Lesson E6 - Contraceptives Flashcards Preview

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Flashcards in Lesson E6 - Contraceptives Deck (253):
1

The term “oral contraceptive” is usually used to refer to a product containing both an _______ and a _______________

- estrogen
- progestin (progesterone-like compound)

2

The preparations which contain an ______ and a ______ are the most ___________ developed to date and are also the ___________.

- estrogen
- progestin
- effective contraceptives
- most widely used

3

What was the first combinations of an estrogen and a progestin?

- Enovid-E
- Developed in 1955, by Pincus and Rock in Puerto Rico
- Became available in Canada in 1961

4

When are fixed combinations of estrogen and progestin intended to be taken?

- From the 5th to the 25th day of the cycle
- You count day 1 as the onset of menses

5

Define Multiphasic (biphasic and triphasic) preparations

- Usually contain a fixed amount of an estrogen and variable amounts of a progestin
- The progestin increases from week to week
- Currently the contraceptives of choice

6

What are the advantages of the Multiphasic (biphasic and triphasic) preparations

- the hormone dose is kept to a minimum and adverse events are believed to be reduced as compared to a fixed-dose combination.
- In addition, the hormonal sequence more closely mimics the pattern of hormones released in the normal ovarian cycle and this may be a further advantage.
- These “phasic” preparations are currently the oral contraceptives of choice.

7

Define continuous estrogen progestin preparations

- products where an estrogen progestin combination product are taken for 28 days each cycle with no drug free period.

8

Define the transdermal Contraceptive patch

- These products contain ethinyl estradiol and norelgestromin (progestin) in a patch that is applied to the skin.
- Drug delivered at a constant rate for 7 days (time the patch is worn)
- Three patches are used each cycle.
- The mechanism of action is the same as for combined estrogen-progestin oral contraceptives.

9

True or False? The mechanism of action of transdermal contraceptive is the same as for combined estrogen-progestin oral contraceptives.

True

10

Define Low-dose progestin or the mini-pill

- contains a synthetic progestin, e.g. norethindrone.
- A daily dose of progestin is taken as long as the drug is needed.
- Patient acceptability is less than with the estrogen-progestin combinations.
- Breakthrough bleeding (bleeding between periods) is often a problem. Efficacy in preventing pregnancy is also less than with the combination products.

11

What is often a problem with Low-dose progestin or the mini-pill?

- Breakthrough bleeding (bleeding between periods) is often a problem. Efficacy in preventing pregnancy is also less than with the combination products.

12

Define the norplant contraceptive

- is comprised of silicone tubes filled with L-norgestrel (a progestin) which are implanted under the skin.
- The drug is released over a period of five years and provides effective contraception during this time.
- The cost of the drug product and surgical placement is approximately $700, which is equivalent to using an estrogen-progestin combination product for three years.

12

Define the norplant contraceptive

- is comprised of silicone tubes filled with L-norgestrel (a progestin) which are implanted under the skin.
- The drug is released over a period of five years and provides effective contraception during this time.
- The cost of the drug product and surgical placement is approximately $700, which is equivalent to using an estrogen-progestin combination product for three years.

12

Define the norplant contraceptive

- is comprised of silicone tubes filled with L-norgestrel (a progestin) which are implanted under the skin.
- The drug is released over a period of five years and provides effective contraception during this time.
- The cost of the drug product and surgical placement is approximately $700, which is equivalent to using an estrogen-progestin combination product for three years.

12

Define the norplant contraceptive

- is comprised of silicone tubes filled with L-norgestrel (a progestin) which are implanted under the skin.
- The drug is released over a period of five years and provides effective contraception during this time.
- The cost of the drug product and surgical placement is approximately $700, which is equivalent to using an estrogen-progestin combination product for three years.

12

Define the norplant contraceptive

- is comprised of silicone tubes filled with L-norgestrel (a progestin) which are implanted under the skin.
- The drug is released over a period of five years and provides effective contraception during this time.
- The cost of the drug product and surgical placement is approximately $700, which is equivalent to using an estrogen-progestin combination product for three years.

13

Is the norplant contraceptive more or less expensive than using a estrogen-progestin combination product?

- Cheaper
- It last 5 years and is the same price as using a estrogen-progestin combination product for 3 years

13

Is the norplant contraceptive more or less expensive than using a estrogen-progestin combination product?

- Cheaper
- It last 5 years and is the same price as using a estrogen-progestin combination product for 3 years

13

Is the norplant contraceptive more or less expensive than using a estrogen-progestin combination product?

- Cheaper
- It last 5 years and is the same price as using a estrogen-progestin combination product for 3 years

13

Is the norplant contraceptive more or less expensive than using a estrogen-progestin combination product?

- Cheaper
- It last 5 years and is the same price as using a estrogen-progestin combination product for 3 years

13

When are progestin-alone preparations are most suitable ?

- in those individuals where estrogens are contraindicated (should not be used).

14

Define the depoprovera contraceptive

- Injectable progestin injected every three months
- provides contraception for about 3 months.

14

Define the depoprovera contraceptive

- Injectable progestin injected every three months
- provides contraception for about 3 months.

14

Define the depoprovera contraceptive

- Injectable progestin injected every three months
- provides contraception for about 3 months.

14

Define the depoprovera contraceptive

- Injectable progestin injected every three months
- provides contraception for about 3 months.

