Contraception, Fertility and Menopause Flashcards by Emily Moseley

What things need to be considered in a contraceptive consultation?

Health

Age

Desire for fertility

Social/religious/ethical

Education

Compliance

Cost

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List the 4 broad contraceptive methods

Natural/physiological

Barrier

Hormonal

Surgical

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List the 3 natural/physiological forms of contraception

Rhythm method

Coitus interruptus

Lactation

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Give some advantages and disadvantages of the rhythm method

No STI protection

Cheap

No side effects

No religious/ethical barriers

Limits sexual activity

Failure rate

Education

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Discuss the lactation method of contraception

Regular and exclusive breastfeeding

Prevent ovulation

Prolactin inhibits secretion of FSH - no ovulation

Only works in theory for 6 months

High failure rate?

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Discuss the coitus interruptus method of contraception

Penile withdrawal before ejaculation

Prevent sperm/egg interaction

No STI protection

Significant failure rate

Cheap

Education

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List the 4 barrier methods of contraception

Condom

Diaphragm

Cervical cap

+/- spermicide

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Give advantages and disadvantages to condom use

STI protection

Cheap and readily available

Latex allergies

Loss of sensation

Accidents

Education

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Give advantages and disadvantages to diaphragm and cap use

Needs professional fitting

Education

Use with spermicides

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Discuss the copper IUD

Long-acting reversible contraception

Releases copper which is a spermicide and mechanically prevents implantation

Long term

Can be used as emergency contraception if implanted within 5 days of unprotected sex

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Give advantages and disadvantages to the copper coil

No interruption to sexual activity

No artificial hormones

Amenorrhea

Partner unaware

Decreased libido

Irregular bleeding

Cost

Invasive

No STI protection

Expulsion

Perforation

Infection (PID)

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Discuss methods of termination of pregnancy

Legal to 34/40

Medical
- mifepristone/misoprostol (9/40)

Surgical

vacuum (15/40)
dilation and curettage (>15/40)

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Discuss surgical methods of contraception

Surgical interruption of sperm and egg interaction

Tubual ligation (FR 0.5%)
Vasectomy (FR 0.05%)

Consider irreversible

Counselling

Cost

Invasive

Failures

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What is ‘the pill’?

Synthetic steroid hormones that mimic the functions of oestrogen and progesterone

Combined or progesterone only pills

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Discuss the molecular MoA of oral contraceptives

Act upon oestrogen and progesterone receptors which are intracellular transcription factors

Steroid hormones diffuse across the cell membrane

Binding with receptor activates the receptor via dissociation from HSP90

Active receptor dimers then influence extensive gene expression

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Name the oestrogen intracellular receptors

ERalpha

ERbeta

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Name the progesterone intracellular receptors

PR-A

PR-B

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How is oral contraceptive progesterone different?

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Usually a synthetic analogue of progesterone

What is the primary outcome of oral contraceptives?

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Suppression of ovulation

Discuss how progesterone inhibits ovulation

It which emergency can progesterone be used?

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Progesterone acts on AP and hypothalamus in -ve feedback the suppresses FSH and LH synthesis

High progesterone early in follicular phase lowers FSH and LH synthesis/activity - ovulation is inhibited

Emergency contraception when oestrogen-derived complications/risk occur

Give some effects of progesterone on the endometrium

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Inhibits endometrial gland development - makes implantation less favourable

Thickens cervical mucus - inhibits sperm motility

Which hormone is in an IUS?

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Progesterone

List some common side effects to oral contraceptives

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Breakthrough bleeding

Nausea

Depression

Increased risk of stroke, DVT, HTN

Slight increase in breast cancer risk in long term use

Give some benefits beyond contraception of the pill

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Relieves symptoms of endometriosis

Dysmenorrhoea

Menorrhagia

Relieves acne

Progesterones reduce risk of endometrial cancer

List the 5 stages of menopause

Pre-menopause Premature menopause/primary ovary failure (POF) Peri-menopause Menopause Post-menopause

Describe the endocrine changes at menopause

Declining oocyte numbers Ovaries can not respond to increased LH and FSH from AP Oestrogen + inhibin drop Which leads to an increase in FSH

What is the mean age of onset of the menopause?

51 years 45-60 years

What is the classic symptom triad of menopause?

Hot flushes Sweats Vaginal dryness

List some other non-specific symptoms of the menopause

Headaches Migranes Palpitations Disturbed sleep Joint and muscle ache

List some urogenital symptoms of menopause

Vaginall dryness Cystitis Urinary frequency Urinary incontinence

List some psychological symptoms of menopause

Loss of concentration Poor memory Irritability Loss of libido Panic attack

List some symptoms of menopause caused by atrophy of connective tissue

Skin thinning Hair loss Brittle nails Aches and pains Osteoporosis

If a woman is having symptoms of menopause <40yo, what hormone would you test for?

FSH is used as a marker of early menopause

How is menopause usually diagnosed?

Age Symptoms Signs

Discuss premature menopause

Premature ovarian failure before 40 years old POF doesn't necessarily mean lack of viable follicles Risks include - premature death - neuro diseases - psychosexual function - mood disorders - osteoporosis - infertility

What are the causes of POF?

Idiopathic Familiar tendency Autoimmune Genetic - fragile X, Turner's Infections - viral Surgical menopause - oophrectomy, total hysterectomy

How is menopause diagnosed?

Amennorhea >12 months

When is perimenopause?

Menopause +/- 5 years

Discuss HRT

Administration of oestrogen relieves menopausal symptoms Preparations use natural oestrogen at lower doses than the pill Combination with progesterone avoids cystic endometrial hyperplasia

What routes of administration are available for HRT?

PO Transdermal patches lasting 2 weeks Subcut oestrogen implants lasts 6 months, + PO progesterone to avoid uterine symptoms (hysterectomy) Topical oestrogen creams - urogential symptoms (atrophy and dyspareunia)

Give some benefits of HRT

Improves vasomotor symptoms (hot flushes, night sweats) Improves urogenital symptoms (vaginal atrophy, vulvovaginitis) Reduces # risk and osteoporosis Reduces osteoclast proliferation

List some adverse effects of HRT

Stroke, thromboembolism Breakthrough bleeding Breast tenderness Increased risk of breast CA ?Increased risk of dementia

What 2 other drugs are available to treat menopausal symptoms?

Raloxifene - selective oestrogen receptor modulator - osteoporosis, acts on ER in bone but not breast or uterus Tibolone - synthetic steroid with metabolites possessing oestrogenic and preogestogenic activities

Contraception, Fertility and Menopause Flashcards

(43 cards)