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Reproduction Week 1 > Lecture 11: Contraception > Flashcards

Lecture 11: Contraception Flashcards

1
Q

What are the three types of contraceptive methods?

A
  1. Non-hormonal
  2. Combined hormonal
  3. Progestin Only
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2
Q

What are the non-hormonal contraceptive methods available?

A
  1. Natural family planning/fertility awareness
  2. IUD
  3. Spermicides
  4. Barriers
  5. emergency contraception (EC) with copper
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3
Q

What are the types of combined hormonal methods available?

A
  1. Pills
  2. Patch
  3. Vaginal Ring
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4
Q

What are the progestin only methods?

A
  1. Pills
  2. Injectable
  3. Implant
  4. IUS(intrauterine SYSTEM aka Mirena)
  5. EC (emergency contraceptive) Plan B
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5
Q

What are advantages of barrier methods?

A
  1. some methods offer protection against STD
  2. Preferred by occasional intercourse
  3. alternatives for hormonal methods
  4. most methods available without prescription
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6
Q

What are the disadvantages of barrier methods

A
  1. not effective as hormonal methods/implants
  2. efficacy is dependent on consistent and correct use
  3. needs use of concomitant spermicide
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7
Q

What are types of barrier methods?

A
  1. condom
    • latex
    • polyurethane
    • sheep membrane
  2. Fertility awareness based methods
    • no side effects and exogenous hormones
    • cycles can be variable
  3. Male sterilization, vasectomy, safe, easy, reversible
  4. spermicide/diaphragm
  5. female condoms (can be inserted well before intercourse, can be used by latex allergies)
  6. Copper intrauterine device
    • contraception for 12 years
    • can be emergency contraception if inserted up to 5 days after intercourse
    • however must be inserted by healthcare professional and can have bleeding changes
  7. Female sterilization
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8
Q

What are the different methods of female tubal occlusion?

A
  1. ligating
  2. blocking with clips or rings
  3. cauterizing
    NONSURGICAL TUBAL OCCLUSION
  4. Essure
    -micro-inserts placed into proximal fallopian tubes
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9
Q

What are the characteristics of spermicides?

A

Chemical barrier that women can use by themselves

Most common is N-9

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10
Q

How do emergency contraceptives work?

A 
Exogenous Progesterone (progestin) inhibits LH production
Exogenous estrogen inhibits FSH production
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11
Q

What are progestins?

A

Synthetically made progesterone

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12
Q

What are progestin effects of OCs?

A
  1. inhibits LH surge and subsequent ovulation
  2. Thickens Cervical mucus (sperm cant penetrate)
  3. Decreases estrogen-driven cell proliferation (e.g. in endometrium)
  4. Converts reproductive tissues from proliferative modes to functional modes
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13
Q

What are estrogen effects of OCs?

A
  1. Inhibits FSH surge and subsequent follicle development
  2. MAY inhibit ovulation
  3. thins cervical mucus…
  4. Increases endometrial proliferation
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14
Q

What is synthetic estrogen?

A

Estradiol

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15
Q

What is ethyline estradiol?

A

A synthetically made estrogen

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16
Q

What are the different types of synthetic progestins?

A
  1. Testosterone derivatives (19 C)
    • estranes
    • gonanes
  2. Progesterone derivatives (21 C)
    • pregnanes
  3. Spirolactones
  4. Anti-progestins (Ella)
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17
Q

What is Medroxyprogesterone acetate?

A

Progesterone ONLY
Injectable
Seen as DepoProvera
The ONLY progestin that is derived specifically from progesterone

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18
Q

What are advantages and disadvantages of Depot Medorxyprogesterone acetate?

A

DepoProvera
Highly effective, decreases endometrial changes
Discontinuation due to spotting/irregular bleeding
-amenorrhea and prolonged menses
-menstrual changes
-WEIGHT GAIN
-injection every 3 months!

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19
Q

If someone is predisposed to obesity, which contraception do you want to avoid?

A

DepoProvera

Medroxyprogesterone acetate

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20
Q

What is Drosperinone?

A

Derived from 17alpha spirolactone

Seen in Yaz and Yasmin

21
Q

What are the effects of progestins in combination OCs?

A
  1. modify mid-cycle surges of LH/FSH
  2. inhibit ovulation by suppressing HPO
  3. diminish ovarian hormone production
  4. produce endometrial change unfavorable to implantation
  5. thickens cervical mucus to impede sperm travel
  6. inhibit sperm action
22
Q

What is the significance of all the different types of progestins?