14

Define the depoprovera contraceptive

- Injectable progestin injected every three months
- provides contraception for about 3 months.

15

True or False? The mechanism of action of estrogen-progestin combination oral contraceptives are essentially the same for the fixed ratio products and the phasic products.

True

15

True or False? The mechanism of action of estrogen-progestin combination oral contraceptives are essentially the same for the fixed ratio products and the phasic products.

True

15

True or False? The mechanism of action of estrogen-progestin combination oral contraceptives are essentially the same for the fixed ratio products and the phasic products.

True

15

True or False? The mechanism of action of estrogen-progestin combination oral contraceptives are essentially the same for the fixed ratio products and the phasic products.

True

15

True or False? The mechanism of action of estrogen-progestin combination oral contraceptives are essentially the same for the fixed ratio products and the phasic products.

True

16

What though to be the causes of most of the side effects associated with Estrogen-progestin combinations? What did they do to try and prevent this?

- majority of the toxicities were thought to be associated with estrogen
- use the lowest acceptable dose (50 mg/day or less)
- Recently it has been suggested that progestin also plays a role

16

What is the mechanism of action for Estrogen-progestin combinations?

1. The estrogen inhibits the release of GNRH from the hypothalamus. The pituitary is not stimulated to release FSH and LH, and without FSH and LH, follicles do not mature and thus ovulation is inhibited.

2. Under conditions in a normal cycle, the secretion of the endocervical glands is a thin watery mucus in the first 14 days when estrogen is present. Under the influence of progesterone, in the last half of the cycle, these secretions are thick and not optimal for sperm migration. The oral contraceptives which contain a progestin render these secretions a thick, scant fluid throughout the entire cycle.

3. As the oral contraceptives contain both estrogen and a progestin, the preparation of the endometrium is not optimal for implantation of a fertilized ovum.

16

What is the mechanism of action for Estrogen-progestin combinations?

1. The estrogen inhibits the release of GNRH from the hypothalamus. The pituitary is not stimulated to release FSH and LH, and without FSH and LH, follicles do not mature and thus ovulation is inhibited.

2. Under conditions in a normal cycle, the secretion of the endocervical glands is a thin watery mucus in the first 14 days when estrogen is present. Under the influence of progesterone, in the last half of the cycle, these secretions are thick and not optimal for sperm migration. The oral contraceptives which contain a progestin render these secretions a thick, scant fluid throughout the entire cycle.

3. As the oral contraceptives contain both estrogen and a progestin, the preparation of the endometrium is not optimal for implantation of a fertilized ovum.

16

What is the mechanism of action for Estrogen-progestin combinations?

1. The estrogen inhibits the release of GNRH from the hypothalamus. The pituitary is not stimulated to release FSH and LH, and without FSH and LH, follicles do not mature and thus ovulation is inhibited.

2. Under conditions in a normal cycle, the secretion of the endocervical glands is a thin watery mucus in the first 14 days when estrogen is present. Under the influence of progesterone, in the last half of the cycle, these secretions are thick and not optimal for sperm migration. The oral contraceptives which contain a progestin render these secretions a thick, scant fluid throughout the entire cycle.

3. As the oral contraceptives contain both estrogen and a progestin, the preparation of the endometrium is not optimal for implantation of a fertilized ovum.

16

What is the mechanism of action for Estrogen-progestin combinations?

1. The estrogen inhibits the release of GNRH from the hypothalamus. The pituitary is not stimulated to release FSH and LH, and without FSH and LH, follicles do not mature and thus ovulation is inhibited.

2. Under conditions in a normal cycle, the secretion of the endocervical glands is a thin watery mucus in the first 14 days when estrogen is present. Under the influence of progesterone, in the last half of the cycle, these secretions are thick and not optimal for sperm migration. The oral contraceptives which contain a progestin render these secretions a thick, scant fluid throughout the entire cycle.

3. As the oral contraceptives contain both estrogen and a progestin, the preparation of the endometrium is not optimal for implantation of a fertilized ovum.

17

Define the mechanism of action Low-dose progestin and Norplant and DepoProvera

1. Progestin inhibits the release of GNRH and thus ovulation.

2. The endometrium is not fully developed and is unsuitable for implantation.

3. Progestins alter the secretions of the endocervical gland to a scant, thick fluid not optimal for sperm migration.

17

Define the mechanism of action Low-dose progestin and Norplant and DepoProvera

1. Progestin inhibits the release of GNRH and thus ovulation.

2. The endometrium is not fully developed and is unsuitable for implantation.

3. Progestins alter the secretions of the endocervical gland to a scant, thick fluid not optimal for sperm migration.

17

Define the mechanism of action Low-dose progestin and Norplant and DepoProvera

1. Progestin inhibits the release of GNRH and thus ovulation.

2. The endometrium is not fully developed and is unsuitable for implantation.

3. Progestins alter the secretions of the endocervical gland to a scant, thick fluid not optimal for sperm migration.

17

Define the mechanism of action Low-dose progestin and Norplant and DepoProvera

1. Progestin inhibits the release of GNRH and thus ovulation.

2. The endometrium is not fully developed and is unsuitable for implantation.

3. Progestins alter the secretions of the endocervical gland to a scant, thick fluid not optimal for sperm migration.

17

Define the mechanism of action Low-dose progestin and Norplant and DepoProvera

1. Progestin inhibits the release of GNRH and thus ovulation.

2. The endometrium is not fully developed and is unsuitable for implantation.

3. Progestins alter the secretions of the endocervical gland to a scant, thick fluid not optimal for sperm migration.

18

In the last decade, the _____________ have gained popularity and the total dose of exogenous hormone is _______.

