Reproduction 15 Flashcards
Name the classes of contraception
Hormonal Barrier IUDs Perminant Natural
Describe the hormonal methods of contraception
Mimic hormonal levels during the luteal phase or pregnancy
Constant exposure to progesterone suppresses ovulation
Progesterone causes the thickening of the cervical mucous and decrease endometrial receptivity
Oestrogen exerts additional negative feedback and induces progesterone receptor expression increasing it’s effects Eg.
Progesterone Only Pill- daily
Combined Oral contraceptive-Daily 92-99.7%
Progesterone only Injection- Long acting Reversible contraceptives (LARC)- 12 weeks- 97-99.7%
Combined hormonal contraception patch (Evra)- 1 week- 92-99.7%
Progesterone only implant (LARC)- 99.5% effective- 3 years
Combined Hormonal Contraceptive vaginal ring-92-99.7%- 3 weeks
Delayed onset Off target effects- some synthetic steriod bind receptors of different classes and can be androgenic- acne
Describe Phasic pills
monophasic- fixed amounts of hormones (estrogen and progestrerone
Biphasic- fixed oestrogen, increased progesterone in the second half of the cycle
Triphasic- fixed/variable oestrogen, progesterone increases in thress phases
Issues are delyaed onset,, and some off target effects
Describe the morning after pill
Emergency contraception- Progesterone only- HIgher levels
eg. Levonelle - Prevents/delays ovulation and alters the environment of the uterus to prevent implantation- less effective as time goes on 1st day- 95% effective, 2nd day- 85% effect, 3rd day- 65% effective
EllaOne- selective progesterone receptor modulator- effective for 120 hours
Describe Barrier methods of contraception
Prevent pregnancy by stopping the sperm and egg from meeting
Includes spermicides- 75%
Condom- 85-98%
prevents pregnancy and STIs-male and
female Diapragm and cap- Latex barriers placed in the vagina before intercourse + spermicidal jelly- 84-94%
Describe IUDs
Intrauterine devices Placed in the uterus
Lasts 5-12yrs- LARC Effective without hormone- >99%
Release of leukocytes and prostacyclins by the endometrium due to the foreign body response- hostile to embryos and sperm
Copper has spermicidal properties
SE- heavy periods, increased risk of ectopic pregnancy
Mirena- 5yrs, LARC, acts as a IUD and releases small amounts of progestin- atophy of the endometrium, thickening of the cervical mucous and may suppress ovulation Reduced menorhagia and dysmenorrhoea 99.9%
Describe permanent contraception
Permanent steralisation female- uterine tubes- 99.5% Male- vasectomy- 99.8%
Describe natural contraception
Coitus interuptus- withdrawal (73%)
Rhythm method (menstrual cycle)- 75%
Fertility awareness method- temp, cervical mucous and position- 75-95%
Natural family spacing- lactational amenorrhoea, prolactin- 98%
Abstinence (not having sex)- 100%
What is the problem with contraception compliance?
Mismatch between actual behaviour with contraceptive and ideal behaviour- larger gap between ideal and actual usage with daily use contraceptives
Improve counselling, developing methods the require low levels of compliance, maximise benefits and minimise SEs
Describe the climacteric
period of reproductive change that proceeds the menopause
Oligomenorrhoea (irregular periods)
Mood changes Loss of libido Hot flushes
Falling oestrogen and raisingFSH/LH
Menopause- 51yrs UK- 12 months amenorrhea (no periods) over 50ys 24 months amenorrhea under 50yrs
Oestrone predominates- adrenals, adipose- least potent oestrogen
Leads to loss of anti-PTH activity- bone catabolism- osteoporosis
Changes in blood lipid ratios- coronary thrombosis
Reduction in vaginal lubrication
Behavioural changes- endocrine or psychological?
Hormonal Replacement therapy- combined progesterone and oestrogen (unopposed oestrogen- endometiral hyperplasia and cancer- only suitable for women who’ve had a hysterectomy)
