Contraception Flashcards
The menstrual cycle is regulated by
positive and negative feedback in the hypothalamic–pituitary–ovarian axis.
Gonadotropin-releasing hormone (GnRH) pulses regulate
follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which in turn, regulate the secretion of estrogen and progesterone from the ovary
The menstrual cycle is divided into
four phases: follicular, ovulatory, luteal, and menstrual.
Follicular phase: FSH stimulates
several follicles to develop
several follicles to develop
estradiol to create negative feedback and decrease FSH levels.
Ovulatory phase: estradiol levels peak
and exert positive feedback to induce an LH surge, which facilitates release of the mature ovum.
Estrogen promotes proliferation
of the endometrium and development of progesterone receptors in the endometrium.
Luteal phase:
progesterone prevents new follicle development as well as differentiation of the endometrium.
If no pregnancy, the
corpus luteum degenerates, leading to menstrual bleeding.
Use the safest, best-tolerated, and most
effective method that the patient desires.
Safety
Tolerance
Effectiveness
Rational Drug Selection
Start with absolute contraindications.
Delivery method should be of patient’s choice.
Fine tune based on:
Menstrual pattern
Side-effect profile
Consider:
Patient’s desire for discretion
Timing of subsequent pregnancy
Steps in choice and initiation
establish rapport
identify those appropriate to receive contraceptive
counseling
assess medical history and contraindication to methods
initiate contraceptive
counseling process
elicit informed preferences for method characteristics
facilitate preference-
concordant decision making
counsel about method initiation and use
World Health Organization Medical Eligibility Criteria for Contraception Use
US Medical Eligibility Criteria for Conception Use
Provide definitive guidance on safety across a broad range of conditions for different patient populations
Both label contraceptive methods as
category 1, 2, 3, or 4 for each identified condition
Categories 1 and 2 are considered
generally safe
Category 4 methods are
contraindicated
For those classified as category 3,
the recommendations state that the “method is usually not recommended unless other more appropriate methods are not available or acceptable.”
Contraception Methods
Combined hormonal contraceptives
Progestin-only contraceptives
Intrauterine devices
Emergency contraceptive pills
Estrogen has positive effects on
bone mass, increases serum triglycerides, and improves ratio of high-density lipoprotein to low-density lipoprotein.
Estrogen stimulates
coagulation and fibrinolyticpathways
Progesterone increases
body temperature and insulin levels.
Progesterone may depress
the central nervous system
Two formulations of estrogen are available in contraceptive
ethinyl estradiol and mestranol
Progestins are primarily responsible
for the contraceptive effect.
Progestins exhibit a
egative effect in the hypothalamic-pituitary-ovarian axis.