- phasic preparations
- reduced

18

In the last decade, the _____________ have gained popularity and the total dose of exogenous hormone is _______.

- phasic preparations
- reduced

18

In the last decade, the _____________ have gained popularity and the total dose of exogenous hormone is _______.

- phasic preparations
- reduced

18

In the last decade, the _____________ have gained popularity and the total dose of exogenous hormone is _______.

- phasic preparations
- reduced

18

In the last decade, the _____________ have gained popularity and the total dose of exogenous hormone is _______.

- phasic preparations
- reduced

19

How effective are the phasic preparations?

- Essentially 100% effective

19

How effective are the phasic preparations?

- Essentially 100% effective

19

How effective are the phasic preparations?

- Essentially 100% effective

19

What is a Vasectomy?

- This is a simple operation in which the sperm ducts are tied off so that sperm cannot reach the penis.
- This is considered a permanent form of contraception, except in the odd case where the sperm duct appears to regenerate or the surgery is not done properly.
- New microsurgery techniques have improved the success rate for reversal of the procedure.

19

How effective are the phasic preparations?

- Essentially 100% effective

20

Why hasn't male drug contraceptives taken orally or injected reached the Canadian market? What hormone releasing antagonist is showing promising evidence?

- It is difficult and most of the drugs have had only an 80% infertility rate
- The gonadotropin releasing hormone antagonists, which would block both sperm and androgen production, are showing some promise as a male contraceptive.

20

How effective are progestin-alone agents?

- About 98% effective

20

How effective are progestin-alone agents?

- About 98% effective

20

How effective are progestin-alone agents?

- About 98% effective

20

How effective are progestin-alone agents?

- About 98% effective

21

When are progestin-alone preparations are most suitable ?

- in those individuals where estrogens are contraindicated (should not be used).

21

When are progestin-alone preparations are most suitable ?

- in those individuals where estrogens are contraindicated (should not be used).

21

When are progestin-alone preparations are most suitable ?

- in those individuals where estrogens are contraindicated (should not be used).

21

When are progestin-alone preparations are most suitable ?

- in those individuals where estrogens are contraindicated (should not be used).

21

When are progestin-alone preparations are most suitable ?

- in those individuals where estrogens are contraindicated (should not be used).

22

Define the norplant contraceptive

- is comprised of silicone tubes filled with L-norgestrel (a progestin) which are implanted under the skin.
- The drug is released over a period of five years and provides effective contraception during this time.
- The cost of the drug product and surgical placement is approximately $700, which is equivalent to using an estrogen-progestin combination product for three years.

22

Define the norplant contraceptive

- is comprised of silicone tubes filled with L-norgestrel (a progestin) which are implanted under the skin.
- The drug is released over a period of five years and provides effective contraception during this time.
- The cost of the drug product and surgical placement is approximately $700, which is equivalent to using an estrogen-progestin combination product for three years.

22

Define the norplant contraceptive

- is comprised of silicone tubes filled with L-norgestrel (a progestin) which are implanted under the skin.
- The drug is released over a period of five years and provides effective contraception during this time.
- The cost of the drug product and surgical placement is approximately $700, which is equivalent to using an estrogen-progestin combination product for three years.

22

Define the norplant contraceptive

- is comprised of silicone tubes filled with L-norgestrel (a progestin) which are implanted under the skin.
- The drug is released over a period of five years and provides effective contraception during this time.
- The cost of the drug product and surgical placement is approximately $700, which is equivalent to using an estrogen-progestin combination product for three years.

22

Define the norplant contraceptive

- is comprised of silicone tubes filled with L-norgestrel (a progestin) which are implanted under the skin.
- The drug is released over a period of five years and provides effective contraception during this time.
- The cost of the drug product and surgical placement is approximately $700, which is equivalent to using an estrogen-progestin combination product for three years.

23

Is the norplant contraceptive more or less expensive than using a estrogen-progestin combination product?

- Cheaper
- It last 5 years and is the same price as using a estrogen-progestin combination product for 3 years

23

Is the norplant contraceptive more or less expensive than using a estrogen-progestin combination product?

- Cheaper
- It last 5 years and is the same price as using a estrogen-progestin combination product for 3 years

23

Is the norplant contraceptive more or less expensive than using a estrogen-progestin combination product?

- Cheaper
- It last 5 years and is the same price as using a estrogen-progestin combination product for 3 years

23

Is the norplant contraceptive more or less expensive than using a estrogen-progestin combination product?

- Cheaper
- It last 5 years and is the same price as using a estrogen-progestin combination product for 3 years

23

Is the norplant contraceptive more or less expensive than using a estrogen-progestin combination product?

- Cheaper
- It last 5 years and is the same price as using a estrogen-progestin combination product for 3 years

24

Define the depoprovera contraceptive

- Injectable progestin injected every three months
- provides contraception for about 3 months.

24

Define the depoprovera contraceptive

- Injectable progestin injected every three months
- provides contraception for about 3 months.

24

Define the depoprovera contraceptive

- Injectable progestin injected every three months
- provides contraception for about 3 months.

