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Flashcards in Contraception Deck (19):
1

Withdrawal method

18-28% pregnancy per year

2

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

3

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

4

Tubal ligation methods

laparotomy
cautery
salpingectomy
Filshie clips
Fallope rings
Essure coils

5

Vasectomy

men who had vasectomy still make sperm, still ejaculate
sperm sits in epididymis, gets reabsorbed

6

MOA of hormonal contraception

inhibits gonadotropipin secretion via negative feedback on pit/hypothalamus
by ethinyl estradiol + progesterone (various forms)

7

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

8

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

9

Progesterone only pill indication

CI for estrogen intake: blood clots, breast cancer risk, liver disease

10

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

11

Progesterone only products

Pill - Micronor
Depo - im/sc
Mirena IUD
Implants

12

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

13

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

14

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

15

Hormonal IUD products

Levonorgestrel-releasing: Mirena, Jadess
inserted in office
3-5 years
non-contraceptive uses

16

Copper IUD products

Nova T, flexi T
inserted in office
3- 10 y

17

Emergency contraception products

Copper IUD
Hormonal: Plan B
Yuzpe method
give within 72 hours of unprotected intercourse
hormonal effectiveness: without EC - 8/100 end in pregnancy; with - 1/100

18

Plan B

Levonorgestrel 1.5 mg x 1 dose, or 0.75 mg q12 h x 2 doses

19

Yuzpe method

EE 100 microg + levonorgestrel 0.5 mg q12h x 2 doses