A

There are different bioavailabilities after oral intake
Gestodene has over 90%
Levonorgestrel has around 90%
Norgestimate = 22%
Higher bioavailability = higher mg required

23
Q

What is the clinical relevance of bioavailability?

A

Comparing mg to mg requirement from OC to OC does not matter

Because mg is dosed based on bioavailability

24
Q

What are the examples of gonanes?

A

Levonorgestrel family
-anything with “gestrel” or “mate” as end name
Plan B, Alesse, Orthcyclin, Mircete

25
What are examples of Estranes?
Norethindrone family Anything that ends in “drone” Ovcon 35, loestrin, orthonovum brand names
26
What contraceptive progestin has longest half-life? Shortest?
Drospirenone (spirolactone) | Norethindrone
27
How does combination OCs affect androgen pathways?
1. Estrogen and progestin metabolism in liver INCREASES sex hormone binding globulin (SHBG) 2. Increased SHBG binds testosterone, thereby DECREASING testosterone floating around 3. suppression of LH and FSH which leads to less testosterone production 4. Inhibition of 5alpha-reductase so less DHT formation
28
What is the clinical effect of OCs?
Less testosterone So less facial hair Less acne
29
What are other clinical effects of hormonal contraception?
1. decreased menstrual flow 2. improved anemia (because less blood loss) 3. suppressed functional ovarian cysts (because suppression of FSH) 4. Decreased acne/hirsutism 5. Cancer protection
30
What are the characteristics of cyclic OCs and bleeding?
Artificial and nonovulatory Withdrawal from hormones Placebo bleedings allows for withdrawal bleeding
31
What does LNG stand for?
Levonorgestrel
32
What is Yuzpe Regimen?
Two doses of estrogen 0.1 mg with norgestrel 1.0mg 12 hours apart First dose within 120 hours of unprotected sex (5 days)
33
What are the advantages of EC combination pill?
75% of unintended prengancies prevented -increased incidence of side effects due to high estrogen component Nausea and vomiting
34
What is levonorgestrel?
Plan B Single dose Nausea
35
What is Ella?
``` Ulipristal Acetate A progesterone receptor modulator whose likely main effect is to INHIBIT or DELAY ovulation Taken as single dose 120 hours after sex -nausea, requires prescription ```
36
How do you dose oral contraceptives?
Dose started high for efficacy Lower does of EE (ethinyl estradiol) and progestin have synergistic effects on pituitary inhibition Lowered to improve safety and decreased side effects
37
What is EE?
Ethinyl estradiol Orally bioactive estrogen used in oral contraceptive pills Synthetic estrogen
38
What are symptoms with traditional oral contraceptive?
1. Pelvic pain 2. headaches 3. breast tenderness 4. bloating/swelling 5. use of pain meds Symptoms felt during the hormone free days
39
What are recent innovations of hormonal contraception?
1. Contraceptive Patch 2. Vaginal Ring 3. Levonorgestrel Intrauterine System - IUS - Mirena 4. Implanon
40
What are the characteristics of contraceptive patch?
Norgestimate + 20 mcg EE Weekly application and comparable to OCPs Application site reactions Higher risk of breast pain, not effective with obese and visible on skin
41
What are the characteristics of vaginal ring?
``` Efficacy comparable to OCPs Etonogestrel + 15 mcg EE -3 weeks -coital problem may lead to discontinuation -lower rate of breakthrough bleeding ```
42
What are the characteristics of the Levonorgestrel Intrauterine System?
``` EXTREMELY effective 20 mcg of Levonorgestrel/24 hours Stays in place to 5 years -increases thickness of cervical mucus -requires professional insertion and can change bleeding pattern Progestin only Mirena T-shaped device ```
43
What are the characteristics of Implanon/Explanon?
``` Extremely effective Use of Etonogestrel Effective immediately and rapid return to fertility 3 years of protection Contains NO estrogen Goes into skin in upper arm ```
44
What are LARC methods?
Long-Acting REVERSIBLE Contraceptive methods | Examples: Mirena, IUS, Implanon, Levonorgestrel Intrauterine System
45
What are risks of birth control?
Increased death Increased CVD mortality Thromboembolism
46
Why does lecturer not give a shit about oral contraceptive side effects?
Because she argues that pregnancy is much riskier | Doesn’t address the fact that we can just use barrier methods….
47
If woman has preexisting medical conditions, what should we do for contraception?
We should use LARC because pregnancy is more dangerous to OCP
48
What is the association between OCPs and endometrial cancer?
OCPs decrease risk of endometrial cancer

Reproduction Week 1 (13 decks)

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