24

Define the depoprovera contraceptive

- Injectable progestin injected every three months
- provides contraception for about 3 months.

24

Define the depoprovera contraceptive

- Injectable progestin injected every three months
- provides contraception for about 3 months.

25

True or False? The mechanism of action of estrogen-progestin combination oral contraceptives are essentially the same for the fixed ratio products and the phasic products.

True

25

True or False? The mechanism of action of estrogen-progestin combination oral contraceptives are essentially the same for the fixed ratio products and the phasic products.

True

25

True or False? The mechanism of action of estrogen-progestin combination oral contraceptives are essentially the same for the fixed ratio products and the phasic products.

True

25

True or False? The mechanism of action of estrogen-progestin combination oral contraceptives are essentially the same for the fixed ratio products and the phasic products.

True

25

True or False? The mechanism of action of estrogen-progestin combination oral contraceptives are essentially the same for the fixed ratio products and the phasic products.

True

26

What is the mechanism of action for Estrogen-progestin combinations?

1. The estrogen inhibits the release of GNRH from the hypothalamus. The pituitary is not stimulated to release FSH and LH, and without FSH and LH, follicles do not mature and thus ovulation is inhibited.

2. Under conditions in a normal cycle, the secretion of the endocervical glands is a thin watery mucus in the first 14 days when estrogen is present. Under the influence of progesterone, in the last half of the cycle, these secretions are thick and not optimal for sperm migration. The oral contraceptives which contain a progestin render these secretions a thick, scant fluid throughout the entire cycle.

3. As the oral contraceptives contain both estrogen and a progestin, the preparation of the endometrium is not optimal for implantation of a fertilized ovum.

26

What is the mechanism of action for Estrogen-progestin combinations?

1. The estrogen inhibits the release of GNRH from the hypothalamus. The pituitary is not stimulated to release FSH and LH, and without FSH and LH, follicles do not mature and thus ovulation is inhibited.

2. Under conditions in a normal cycle, the secretion of the endocervical glands is a thin watery mucus in the first 14 days when estrogen is present. Under the influence of progesterone, in the last half of the cycle, these secretions are thick and not optimal for sperm migration. The oral contraceptives which contain a progestin render these secretions a thick, scant fluid throughout the entire cycle.

3. As the oral contraceptives contain both estrogen and a progestin, the preparation of the endometrium is not optimal for implantation of a fertilized ovum.

26

What is the mechanism of action for Estrogen-progestin combinations?

1. The estrogen inhibits the release of GNRH from the hypothalamus. The pituitary is not stimulated to release FSH and LH, and without FSH and LH, follicles do not mature and thus ovulation is inhibited.

2. Under conditions in a normal cycle, the secretion of the endocervical glands is a thin watery mucus in the first 14 days when estrogen is present. Under the influence of progesterone, in the last half of the cycle, these secretions are thick and not optimal for sperm migration. The oral contraceptives which contain a progestin render these secretions a thick, scant fluid throughout the entire cycle.

3. As the oral contraceptives contain both estrogen and a progestin, the preparation of the endometrium is not optimal for implantation of a fertilized ovum.

26

What is the mechanism of action for Estrogen-progestin combinations?

1. The estrogen inhibits the release of GNRH from the hypothalamus. The pituitary is not stimulated to release FSH and LH, and without FSH and LH, follicles do not mature and thus ovulation is inhibited.

2. Under conditions in a normal cycle, the secretion of the endocervical glands is a thin watery mucus in the first 14 days when estrogen is present. Under the influence of progesterone, in the last half of the cycle, these secretions are thick and not optimal for sperm migration. The oral contraceptives which contain a progestin render these secretions a thick, scant fluid throughout the entire cycle.

3. As the oral contraceptives contain both estrogen and a progestin, the preparation of the endometrium is not optimal for implantation of a fertilized ovum.

26

What is the mechanism of action for Estrogen-progestin combinations?

1. The estrogen inhibits the release of GNRH from the hypothalamus. The pituitary is not stimulated to release FSH and LH, and without FSH and LH, follicles do not mature and thus ovulation is inhibited.

2. Under conditions in a normal cycle, the secretion of the endocervical glands is a thin watery mucus in the first 14 days when estrogen is present. Under the influence of progesterone, in the last half of the cycle, these secretions are thick and not optimal for sperm migration. The oral contraceptives which contain a progestin render these secretions a thick, scant fluid throughout the entire cycle.

3. As the oral contraceptives contain both estrogen and a progestin, the preparation of the endometrium is not optimal for implantation of a fertilized ovum.

27

Define the mechanism of action Low-dose progestin and Norplant and DepoProvera

1. Progestin inhibits the release of GNRH and thus ovulation.

2. The endometrium is not fully developed and is unsuitable for implantation.

3. Progestins alter the secretions of the endocervical gland to a scant, thick fluid not optimal for sperm migration.

27

Define the mechanism of action Low-dose progestin and Norplant and DepoProvera

1. Progestin inhibits the release of GNRH and thus ovulation.

2. The endometrium is not fully developed and is unsuitable for implantation.

3. Progestins alter the secretions of the endocervical gland to a scant, thick fluid not optimal for sperm migration.

27

Define the mechanism of action Low-dose progestin and Norplant and DepoProvera

1. Progestin inhibits the release of GNRH and thus ovulation.

2. The endometrium is not fully developed and is unsuitable for implantation.

3. Progestins alter the secretions of the endocervical gland to a scant, thick fluid not optimal for sperm migration.

27

Define the mechanism of action Low-dose progestin and Norplant and DepoProvera

1. Progestin inhibits the release of GNRH and thus ovulation.

2. The endometrium is not fully developed and is unsuitable for implantation.

3. Progestins alter the secretions of the endocervical gland to a scant, thick fluid not optimal for sperm migration.

27

Define the mechanism of action Low-dose progestin and Norplant and DepoProvera

1. Progestin inhibits the release of GNRH and thus ovulation.

2. The endometrium is not fully developed and is unsuitable for implantation.

3. Progestins alter the secretions of the endocervical gland to a scant, thick fluid not optimal for sperm migration.

28

In the last decade, the _____________ have gained popularity and the total dose of exogenous hormone is _______.

