Contraception Flashcards
Withdrawal method
18-28% pregnancy per year
Fertility awareness methods
ovulation predictor kits
cycle beads
measuring basal body temperature - increase in body temperature follows LH surge as progesterone levels rise
elevation in T retrospectively predicts ovulation, significes end of fertile period
Monitoring cervical mucous changes
Cervical mucous changes during menstrual cycle
Prior to ovulation: estradiol - favour sperm motility, passage through cervical canal/capacitation (sperm maturation): copious, thin, stretchy, clear mucous
Post-ovulation: progesterone- impedes sperm motility; scant, thick, tenacious mucous
Tubal ligation methods
laparotomy cautery salpingectomy Filshie clips Fallope rings Essure coils
Vasectomy
men who had vasectomy still make sperm, still ejaculate
sperm sits in epididymis, gets reabsorbed
MOA of hormonal contraception
inhibits gonadotropipin secretion via negative feedback on pit/hypothalamus
by ethinyl estradiol + progesterone (various forms)
Ethinyl estradiol MOA (contraceptive)
primarily inhibits FSH release –> inhibits follicular recruitment –> prevents ovulation
If taken estrogen continuously –> no ovulation –> abundant cervical mucous, endometrial lining will increase, and lining will not shed –> ENDOMETRIAL HYPERPLASIA/CANCER!
must combine with progesterone
Progesterone MOA (contraceptive)
primarily suppresses LH release –> prevents ovulation
endometrium not receptive to ovum
cervical mucus thick/impervious
reduced tubal peristalsis
causes lining to thin over time –> allows use of estrogen since can’t use unopposed estrogen
can get irregular bleeding due to thin lining
Progesterone only pill indication
CI for estrogen intake: blood clots, breast cancer risk, liver disease
MOA of progesterone only pills
primarily suppresses LH release - prevents ovulation (40%)
endometrium not receptive to ovum
cervical mucus thick and impervious
reduced tubal peristalsis
Progesterone only products
Pill - Micronor
Depo - im/sc
Mirena IUD
Implants
Progesterone effect on endometrium
stabilizes endometrium
continuous exposure –> endometrium develops a dense network of thin-walled, small, dilated veins which are fragile
Continuous exposure to low levels of estrogen –> prevents endometrial growth; thin endometrial lining develops
Non-contraceptive benefits of hormonal contraceptives
Menses tend to be light and short
for progesterone-only products, may be nonexistent/irregular/light
All hormonal products can be used to treat dysmenorrhea and menorrhagia
also:
- tx PMS
- acne (reduction in free testosterone)
- perimenopausal symptoms
- decrease PID
- decrease ectopic pregnancy
- decrease risk of endometrial cancer
- decrease risk of epithelial ovarian cancer
IUD MOA
chronic inflammatory changes within endometrium and fallopian tubes –> toxic to sperm/ova
prevention of fertilization
discourages implantation
Levonorgestrel-releasing:
- changes in cervical mucus
- thinning/glandular atrophy of endometrium
Hormonal IUD products
Levonorgestrel-releasing: Mirena, Jadess
inserted in office
3-5 years
non-contraceptive uses
