC pill
  • New 30ug COC pill
  • Smoking + COC pill
A

in 100,000 women

  • Normal women - 5
  • Pregnancy - 60
  • Old 30ug - 15
  • New 30ug - 25
  • Smoking + COC pill - 60
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15
Q

What affects the absorption of COC pill?
How do you ensure contraception?

A
  • Antibiotics
    • Continue taking COC
    • Condoms during & 7d after
  • Missed pill policy (MPP)
    • Take pill asap
    • If missed 2+ use condoms for 7 days
  • Diarrhoea
    • Continue taking
    • MPP
  • Vomitting
    • Within 2hr retake COC
    • After 2 hours MPP
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16
Q

What is the combined transdermal patch?
What type of oestrogen is used?
How must it be used?

A

Combined transdermal patch eg Evra

  • Releases ethinyloestradiol (34ug)
  • 3wks on (patch/week) & 1wk off
17
Q

What is the combined vaginal ring?
What type of oestrogen & progestogen does it release?
How should it be used?

A

Combined vaginal ring eg Novaring

  • Ethinyloestradiol (15ug)
  • Etonogestrel (120ug) [progestogen]
  • 3wks on/ 1wk off
18
Q

For the progestogen-only pill, outline;

  • Name & type of progestogen used
  • Mechanism of action
  • How its taken
A

Name: progestogen type

  • Micronor: Norethisterone (350ug)

Mechanism

  • Makes cervical mucus hostile to sperm
  • Inhibits ovulation in 50% women

Taken daily at the same time (+/- 3hr)

19
Q

What is the efficacy of the progestogen-only pill?

A

PI = 1

20
Q

Outline the S/E of the progestogen-only pill?

A

Progestogenic

  • Mastalgia
  • Weight gain
  • Depression/ PMT-like symptoms

Other;

  • Spotting (breakthrough bleeding)
21
Q

Outline the positives & benefits of the progestogen-only pill (not including S/E)

A

Positives

  • Can be used in all situations where COC pill is contraindicated

Negatives

  • Timing is meticulous
22
Q

For Depo-Provera, outline;

  • What it consists of
  • How it is administered
  • Indications
  • Common S/E, risks & contraindications
  • Efficacy
A
  • Progestogen: Medroxyprogesterone acetate
  • IM every 3/12 (150ug)
  • Indications
    • Compliance problems
    • Lactation
  • S/E
    • Breast discomfort
    • Weight gain
    • Depression/ PMT-like symptoms
    • Osteoporosis (not young & elderly)
    • Irregular bleeding in first weeks
  • PI <1
23
Q

For Nuristerat, outline;

  • What it consists of
  • How it is administered
  • Indications
  • Common S/E, risks & contraindications
A
  • Progestogen: Medroxyprogesterone acetate
  • IM every 8 weeks
  • Indications
    • Short term interim contraception
  • S/E
    • Breast discomfort
    • Weight gain
    • Depression/ PMT-like symptoms
24
Q

For Nexplanon, outline;

  • What is consists of
  • How it is administered
  • Efficacy
  • S/E
A
  • 40mm rod containing progtogen: Etonogestrel
  • Sub-dermal upper arm with local anaesthetic for 3 years
  • PI <1
  • Progestogenic S/E
    • Mastalgia
    • Weight gain
    • Depression/ PMT-like symptoms
25
Q

What are the emergency contraceptives available?

A
  • Morning after pill
  • Intrauterine device (IUD)
26
Q

For the morning after pill, outline;

  • Types
  • Mechanism of action
  • Administration
  • Efficacy
A
  1. Levonelle
    • 1.5mg Levonorgestrel (progestogen)
    • Mechanism
      • Affects sperm function & endometrial receptivity
      • May prevent ovulation
    • Best <24hr (95%), <72hr (58%)
  2. Uliprostal (ellaOne)
    • Selective progesterone receptor modulatior (SPRM)
    • Mechanism
      • SPRM prevents/ delays ovulation
      • Reduce embryo implantation
    • Used <120hr after intercourse
27
Q

How do IUD’s work as emergency contraception

A
  • Prevent implantation
  • Most efficacious method of emergency contraception
  • Upto 5 days post sex/ first day of ovulation
  • Antibiotics given prophylactically
28
Q

Outline the different types of barrier contraception

A
  • Male condom
  • Female condom
  • Diaphragms & caps
  • Spermicides
  • IUD’s
29
Q

For diaphragms & caps;

  • When should they be inserted
  • What is their efficacy
A
  • Pre-intercourse for 6 hours
  • PI = 5
30
Q

How do spermicides work?

  • What ingredients are in them?
A
  • Function as a barrier
  • Contain nonoxynol-9; spermicide
31
Q

Outline the types of IUD and how each function

A
  • Copper
    • Toxic to sperm
    • Block fertilisation & implantation
  • Hormonal - progesterone
    • Levonorgestrel (Mirena)
    • IUS
32
Q

Outline the complications of IUDs?

A
  • Copper
    • Heavy & painful bleeding
  • ALL
    • Pain/ cervical shock (inc vagal tone)
    • Perforation
    • Expulsion
    • Infection (normally a residual infection)
33
Q

Outline the types of female sterilization?

A
  • Filshie clips
    • Inserted laparoscopically
    • Occludes fallopian tube
  • Microinserts
    • Hysteroscopic placement of microinserts intro proximal part of each tubal lumen
    • Essure
34
Q

Outline how male sterilization works?

A
  • Ligation & removal of a small segment of the vas deferens - preventing release of sperm
  • Azoospermia confirmed by 2 semen analyses (may take 6 months to achieve)
35
Q

Outline how male hormonal contraception may work?

A
  • Spermatogenesis halted by administration of progestogens
  • Reduces gonadotrophin drive to testes
    • Also halts androgen production so testosterone replacement therapy required
36
Q

Outline natural contraception methods and how they work?

A
  • Lactation
    • High prolactin levels during lactation inhibit GnRH
  • Withdrawal method
  • ‘Rhythm’ method

Gynaecology (25 decks)

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