- phasic preparations
- reduced

28

In the last decade, the _____________ have gained popularity and the total dose of exogenous hormone is _______.

- phasic preparations
- reduced

28

In the last decade, the _____________ have gained popularity and the total dose of exogenous hormone is _______.

- phasic preparations
- reduced

28

In the last decade, the _____________ have gained popularity and the total dose of exogenous hormone is _______.

- phasic preparations
- reduced

28

In the last decade, the _____________ have gained popularity and the total dose of exogenous hormone is _______.

- phasic preparations
- reduced

29

How effective are the phasic preparations?

- Essentially 100% effective

29

How effective are the phasic preparations?

- Essentially 100% effective

29

How effective are the phasic preparations?

- Essentially 100% effective

29

How effective are the phasic preparations?

- Essentially 100% effective

29

How effective are the phasic preparations?

- Essentially 100% effective

30

How effective are progestin-alone agents?

- About 98% effective

30

How effective are progestin-alone agents?

- About 98% effective

30

How effective are progestin-alone agents?

- About 98% effective

30

How effective are progestin-alone agents?

- About 98% effective

30

How effective are progestin-alone agents?

- About 98% effective

31

When are progestin-alone preparations are most suitable ?

- in those individuals where estrogens are contraindicated (should not be used).

31

When are progestin-alone preparations are most suitable ?

- in those individuals where estrogens are contraindicated (should not be used).

31

When are progestin-alone preparations are most suitable ?

- in those individuals where estrogens are contraindicated (should not be used).

31

When are progestin-alone preparations are most suitable ?

- in those individuals where estrogens are contraindicated (should not be used).

31

When are progestin-alone preparations are most suitable ?

- in those individuals where estrogens are contraindicated (should not be used).

32

Define the norplant contraceptive

- is comprised of silicone tubes filled with L-norgestrel (a progestin) which are implanted under the skin.
- The drug is released over a period of five years and provides effective contraception during this time.
- The cost of the drug product and surgical placement is approximately $700, which is equivalent to using an estrogen-progestin combination product for three years.

32

Define the norplant contraceptive

- is comprised of silicone tubes filled with L-norgestrel (a progestin) which are implanted under the skin.
- The drug is released over a period of five years and provides effective contraception during this time.
- The cost of the drug product and surgical placement is approximately $700, which is equivalent to using an estrogen-progestin combination product for three years.

32

Define the norplant contraceptive

- is comprised of silicone tubes filled with L-norgestrel (a progestin) which are implanted under the skin.
- The drug is released over a period of five years and provides effective contraception during this time.
- The cost of the drug product and surgical placement is approximately $700, which is equivalent to using an estrogen-progestin combination product for three years.

32

Define the norplant contraceptive

- is comprised of silicone tubes filled with L-norgestrel (a progestin) which are implanted under the skin.
- The drug is released over a period of five years and provides effective contraception during this time.
- The cost of the drug product and surgical placement is approximately $700, which is equivalent to using an estrogen-progestin combination product for three years.

33

Is the norplant contraceptive more or less expensive than using a estrogen-progestin combination product?

- Cheaper
- It last 5 years and is the same price as using a estrogen-progestin combination product for 3 years

33

Is the norplant contraceptive more or less expensive than using a estrogen-progestin combination product?

- Cheaper
- It last 5 years and is the same price as using a estrogen-progestin combination product for 3 years

33

Is the norplant contraceptive more or less expensive than using a estrogen-progestin combination product?

- Cheaper
- It last 5 years and is the same price as using a estrogen-progestin combination product for 3 years

33

Is the norplant contraceptive more or less expensive than using a estrogen-progestin combination product?

- Cheaper
- It last 5 years and is the same price as using a estrogen-progestin combination product for 3 years

34

Define the depoprovera contraceptive

- Injectable progestin injected every three months
- provides contraception for about 3 months.

34

Define the depoprovera contraceptive

- Injectable progestin injected every three months
- provides contraception for about 3 months.

34

Define the depoprovera contraceptive

- Injectable progestin injected every three months
- provides contraception for about 3 months.

34

Define the depoprovera contraceptive

- Injectable progestin injected every three months
- provides contraception for about 3 months.

35

True or False? The mechanism of action of estrogen-progestin combination oral contraceptives are essentially the same for the fixed ratio products and the phasic products.

True

35

True or False? The mechanism of action of estrogen-progestin combination oral contraceptives are essentially the same for the fixed ratio products and the phasic products.

True

35

True or False? The mechanism of action of estrogen-progestin combination oral contraceptives are essentially the same for the fixed ratio products and the phasic products.

