L15 Female Contraception

Question 1

World population growth projection trends are generally…

Answer 1

Decreasing

Question 2

Name modern methods of contraception (8) and traditional or natural methods of contraception (3)

Answer 2

Modern: sterilization, oral hormonal pills, IUD, condoms, injectables, implants, vaginal barrier methods, emergency contraception

Traditional: rhythm (abstinence), withdrawal, lactations amenorrhea method (LAM)

Question 3

Which family planning methods are permanent?

Answer 3

Sterilization (female and male)

Question 4

What are the major components of the endocrine system

Answer 4

Hypothalamus (GnRH), anterior pituitary (LH, FSH), Testis/ovary (gametogenesis, gonadal hormone production)

Question 5

What hormones do LH and FSH trigger in the testes and ovaries?

Answer 5

Testeosterone in testis
Estrogen in ovaries

Question 6

What change allows puberty to are course

Answer 6

Hypothalamus and pituitary sensitivity to negative feedback decreases

Question 7

What are the two steroid hormones produced by the ovary?

Answer 7

Estrogen and progesterone

Question 8

TF: estrogen and progesterone send negative feedback signals to both the anterior pituitary and the hypothalamus

Answer 8

True

Question 9

Pulsatile FSH and LH released by _ stimulate _ and _

Answer 9

Anterior pituitary
Maturation of ovarian follicles
Steroid synthesis

Question 10

Which cells does LH act on in the ovary? What does it do

Answer 10

Theca cells
Increase steroid synthesis and FSH receptors

Question 11

What are the effects of FSH on the ovary?

Answer 11

Q. Regulate follicle growth and maturation
2. Increases the activities of cholesterol side chain cleavage (progesterone synthesis by CYP11A1) and conversion of T to estradiol in granulosa cells by aromatase (FSH)

Question 12

How do nuclear steroid hormone receptors work

Answer 12

Nuclear steroid hormone receptor has ligand binding domain and DNA binding domain
They will act to turn on transcription inside nucleus

Question 13

Name the steroid receptors for progesterone and estrogen

Answer 13

Progesterone: hPR
Estrogen: hERalpha hERbeta

Question 14

Describe the two paths for progesterone action. Which one is faster

Answer 14

1. Nuclear receptors: activated genes (genomic) trigger biological function
2. Membrane receptors (faster): secondary messengers (non genomic) trigger biological function

Question 15

TF: estrogen has nuclear receptors

Answer 15

True

Question 16

What can estrogens and progestins as drugs be used for

Answer 16

Fertility control: contraception and ovulation induction
Hormone replacement therapy
Cancer chemotherapy
Other

Question 17

What are the relative levels of LH, FSH, progesterone and estrogen during menses

Answer 17

FSH>LH>estradiol>progesterone

Question 18

What causes follicular rupture

Answer 18

LH and FSH surge (caused by estradiol surge)

Question 19

When are progesterone levels highest?

Answer 19

When the corpus outermost is developing (peak when corpus outermost is mature)

Question 20

TF: there is more progesterone during follicular phase than during luteal phase

Answer 20

False

Question 21

TF: progesterone is secreted by corpus luteum

Answer 21

True

Question 22

Describe the positive feedback regulation of ovulation

Answer 22

Estradiol surge triggers increase GnRH release, causing increase LH and FSH release

Question 23

TF: both FSH and LH increase at similar levels when estradiol increases

Answer 23

False, there is a higher LH surge than FSH (although FSH levels do increase)

Question 24

Describe the negative feedback involved in ovulation and the menstrual cycle?

