Cycle/Hormonal Overview Flashcards
(23 cards)
Menstrual Cycle Phases
23-35 days (average 28 days)
-Start of bleeding (menses) is day 1
-Follicular phases begins with onset of menses, when estrogen/progesterone levels are LOW
- Follicular
-FSH spurs follicle development and causes estrogen to surge (estrogen peaks by end of this phase) = LH and FSH increase - Ovulatory
-LH surge triggers ovulation 24-36 hours later (ovulation is release of egg (ova) from ovary) - Luteal
-Corpus luteum develops in ovaries, ~14 days, progesterone is dominant here
Fertility Awareness
Oocyte lives for 24 hours once released (sperm can live for 3 days)
Ovulation kits predict best time to conceive by testing for LH in urine and are POSITIVE if LH is present
-Should have sex when this LH surge is detected and for the following 2 days
Pregnancy
Human chorionic gonadotropin (hCG) is released when a fertilized egg attaches to uterus lining (implantation)
hCG in urine/blood = pregnancy
A home urine test can detect pregnancy sooner if
the woman tests the first urine in the morning, when the hCG level is highest
Preconception Health
Woman planning to conceive (all all women of childbearing age) should
-Increase folic acid (folate, B9 = 400 mcg, if pregnant then 600 mcg)
-No smoking/drugs/excessive alcohol
-Keep vaccinations current (avoid toxoplasmosis)
-Avoid toxic chemicals (hazardous drugs list)
-Consult for teratogenic potential of current meds
Contraception: Return to Fertility
A prompt return to fertility occurs when most contraceptives are discontinued
The only reversible contraceptive method that
has a delay in return to fertility is the medroxyprogesterone injection
Effectiveness of Contraceptive Methods
Most Effective
-Impant, IUD, male/females sterilization (vasectomy, abd/lapro/hysteroscopic)
Next
-Injectable, pill, patch, ring, diaphragm
Next
-Condom (male or female), withdrawal, sponge
Least Effective
-Fertility-awareness methods, spermicide
**contraception does not protect against STIs except for condoms (from some STIs)
Diaphragms and Caps
Soft latex/silicone barriers that cover cervix and prevent sperm passage
Used with spermicide
Many require Rx for fitting
CAYA diaphragm is a single size (no fitting)
Condoms
Condoms help protect against many STIs (only if they are latex or polyurethane (plastic)
-not “natural” sheepskin
Use with spermicide can cause irritation and increase HIV risk
Lubricant makes condoms less likely to break (reduce friction)
-NO OIL based, only water/silicone based lubes
Spermicide nonoxynol-9
-Do not use with anal sex
-Do not use with vaginal rings
-Do not use in recurrent UTI hx or UT abnormalities
Phexxi (Rx option) is a vaginal gel that makes pH acidic (3.5-4.5) which is bad for sperm (reduce mobility)
Hormonal Contraceptives
Work by inhibiting FSH and LH (prevent ovulation)
Progestin only
-Pill, injectable, implant, IUD
Estrogen/Progestin combo
-Pill, ring, patch
Also have benefits: decrease menstrual pain, irregularity, endometriosis pain, acne,
-lower risk of ectopic pregnancy, noncancerous breast cysts/lumps, endometrial/ovarian cancer
FDA Requirement for Oral Contraceptives
FDA requires that the Patient Package Insert (PPI) be dispensed with oral contraceptives
-it will be in the product packaging
The PPI has important safety information, instructions on proper use and what to do if pills are missed
Estrogen/Progestin Combinations
Most COCs contain
-Estrogen as ethinyl estradiol (EE) and a
-Progestin (norethindrone, levonorgestrel, drospirenone)
Monophasic = same dose of estrogen and progestin throughout pill pack
Bi/tri/quad phasic = mimic E/P levels during a cycle (triphasic = 3 hormone changes)
Drospirenone
Unique progestin that is used in some COCs to reduce adverse effects commonly seen with oral
contraceptives
Mild K-sparing diuretic which decreases bloating, PMS sx, and weight gain
-Less acne (anti-androgenic)
Other progestins with low androgenic activity:
-Norgestimate
-Desogestrel
-Dienogest
Other Indications of COCs
First line for
-PCOS
-Endometriosis
-Menorrhagia (heavy bleeding)
Elagolix (Orilissa)
FDA-approved for endometriosis pain
Indicated for heavy menstrual bleeding (menorrhagia)
-Natazia (COC)
-Mirena (levonorgestrel IUD)
-Oriahnn (estradiol, norethin, elagolix in one) for heavy bleeding of uterine fibroids (not a contraceptive)
-Oral tranexamic acid (non hormone tx for menorrhagia)
Progestin-Only Pills
28 days of active pills
-Suppress ovulation, thicken mucus, thin endometrium
Used in
-Lactating women (estrogen decreases milk production)
-CI or intolerance to estrogen
-Migraine ppx (safe with aura, unlike estrogen)
Patches: CI
Higher systemic estrogen exposure
Higher risk of thromboembolism
Avoid in
-35+ years old who smoke
-Cerebrovascular disease
-Past blood clots
-Postpartum
-BMI 30+ (Xulane, Zafemy, Twirla)
Xulane and Zafemy
Avoid in BMI 30+ (TE risk)
Avoid in > 198 lbs (90 kg) (less effective)
Twirla
Avoid in BMI 30+ (less effective)
Injectable Contraception
Depo-Provera, Depo-subQ Provera 104
-depot medroxyprogesterone acetate (DMPA)
Suppresses ovulation, thickens mucus, thin endometrium
DMPA is given IM (150 mg) or SQ (104 mg) every 3 months
Amethyst
Approved for extended cycle of 84 days of active hormonal pills followed by 7 days of inactive pills
-Bleeding occurs every 3 months
-Spotting/breakthrough bleeding is common with continuous contraception
*resolves after 3-6 months
Less anemia and menstrual migraines