True

35

True or False? The mechanism of action of estrogen-progestin combination oral contraceptives are essentially the same for the fixed ratio products and the phasic products.

True

36

What is the mechanism of action for Estrogen-progestin combinations?

1. The estrogen inhibits the release of GNRH from the hypothalamus. The pituitary is not stimulated to release FSH and LH, and without FSH and LH, follicles do not mature and thus ovulation is inhibited.

2. Under conditions in a normal cycle, the secretion of the endocervical glands is a thin watery mucus in the first 14 days when estrogen is present. Under the influence of progesterone, in the last half of the cycle, these secretions are thick and not optimal for sperm migration. The oral contraceptives which contain a progestin render these secretions a thick, scant fluid throughout the entire cycle.

3. As the oral contraceptives contain both estrogen and a progestin, the preparation of the endometrium is not optimal for implantation of a fertilized ovum.

36

What is the mechanism of action for Estrogen-progestin combinations?

1. The estrogen inhibits the release of GNRH from the hypothalamus. The pituitary is not stimulated to release FSH and LH, and without FSH and LH, follicles do not mature and thus ovulation is inhibited.

2. Under conditions in a normal cycle, the secretion of the endocervical glands is a thin watery mucus in the first 14 days when estrogen is present. Under the influence of progesterone, in the last half of the cycle, these secretions are thick and not optimal for sperm migration. The oral contraceptives which contain a progestin render these secretions a thick, scant fluid throughout the entire cycle.

3. As the oral contraceptives contain both estrogen and a progestin, the preparation of the endometrium is not optimal for implantation of a fertilized ovum.

36

What is the mechanism of action for Estrogen-progestin combinations?

1. The estrogen inhibits the release of GNRH from the hypothalamus. The pituitary is not stimulated to release FSH and LH, and without FSH and LH, follicles do not mature and thus ovulation is inhibited.

2. Under conditions in a normal cycle, the secretion of the endocervical glands is a thin watery mucus in the first 14 days when estrogen is present. Under the influence of progesterone, in the last half of the cycle, these secretions are thick and not optimal for sperm migration. The oral contraceptives which contain a progestin render these secretions a thick, scant fluid throughout the entire cycle.

3. As the oral contraceptives contain both estrogen and a progestin, the preparation of the endometrium is not optimal for implantation of a fertilized ovum.

36

What is the mechanism of action for Estrogen-progestin combinations?

1. The estrogen inhibits the release of GNRH from the hypothalamus. The pituitary is not stimulated to release FSH and LH, and without FSH and LH, follicles do not mature and thus ovulation is inhibited.

2. Under conditions in a normal cycle, the secretion of the endocervical glands is a thin watery mucus in the first 14 days when estrogen is present. Under the influence of progesterone, in the last half of the cycle, these secretions are thick and not optimal for sperm migration. The oral contraceptives which contain a progestin render these secretions a thick, scant fluid throughout the entire cycle.

3. As the oral contraceptives contain both estrogen and a progestin, the preparation of the endometrium is not optimal for implantation of a fertilized ovum.

37

Define the mechanism of action Low-dose progestin and Norplant and DepoProvera

1. Progestin inhibits the release of GNRH and thus ovulation.

2. The endometrium is not fully developed and is unsuitable for implantation.

3. Progestins alter the secretions of the endocervical gland to a scant, thick fluid not optimal for sperm migration.

37

Define the mechanism of action Low-dose progestin and Norplant and DepoProvera

1. Progestin inhibits the release of GNRH and thus ovulation.

2. The endometrium is not fully developed and is unsuitable for implantation.

3. Progestins alter the secretions of the endocervical gland to a scant, thick fluid not optimal for sperm migration.

37

Define the mechanism of action Low-dose progestin and Norplant and DepoProvera

1. Progestin inhibits the release of GNRH and thus ovulation.

2. The endometrium is not fully developed and is unsuitable for implantation.

3. Progestins alter the secretions of the endocervical gland to a scant, thick fluid not optimal for sperm migration.

37

Define the mechanism of action Low-dose progestin and Norplant and DepoProvera

1. Progestin inhibits the release of GNRH and thus ovulation.

2. The endometrium is not fully developed and is unsuitable for implantation.

3. Progestins alter the secretions of the endocervical gland to a scant, thick fluid not optimal for sperm migration.

38

In the last decade, the _____________ have gained popularity and the total dose of exogenous hormone is _______.

- phasic preparations
- reduced

38

In the last decade, the _____________ have gained popularity and the total dose of exogenous hormone is _______.

- phasic preparations
- reduced

38

In the last decade, the _____________ have gained popularity and the total dose of exogenous hormone is _______.

- phasic preparations
- reduced

38

In the last decade, the _____________ have gained popularity and the total dose of exogenous hormone is _______.

- phasic preparations
- reduced

39

How effective are the phasic preparations?

- Essentially 100% effective

39

How effective are the phasic preparations?

- Essentially 100% effective

39

How effective are the phasic preparations?

- Essentially 100% effective

39

How effective are the phasic preparations?

- Essentially 100% effective

40

How effective are progestin-alone agents?

- About 98% effective

40

How effective are progestin-alone agents?

- About 98% effective

40

How effective are progestin-alone agents?

- About 98% effective

40

How effective are progestin-alone agents?

- About 98% effective

41

When are progestin-alone preparations are most suitable ?