Answer 24

Increase in estradiol and progesterone cause decreased levels of LH and FSH released from the pituitary (also negative feedback on GnRH release)

Question 25

TF: progesterone acts to thicken the uterine endometrium

Answer 25

True

Question 26

During which phase are women most fertile

Answer 26

Follicular phase | Days leading up to ovulation + ovulation = most fertile

Question 27

TF: basal body temperature can indicate fertility

Answer 27

True, higher temperatures are detected during luteal phase

Question 28

Why are analogs of estrogen and progestin (progesterone analog) used for oral contraceptives

Answer 28

They are less rapidly inactivated by enzymes

Question 29

Oral contraceptives were approved by the FDA for what reasons?

Answer 29

To treat infertility and menstrual irregularities

Question 30

What was the trend for pill dosage?

Answer 30

Decreasing

Question 31

TF: oral contraceptive pills keep LH, FSH, Estrogen and Progesterone levels constant

Answer 31

True

Question 32

What is the mechanism of action of contraceptive pills

Answer 32

LH and FSH release are inhibited (as well as GnRH and higher brain centres) Ovulation is inhibited - no ripe follicle

Question 33

What are the 3 functions of oral contraceptive pills

Answer 33

1. Prevent ovary from releasing an egg 2. Thicken cervical mucus to deter sperm from reaching egg 3. Thin the lining of the uterus entering implantation of zygote

Question 34

For what reason is the typical use failure rate greater than the perfect use failure rate

Answer 34

Poor compliance (missing pills)

Question 35

Examples of P450s and antibiotics that can interact with oral contraceptives

Answer 35

P450s: barbiturates, phenytoin, rifampicin Antibiotics: ampicillin, tetracycline, neomycin

Question 36

Are oral contraceptives still effective after taking P450 inducers? What about antibiotics?

Answer 36

Inducing P450s cause increased drug metabolism while antibiotics may decrease enterohepatic circulation

Question 37

What are the advantages of oral contraceptive pills (7)

Answer 37

Regular periods, women over 40 can use, decrease cramps and bleeding (and anemia), decrease risk of ovarian/endometrial/colorectal cancer, decrease breast tenderness and acne, increase bone density, does not interfere with sex

Question 38

What are the disadvantages of oral contraceptive pills (2)

Answer 38

Increase risk of venous thromboembolism, slight increase in risk of breast cancer (increased in smokers)

Question 39

The use of oral contraceptives in BRCA1/2 carriers appears to _

Answer 39

Decrease risk of ovarian cancer with no increase in breast cancer

Question 40

TF: oral contraceptives thicken the blood

Answer 40

True

Question 41

What do contraceptive patches release?

Answer 41

Norelgestromin (NGMN) Ethinyl estradiol (EE)

Question 42

TF: contraceptive patches are more efficient than oral contraceptives

Answer 42

After 6 cycles, chances of getting pregnant are half that of oral contraceptive users Patch compliance better than OC: unaffected by age (though lower in younger subjects) *compliance is if the subject is using it correctly and regularly Less efficacious in overweight women

Question 43

What steroids are usually found in implants

Answer 43

Levonorgestrel (progesterone analog)

Question 44

TF: implants of progesterone analogs work by decreasing the LH surge

Answer 44

True

Question 45

What are the two kinds of IUD (intra-uterine devices) and their differences?

Answer 45

Hormonal (levonorgestrel) and copper Copper IUD lasts 10 years while hormonal IUD last 3-5 years

Question 46

What hormones does the plan b pill release

Answer 46

Levonorgesterol (progesterone analog) There is also: Selective progesterone receptor modulator (uliprostal acetate)

Question 47

How does plan B work?

Answer 47

Temporarily blocks ovulation and fertilization

Question 48

TF: plan B can induce withdrawal bleed

Answer 48

True

Question 49

TF: plan B can be taken up to 7 days after unprotected sex

Answer 49

False, it is 5 days

Question 50

What is used for medical termination of pregnancy

Answer 50

Mifepristone (progesterone receptor antagonist) + misoprostal (prostaglandin analog)

Question 51

What does misoprostal do?

Answer 51

It is used in combination with mifepristone for medical termination of pregnancy, it dilates the cervix and induces uterine contractions