SM_225b: Pregnancy Prevention Flashcards
Describe contraceptive methods that keep sperm out of the vagina
Contraceptive methods that keep sperm out of the vagina
- Abstinence / rhythm
- Vasectomy
- Barriers: male condoms, female condoms, diaphragm, cervical cap
- Spermicides
Describe contraceptive methods that keep sperm out of the cervix
Contraceptive methods that keep sperm out of the cervix
- Changes estrogen-dominant ovulatory cervical mucus to progestin-dominant mucus which inhibits sperm migration
- Hormonal contraception
- Progestin IUD
Describe contraceptive methods that prevent ovulation
Contraceptive methods that prevent ovulation
- Systemic hormonal methods: combination oral, progestin-only oral, combination patch, combination vaginal ring, progestin injectable, combination injectable, progestin implant
Contraceptive method that prevents fertilization is ____
Contraceptive method that prevents fertilization is tubal ligation
Contraceptive method that alters tubal motility is ___
Contraceptive method that alters tubal motility is progestin-only methods
Describe contraceptive methods that prevent implantation and kill sperm
Contraceptive methods that prevent implantation and kill sperm
- Endometrial atrophy: prevents implantation, hormonal contraception, progestin IUD
- Endometrial inflammation: spermicidal, prevents implantation, copper IUD
Theoretical efficacy of contraception is ___ which requires ___
Theoretical efficacy of contraception is perfect use effectiveness which requires consistent and correct use
Use effectiveness is ____ and includes ____
Use effectiveness is typically observed effectiveness and includes inconsistent and incorrect use
- Always lower than theoretical efficacy but how much lower varies with the method
Describe long-acting reversible contraception
Long-acting reversible contraception
- Methods that require daily action have lower use effectiveness rate than weekly, monthly, or yearly methods
- Separation of the act of contraception (decision) from the act of intercourse improves efficacy
- Long-acting reversible contraception methods: hormone-releasing implants, IUDs, depo-injections - increasingly popular because of improved use effectiveness
Describe oral contraception
Oral contraception
- Naturally occuring estradiol and progesterone have poor oral bioavailability and relatively short half-lives
- Oral hormonal contraception utilizes chemically modified compounds that improve bioavailability and resist metabolism (longer half-lives)
Progestin contraception works primarily by ____
Progestin contraception works primarily by suppressing ovulation
- Suppresses LH and LH surge
- Decreases frequency of GnRH pulses
- Thickens cervical mucus
- Decreases motility of tubal cilia
Prolonged exposure to progestin leads to ____
Prolonged exposure to progestin leads to endometrial atrophy
Estrogen acts by ____
Estrogen acts by stabilizing the endometrium
- Stimulates endometrial proliferation
- Suppresses FSH
- Contributes to suppression of LH surge
In hormonal contraception, progestin is sufficient to ____, while estrogen is added to ____
In hormonal contraception, progestin is sufficient to suppress ovulation, while estrogen is added to improve bleeding profiles
- Combination (estrogen and progestin) and progestin-only are used
Initial progestins were based on _____ and had a side effect of _____
Initial progestins were based on nortestosterone (norethindrone) and had a side effect of acne and oily skin
- Increased affinity to progestin receptor
- Decreased anabolic effect
- Slower metabolism
Drosiperone is a ____ with ____ and ____ activity
Drosiperone is a fourth-generation progestin with anti-mineralocorticoid and anti-androgenic activity
- Analog of spironolactone
- Reduces: acne, water and Na retention
- Prescribed for acne or PMS
- At risk for increase in K
Primary estrogen in oral hormonal contraception is ____
Primary estrogen in oral hormonal contraception is ethinyl estradiol
- Ethinyl group improves bioavailability and reduces metabolism
Too much ethinyl estradiol results primarily in ____
Too much ethinyl estradiol results primarily in thrombotic complications
- Increase in hepatic coagulation factors
Too little ethinyl estradiol results in ____
Too little ethinyl estradiol results in endometrial spotting
Estrogen effects and side effects are ___ related
Estrogen effects and side effects are dose related
- Ovulation suppression: 20 mcg
- Endometrial control: 30-35 mcg
- Thrombotic complications: ≥ 50 mcg
Describe oral contraception beneficial side effects
Oral contraception beneficial side effects
- Less anemia
- Decreased risk of endometrial cancer
- Decreased risk of ovarian cancer
- Decreased dysmenorrhea
- Decreased PID
- Increased bone density
Describe combined oral contraception
Combined oral contraception
- One pill daily
- Classic regimen: 3 weeks of active pills, and 1 week of placebo with withdrawal bleeding
- Monophasic and multiphasic: same combination of hormones in each pill vs variable concentrations of ethinyl estradiol and progestin
- Newer regimens seek to reduce frequency and/or duration of bleeding and reduce risk of early follicular recruitment during placebo week
Progestin only pills are administered ____ with the indication of ____
Progestin only pills are administered once per day with the indication of estrogen avoidance
- No placebo pills / no withdrawal bleed
- Estrogen avoidance: lactation, women at risk for thromboemboli, HTN
Describe first pass metabolism of oral contraceptives
First pass metabolism of oral contraceptives
- Blood from intestines passes first through liver where estrogen and progesteorne molecules are metabolized before blood gets to rest of body
- Liver sees much higher drug levels than the rest of the body
Homronal contraception with alternate delivery sites has ____
Homronal contraception with alternate delivery sites has improved compliance compared to oral daily pills
- Bypasses GI absorption and first pass metabolism
- Utilizes active drugs rather than oral prodrugs
- Injectables, implants, transdermal patches, intravaginal rings
Non-oral progestin-only injections include ____
Non-oral progestin-only injections include medroxyprogesterone acetate
- Intramuscularly or subcutaneously
Non-oral progestin-only subdermal implants are ____ with ____
Non-oral progestin-only subdermal implants are an implanted rod of etonogestrel with a 3-year duration
(long-acting reversible contraception)
Intrauterine device is a form of ____ and can be ____ or ____
Intrauterine device is a form of long-acting reversible contraception and can be copper-containing or progestin-releasing
- Copper-containing IUD: causes sterile inflammation of the endometrium, spermicidal, side effects of heavier menses / cramps / irregular bleeding
- Progestin-releasing IUD: thickens cervical mucus, causes endometrial atrophy, possible side effects are less bleeding / decreases cramps / irregular breakthrough bleeding
Copper-containing IUD has side effects of ____, ____, and ____
Copper-containing IUD has side effects of heavier menses, cramps, and irregular bleeding
Progestin-releasing IUD has side effects of ____, ____, and ____
Progestin-releasing IUD has side effects of less bleeding, decreases cramps, and irregular breakthrough bleeding
Spermicide is ____ and functions as a ____
Spermicide is nonoxynol 9 and functions as a surfactant that damages the cell membranes of sperm
Condoms have the advantage of ____
Condoms have the advantage of protection from STDs
Barrier contraception failure rates are ____ because ____
Barrier contraception failure rates are relatively high because closely associated with intercourse
Describe emergency contraception
Emergency contraception
- Hormonal regimen within 72 hours of exposure: high dose levonorgestrel (plan B)
- Hormonal regi\men within 120 hours of exposure: anti-progestin (ulipristal acetate)
- Mechanism: delays or alters ovulation, may impede tubal transport, prevents implantation through endometrial changes
- Copper IUD inserted within 120 hours: prevents implantation and effective for this exposure and provides future contraception