- in those individuals where estrogens are contraindicated (should not be used).

41

When are progestin-alone preparations are most suitable ?

- in those individuals where estrogens are contraindicated (should not be used).

41

When are progestin-alone preparations are most suitable ?

- in those individuals where estrogens are contraindicated (should not be used).

41

When are progestin-alone preparations are most suitable ?

- in those individuals where estrogens are contraindicated (should not be used).

42

Define the norplant contraceptive

- is comprised of silicone tubes filled with L-norgestrel (a progestin) which are implanted under the skin.
- The drug is released over a period of five years and provides effective contraception during this time.
- The cost of the drug product and surgical placement is approximately $700, which is equivalent to using an estrogen-progestin combination product for three years.

42

Define the norplant contraceptive

- is comprised of silicone tubes filled with L-norgestrel (a progestin) which are implanted under the skin.
- The drug is released over a period of five years and provides effective contraception during this time.
- The cost of the drug product and surgical placement is approximately $700, which is equivalent to using an estrogen-progestin combination product for three years.

42

Define the norplant contraceptive

- is comprised of silicone tubes filled with L-norgestrel (a progestin) which are implanted under the skin.
- The drug is released over a period of five years and provides effective contraception during this time.
- The cost of the drug product and surgical placement is approximately $700, which is equivalent to using an estrogen-progestin combination product for three years.

43

Is the norplant contraceptive more or less expensive than using a estrogen-progestin combination product?

- Cheaper
- It last 5 years and is the same price as using a estrogen-progestin combination product for 3 years

43

Is the norplant contraceptive more or less expensive than using a estrogen-progestin combination product?

- Cheaper
- It last 5 years and is the same price as using a estrogen-progestin combination product for 3 years

43

Is the norplant contraceptive more or less expensive than using a estrogen-progestin combination product?

- Cheaper
- It last 5 years and is the same price as using a estrogen-progestin combination product for 3 years

44

Define the depoprovera contraceptive

- Injectable progestin injected every three months
- provides contraception for about 3 months.

44

Define the depoprovera contraceptive

- Injectable progestin injected every three months
- provides contraception for about 3 months.

44

Define the depoprovera contraceptive

- Injectable progestin injected every three months
- provides contraception for about 3 months.

45

True or False? The mechanism of action of estrogen-progestin combination oral contraceptives are essentially the same for the fixed ratio products and the phasic products.

True

45

True or False? The mechanism of action of estrogen-progestin combination oral contraceptives are essentially the same for the fixed ratio products and the phasic products.

True

45

True or False? The mechanism of action of estrogen-progestin combination oral contraceptives are essentially the same for the fixed ratio products and the phasic products.

True

46

What is the mechanism of action for Estrogen-progestin combinations?

1. The estrogen inhibits the release of GNRH from the hypothalamus. The pituitary is not stimulated to release FSH and LH, and without FSH and LH, follicles do not mature and thus ovulation is inhibited.

2. Under conditions in a normal cycle, the secretion of the endocervical glands is a thin watery mucus in the first 14 days when estrogen is present. Under the influence of progesterone, in the last half of the cycle, these secretions are thick and not optimal for sperm migration. The oral contraceptives which contain a progestin render these secretions a thick, scant fluid throughout the entire cycle.

3. As the oral contraceptives contain both estrogen and a progestin, the preparation of the endometrium is not optimal for implantation of a fertilized ovum.

46

What is the mechanism of action for Estrogen-progestin combinations?

1. The estrogen inhibits the release of GNRH from the hypothalamus. The pituitary is not stimulated to release FSH and LH, and without FSH and LH, follicles do not mature and thus ovulation is inhibited.

2. Under conditions in a normal cycle, the secretion of the endocervical glands is a thin watery mucus in the first 14 days when estrogen is present. Under the influence of progesterone, in the last half of the cycle, these secretions are thick and not optimal for sperm migration. The oral contraceptives which contain a progestin render these secretions a thick, scant fluid throughout the entire cycle.

3. As the oral contraceptives contain both estrogen and a progestin, the preparation of the endometrium is not optimal for implantation of a fertilized ovum.

46

What is the mechanism of action for Estrogen-progestin combinations?

1. The estrogen inhibits the release of GNRH from the hypothalamus. The pituitary is not stimulated to release FSH and LH, and without FSH and LH, follicles do not mature and thus ovulation is inhibited.

2. Under conditions in a normal cycle, the secretion of the endocervical glands is a thin watery mucus in the first 14 days when estrogen is present. Under the influence of progesterone, in the last half of the cycle, these secretions are thick and not optimal for sperm migration. The oral contraceptives which contain a progestin render these secretions a thick, scant fluid throughout the entire cycle.

3. As the oral contraceptives contain both estrogen and a progestin, the preparation of the endometrium is not optimal for implantation of a fertilized ovum.

47

Define the mechanism of action Low-dose progestin and Norplant and DepoProvera

1. Progestin inhibits the release of GNRH and thus ovulation.

2. The endometrium is not fully developed and is unsuitable for implantation.

3. Progestins alter the secretions of the endocervical gland to a scant, thick fluid not optimal for sperm migration.

47

Define the mechanism of action Low-dose progestin and Norplant and DepoProvera

1. Progestin inhibits the release of GNRH and thus ovulation.

2. The endometrium is not fully developed and is unsuitable for implantation.

3. Progestins alter the secretions of the endocervical gland to a scant, thick fluid not optimal for sperm migration.

47

Define the mechanism of action Low-dose progestin and Norplant and DepoProvera

1. Progestin inhibits the release of GNRH and thus ovulation.

2. The endometrium is not fully developed and is unsuitable for implantation.

3. Progestins alter the secretions of the endocervical gland to a scant, thick fluid not optimal for sperm migration.

48

In the last decade, the _____________ have gained popularity and the total dose of exogenous hormone is _______.

