Flashcards in Lecture 11: Contraception Deck (48)
What are the three types of contraceptive methods?
2. Combined hormonal
3. Progestin Only
What are the non-hormonal contraceptive methods available?
1. Natural family planning/fertility awareness
5. emergency contraception (EC) with copper
What are the types of combined hormonal methods available?
3. Vaginal Ring
What are the progestin only methods?
4. IUS(intrauterine SYSTEM aka Mirena)
5. EC (emergency contraceptive) Plan B
What are advantages of barrier methods?
1. some methods offer protection against STD
2. Preferred by occasional intercourse
3. alternatives for hormonal methods
4. most methods available without prescription
What are the disadvantages of barrier methods
1. not effective as hormonal methods/implants
2. efficacy is dependent on consistent and correct use
3. needs use of concomitant spermicide
What are types of barrier methods?
2. Fertility awareness based methods
-no side effects and exogenous hormones
-cycles can be variable
3. Male sterilization, vasectomy, safe, easy, reversible
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
What are the different methods of female tubal occlusion?
2. blocking with clips or rings
NONSURGICAL TUBAL OCCLUSION
-micro-inserts placed into proximal fallopian tubes
What are the characteristics of spermicides?
Chemical barrier that women can use by themselves
Most common is N-9
How do emergency contraceptives work?
Exogenous Progesterone (progestin) inhibits LH production
Exogenous estrogen inhibits FSH production
What are progestins?
Synthetically made progesterone
What are progestin effects of OCs?
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
What are estrogen effects of OCs?
1. Inhibits FSH surge and subsequent follicle development
2. MAY inhibit ovulation
3. thins cervical mucus…
4. Increases endometrial proliferation
What is synthetic estrogen?
What is ethyline estradiol?
A synthetically made estrogen
What are the different types of synthetic progestins?
1. Testosterone derivatives (19 C)
2. Progesterone derivatives (21 C)
4. Anti-progestins (Ella)
What is Medroxyprogesterone acetate?
Seen as DepoProvera
The ONLY progestin that is derived specifically from progesterone
What are advantages and disadvantages of Depot Medorxyprogesterone acetate?
Highly effective, decreases endometrial changes
Discontinuation due to spotting/irregular bleeding
-amenorrhea and prolonged menses
-injection every 3 months!
If someone is predisposed to obesity, which contraception do you want to avoid?
What is Drosperinone?
Derived from 17alpha spirolactone
Seen in Yaz and Yasmin
What are the effects of progestins in combination OCs?
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
What is the significance of all the different types of progestins?
There are different bioavailabilities after oral intake
Gestodene has over 90%
Levonorgestrel has around 90%
Norgestimate = 22%
Higher bioavailability = higher mg required
What is the clinical relevance of bioavailability?
Comparing mg to mg requirement from OC to OC does not matter
Because mg is dosed based on bioavailability
What are the examples of gonanes?
-anything with “gestrel” or “mate” as end name
Plan B, Alesse, Orthcyclin, Mircete
What are examples of Estranes?
Anything that ends in “drone”
Ovcon 35, loestrin, orthonovum brand names
What contraceptive progestin has longest half-life? Shortest?
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
What is the clinical effect of OCs?
So less facial hair
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