Birth Control Flashcards
(16 cards)
Where does fertilization happen?
Fallopian tubes
Ingredients for viable pregnancy?
ovulation viable sperm intercourse cervix that admits sperm patent fallopian tubes meeting of eggs and sperm healthy endometrium
What are some non-chemical methods?
~ using cycle length to predict fertile days
~ ovulation predictor kits (LH surge immediately precedes ovulation)
~ basal body temperature - spikes right AFTER ovulation as progesterone rises
~ cervical mucous - thickens post ovulation under progesterone -> reduces sperm motility, prior to ovulation under estrogen thin and stretchy
“permanent” methods of birth control?
~ (fallopian) tubal ligation, often laparoscopic, often after last C-section
~ vasectomy (takes ~3 months post procedure, sperm testing necessary, interruption at vas deferens
examples of barrier methods?
~ condoms ~ vaginal sponge ~ cervical cap ~ diaphragm ~ spermicides
MOA of combined estrogen/progesterone pill?
estradiol:
~ inhibits release of FSH at ant. pituitary - no follicular recruitment - no ovulation
progesterone:
~ inhibits LH release at ant. pituitary - prevents ovulation
~ endometrium not as receptive to ovum (more blood vessels, more friable)
~ mucous thicker and harder to navigate through for sperm
~ reduces tubal peristalsis (sperm and egg have trouble meeting)
what are some names for progesterone?
norgestrel (think NOrGESTation)
levonorgestrel
norethindrone acetate
what is a common name for estrogen? ethinyl estradiol (like alcohol, but with more "i"s)
modes of combined hormonal contraceptives?
pills - monophasic/triphasic
Alesse - good low dose start - but b/c low dose can result in breakthrough bleeds
Tri-cyclen - triphasic with changing progesterone levels
Yasmin/Yaz - improved acne
transdermal patch - Ortho-Evra (think feet = skin, so transdermal), 3 weeks on, each week, 1 week off
vaginal ring - Nuvaring - 3 weeks in 1 week off
progesterone only contraception, MOA?
~ reduces LH release - prevents ovulation
~ unreceptive endometrium - in the cycle, interrupted progesterone - endometrium develops blood vessels and grows more; continuous exposure of the pill - prevents endometrial growth and thin endometrium results => light and short menses, in some nonexistent -> great for menorrhagia (excessive bleeding during period) and dysmenorrhea (excessive pain during menstruation) treatment
~ thicker mucous for sperm to travel
~ decreased tubal peristalsis
What are some benefits of oral contraceptives apart from contraception?
~ menorrhagia improvement ~ decreased anemia ~ dysmenorrhea improvement ~ decreased perimenopausal symptoms ~ treatment of PMS ~ treatment of acne ~ decreased PID ~ decreased ectopics ~ decreased epithelial ovarian and endometrial CA
Examples of progesterone-only contraception?
~”micro-pill” = MICROnor - norethindrone 0.35 mg
taken daily, no pill free interval
most women have regular cycles
great for postpartum breastfeeding
suitable for women with thromboembolic or CV disease or those with intolerances to estrogen
but: can have mood changes, acne, hirsutism, weight gain, headache, breast tenderness, irregular menstrual bleeding
~IM/SubQ injection of Depo-Provera (think IM so DEEP) - 1 injection every 3 months (q12-14 wks), usually no period, must be done within 5 days of menses but decreased bone density
but restoration of fertility can take up to 1-2 yrs
~ IUD - “Mirena”, “Jadess” - levonorgestrel
How do IUDs work?
~ inflammatory changes in endometrium and fallopian tubes - > toxic to sperm and ova -> prevents fertilization and implantation
~ Mirena, Jadess (levonorgestrel) -> also changes in cerfical mucous and endometrial atrophy/thinning
lasts 3-5 years; really well liked b/c of light periods
~ copper - no hormones, just irritation “Nova T”, Flexi T”, lasts 3-10 years
~ S/E: Copper: increased blood loss and duration of menses, dysmenorrhea
progesterone: bloating and headache
~ absolute counter indications: known or suspected pregnancy undiagnosed genital bleed PID STIs for copper: Cu allergy or Wilson's
Emergency contraception examples?
non-hormonal: copper T IUD - can be done in up to 7 days post-activity, 1% failure, can only use copper (no Mirenas)
hormonal: Plan B = levonorgestrel 1.5 mg x 1 dose or 0.75 mg q12 h x 2 doses
Yuzpe method = EE 100 microgram and levonorgestrel 0.5 mg q12X 2 doses
both pills best within 72 hrs of unprotected intercourse
effectiveness: without emergency contraception 8% pregnancy, with emergency contraception 1% end in pregnancy
Plan B considered better than Yuzpe, less S/E and greater efficacy
neither way is abortive
common side effects of oral contraceptives?
ESTROGEN:
- headache
- nausea
- weight gain (rare)
- fluid retention
- thromboembolic events
- liver adenoma
- breakthrough bleeding if estradiol levels low in the pill
- migranes and headaches
PROGESTERONE:
- amenorrhea
- headaches
- increased appetite
- decreased libido
- modd chagnes
- hypertension
- acne/hirsutism
common contraindications of oral contraceptives?
- known/suspected pregnancy
- cardiovascular disease
- coagulopathy or prior thromboembolic events
- smoker > 35
- estrogen-dependent tumours (breasts, uterus)
- impaired liver function - can make worse
- congenital hypertriglyceridemia ~ can increase thromboembolic events
- uncontrolled hypertension - progesterone can make worse
- migraines with focal neuro symptoms - can make worse
Before prescribing contraceptives:
~ history and physical to evaluate risks, including blood pressure and breast exam (need to rule out estrogen-dependent tumours)
~ schedule follow-up visit 6 weeks post intake
~ pelvic exam (can be delayed till next visit)
