Oral contraceptives

Question 1

What are the 4 fertility regulating hormones?

Answer 1

Gonadotrophin releasing hormone (GnRH)
FSH - gonadorophin
LH - gonadotrophin
Progesterone
Oestrogens

Question 2

What are the 2 phases of the menstrual cycle?

Answer 2

Follicular phase (1-14)
Luteal phase (14-28)

Question 3

What days are ‘bleeding’?

Answer 3

1-5

Question 4

Which hormone thickens the endometrial lining?

Answer 4

Estrogen

Question 5

Which hormone maintains the thickening of the endometrial lining?

Answer 5

Progesterone

Question 6

What do synthetic steroids do to progesterone and estrogen?

Answer 6

Increase their half lives

Question 7

What are the two types of oral contraceptives?

Answer 7

1. Combined oral contraceptives (COC’s)

2. Progestin-only contraceptive (less common)

Question 8

What is the estrogen in in COC’s usually?

Answer 8

Ethinyl estrodiol

Question 9

Progestin varies in 2nd and 3rd generation pills. Which generation is highly effective and more common?

Answer 9

3rd generation pills

Question 10

What is the usual cause of a decreased success rate in using the oral contraceptive?

Answer 10

Lack of compliance by users

Question 11

What are the 3 hormonal variants in the COC pills?

Answer 11

1. Monophasic: constant dose of estrogen and progestin throughout monthly cycle
2. Biphasic: estrogen constant, progestin increased in the second half of the cycle
3. Triphasic: does of estrogen higher in middle part of cycle or remains constant. Progestin increases in 3 steps during the cycle

Question 12

What type of pill is the Mini Pill?

Answer 12

Progestin-only pill.

Question 13

How does the mini pill offer increased safety?

Answer 13

high doses of estrogen are associated with CV adverse side effects, so having progestin only is safer in a lot of ways.

Suitable for breast feeding women (no estrogen)

Smokers prescribed it if they don’t want to stop smoking.

Question 14

How is the mini pill slightly less effective than COC’s?

Answer 14

It’s taken every 24 hours without a break, with only a 3 hour window for missed pills. NEED COMPLIANCE!!!

Question 15

How do oral contraceptives help to reduce the chances of getting pregnant?

Answer 15

• prevent ovulation
• Thicken cervical mucus to stop sperm
• Reduce motility of fallopian tubes
• Thin endometrium to prevent implantation

Question 16

What are the hormonal effects of estrogen?

Answer 16

Prevents release of FSH by neg. feedback on Ant. Pituitary (suppresses development of follicle)

Question 17

What are the hormonal effects of progestin?

Answer 17

Inhibits secretion of LH and FSH (neg. feedback) and suppresses ovulation.

Increases thickness of cervical mucus.

Question 18

What are common side effects of COC’s?

Answer 18

Mood changes, depression, headaches
Fluid retention, weight changes
Nausea, vomiting
Cramps, breakthrough bleeding

Question 19

What are serious but rare side effects of COC’s?

Answer 19

Risk of breast cancer
Hypertension
Deep vein thrombosis
CV disease

Question 20

What are the 2 main big health benefits of COC/s?

Answer 20

Decreased risk of ovarian cancer and endometrial cancer.

Question 21

What are oral contraceptives metabolised by?

Answer 21

CYP450 enzymes

Question 22

What is the emergency contraceptive pill?

Answer 22

Combo high dose ethinyl estradiol and progestin OR progestin only.

Given within 72 hours of sex. Requires second dose 12 hours later.

Question 23

What does the ECP do?

Answer 23

Prevents ovulation and implantation

Question 24

What is the abortion pill called?

Answer 24

RU 486, Mifepristone

Question 25

What does the abortion pill do?

Answer 25

A progesterone receptor antagonist that prevents the effect of progesterone. Single dose terminates pregnancy immediately.

Causes abortion in 97% of users if taken within 50 days of last menstruation.

Question 26

What is the axis called that neg. feedback of progesterone and estrogen acts on?

Answer 26

Hypthalamic-pituitary-gonadal axis.