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Flashcards in Contraception Deck (21):

FSH promotes _______ by causing ______ that line each ______ to ________ and _______

ovarian follicular growth; granulosa cells; follicle; proliferate; produce estradiol


LH promotes _______ production in _____ cells adjacent to _____ cells

androgen; theca; granulosa


menstrual cycle: LH surge causes _______, ______ with increased _______ and slowed _______ synthesis

resumption of meiosis in the dominant oocyte; luteinization of granulosa cells; progesterone; estrogen


most reliable predictor of ovulation is what occurrence?

onset of LH surge


menstrual cycle: during the luteal phase, shift is to ____ dominance which _______ and causes ______ changes to the endometrium

progesterone; suppresses new follicular growth; secretory


menstrual cycle: if pregnancy does not occur the corpus luteum declines ____ days after ovulation with a drop in __________ with resultant shedding of the endometrial lining, _______, and ________

9-11; progesterone, estrogen, and inhibin levels; rise in FSH and LH; development of a new follicle


after ovulation the oocyte retains potential for fertilization for ______. sperm remain viable in the reproductive tract for up to _____.

12-24 hours; 120 hours


combined hormonal methods: mechanism of action

estrogen PLUS progestin; prevent ovulation, thicken cervical mucus


_____ is the dominant hormone in combined hormonal contraceptive formulations.



what is the mechanism of action of progestin in combined hormonal contraceptive formulations? what about estrogen?

progestin diminishes frequency of hypothalamic GnRH pulse frequency, inhibits estrogen-induced LH surge at mic-cycle
estrogen suppresses FSH preventing selection and emergence of dominant follicle


combined contraceptive vaginal ring: mode of action, what does it contain

suppression of ovulation; ethylene vinyl acetate


combined transdermal patch: drawback compared to oral contraceptive pill

higher rate of venous thromboembolism


combined hormonal contraceptive effects on coagulation cascade

1. increase levels of procoagulant factors 2, 7, 8, 10 and fibrinogen
2. decrease anticoagulant protein S, antithrombin, and tissue factor pathway inhibitor
3. induce resistance to natural anticoagulant activated protein C


contraindications to combined hormonal contraceptives

1. smokers > 35 years old (increased risk of cardiovascular events)
2. history of thromboembolism and stroke
3. history of estrogen-dependent tumor
4. postpartum: 3-6 weeks after delivery (hypercoagulable state)


progestin only pills: mechanism of action

prevents fertilization from thickening of cervical mucus and slowing ovum transport through decreased tubal motility


best method of contraception for patients who experience seizures

DMPA depot medroxyprogesterone acetate injection


DMPA depot medroxyprogesterone acetate injection decreases frequency of what conditions not related to pregnancy?

seizures and sickle cell crises


what is the most effective reversible method of contraception and what is the mechanism of action

contraceptive implant; contains progestin etonogestrel --> inhibits ovulation


which anti-epileptics induce hepatic cytochrome p450 3A4 (the same enzyme that metabolizes estrogens and progestins)

phenytoin, carbamazepine, phenobarbital


IUDs: two types

copper, progestin levonorgestrel


copper IUD: mechanism of action

primary: prevention of normal fertilization; copper ions reduce motility and viability of sperm, toxic to oocytes
secondary: inhibition of implantation, especially if used for emergency contraception