Flashcards in Contraception Deck (24):
What's the most effective form of emergency contraception (EC)?
Copper T IUD
Between vasectomy (male) and tubal sterilization (female) which is less risky/invasive?
Vasectomy is less risky and invasive.
What's a non-surgical form of tubal sterilization?
Nonsurgical Tubal Occlusion: Coil is inserted into fallopian tubes. Induces occlusion of tube, confirmed by hysterosalpingogram.
What is the Yuzpze Regimen for emergency contraception (EC)? What's the major disadvantage?
2 doses of ethinyl estradiol + norgesteral, 12 hours apart.
High dose estrogen causes nausea and vomiting.
What is "Plan B"? Time frame? How does its effectiveness compare to the Yupze Regimen?
Levonorgestrol only, single dose EC. Must be taken within 120 hours of unprotected sex - sooner is better.
It's more effective, and has fewer side effects.
What is "Ella"? Time frame? Disadvantages?
Progesterone receptor inhibitor that delays / inhibits ovulation. Used for EC. Can be used up to 120 hrs have unprotected sex.
Causes nausea/vomiting, not easily available.
4 effects of progestins in oral contraceptives (OCs)?
Inhibits LH surge, preventing ovulation.
Reduces proliferation of endometrial tissue.
Thickens cervical mucus.
Converts reproductive tissues from "proliferative" to "functional."
(may also affect sperm motility)
4 effects of estrogens in OCs?
Inhibits FSH surge, and thus follicle development.
May help inhibit ovulation.
Thins cervical mucus. (bad for contraception)
Increases endometrial proliferation.
What are 4 types of synthetic progestins?
Testosterone derivatives (estranes, gonanes)
Progesterone derivatives (pregnanes)
What's medroxyprogesterone acetate (MDPA)?
aka. DepoProvera, it's an injectable progestin for long-acting contraception.
3 disadvantages of MDPA?
Requires injection every 3mo.
Significance of bioavailability? What's one OC hormone with particularly high bioavailability?
Can give less drug, may mean less variation in dosage between patients.
Levonorgestrel has bioavailability of about 90%.
Does a longer serum half-life correlate with higher efficacy of OC?
What effects do combined OCs have on androgens?
They increase levels of androgen-binding proteins in serum, decreasing levels of free T. This has anti-verilizing effects (including less acne and facial hair).
5 things combined OCs are good for other than contraception?
Reduced menstrual flow/symptoms.
Suppresses ovarian cyst activity.
Good for acne / facial hair.
Protective against cancer.
What's the deal with withdrawal bleeding while taking OCs?
It's non-ovulatory, it's from the loss of endometrium-sustaining hormones. There's no harm in not having it.
How has dosing of OCs changed over time?
It has decreased a lot. People realized that they work synergistically.
How different are the patch / vaginal ring different from OCPs?
They're not, really. The dosing is similar - it's just different sites of absorption.
What do Mirena and Implanon have in them?
How are progestin IUDs thought to work?
Mainly by local activity of progestins thickening cervical mucus and decreasing endometrial proliferation.
Note that it does not commonly suppress ovulation.
Significant risks of hormonal contraceptives?
Clotting / CV mortality: But this may be more due to smoking / synergy with smoking.
Does the estrogen or the progestin in OCs seem to play more of a role increasing risk for VTE? How does the increased risk from OCs compare to the increased risk from pregnancy?
Pregnancy makes women have wayyy more estrogen than does OCs, and consistently, the risk for VTE is much higher.
Overall, how you should you use / not use hormonal contraceptives in women with conditions predisposing them to clots?
You should be more aggressive with the contraceptives, because pregnancy is all the more dangerous in these patients.