- phasic preparations
- reduced

48

In the last decade, the _____________ have gained popularity and the total dose of exogenous hormone is _______.

- phasic preparations
- reduced

48

In the last decade, the _____________ have gained popularity and the total dose of exogenous hormone is _______.

- phasic preparations
- reduced

49

How effective are the phasic preparations?

- Essentially 100% effective

49

How effective are the phasic preparations?

- Essentially 100% effective

49

How effective are the phasic preparations?

- Essentially 100% effective

50

How effective are progestin-alone agents?

- About 98% effective

50

How effective are progestin-alone agents?

- About 98% effective

50

How effective are progestin-alone agents?

- About 98% effective

51

When are progestin-alone preparations are most suitable ?

- in those individuals where estrogens are contraindicated (should not be used).

51

When are progestin-alone preparations are most suitable ?

- in those individuals where estrogens are contraindicated (should not be used).

51

When are progestin-alone preparations are most suitable ?

- in those individuals where estrogens are contraindicated (should not be used).

52

Define the norplant contraceptive

- is comprised of silicone tubes filled with L-norgestrel (a progestin) which are implanted under the skin.
- The drug is released over a period of five years and provides effective contraception during this time.
- The cost of the drug product and surgical placement is approximately $700, which is equivalent to using an estrogen-progestin combination product for three years.

52

Define the norplant contraceptive

- is comprised of silicone tubes filled with L-norgestrel (a progestin) which are implanted under the skin.
- The drug is released over a period of five years and provides effective contraception during this time.
- The cost of the drug product and surgical placement is approximately $700, which is equivalent to using an estrogen-progestin combination product for three years.

52

Define the norplant contraceptive

- is comprised of silicone tubes filled with L-norgestrel (a progestin) which are implanted under the skin.
- The drug is released over a period of five years and provides effective contraception during this time.
- The cost of the drug product and surgical placement is approximately $700, which is equivalent to using an estrogen-progestin combination product for three years.

53

Is the norplant contraceptive more or less expensive than using a estrogen-progestin combination product?

- Cheaper
- It last 5 years and is the same price as using a estrogen-progestin combination product for 3 years

53

Is the norplant contraceptive more or less expensive than using a estrogen-progestin combination product?

- Cheaper
- It last 5 years and is the same price as using a estrogen-progestin combination product for 3 years

53

Is the norplant contraceptive more or less expensive than using a estrogen-progestin combination product?

- Cheaper
- It last 5 years and is the same price as using a estrogen-progestin combination product for 3 years

54

Define the depoprovera contraceptive

- Injectable progestin injected every three months
- provides contraception for about 3 months.

54

Define the depoprovera contraceptive

- Injectable progestin injected every three months
- provides contraception for about 3 months.

54

Define the depoprovera contraceptive

- Injectable progestin injected every three months
- provides contraception for about 3 months.

55

True or False? The mechanism of action of estrogen-progestin combination oral contraceptives are essentially the same for the fixed ratio products and the phasic products.

True

55

True or False? The mechanism of action of estrogen-progestin combination oral contraceptives are essentially the same for the fixed ratio products and the phasic products.

True

55

True or False? The mechanism of action of estrogen-progestin combination oral contraceptives are essentially the same for the fixed ratio products and the phasic products.

True

56

What is the mechanism of action for Estrogen-progestin combinations?

1. The estrogen inhibits the release of GNRH from the hypothalamus. The pituitary is not stimulated to release FSH and LH, and without FSH and LH, follicles do not mature and thus ovulation is inhibited.

2. Under conditions in a normal cycle, the secretion of the endocervical glands is a thin watery mucus in the first 14 days when estrogen is present. Under the influence of progesterone, in the last half of the cycle, these secretions are thick and not optimal for sperm migration. The oral contraceptives which contain a progestin render these secretions a thick, scant fluid throughout the entire cycle.

3. As the oral contraceptives contain both estrogen and a progestin, the preparation of the endometrium is not optimal for implantation of a fertilized ovum.

56

What is the mechanism of action for Estrogen-progestin combinations?

1. The estrogen inhibits the release of GNRH from the hypothalamus. The pituitary is not stimulated to release FSH and LH, and without FSH and LH, follicles do not mature and thus ovulation is inhibited.

2. Under conditions in a normal cycle, the secretion of the endocervical glands is a thin watery mucus in the first 14 days when estrogen is present. Under the influence of progesterone, in the last half of the cycle, these secretions are thick and not optimal for sperm migration. The oral contraceptives which contain a progestin render these secretions a thick, scant fluid throughout the entire cycle.

3. As the oral contraceptives contain both estrogen and a progestin, the preparation of the endometrium is not optimal for implantation of a fertilized ovum.

56

What is the mechanism of action for Estrogen-progestin combinations?

1. The estrogen inhibits the release of GNRH from the hypothalamus. The pituitary is not stimulated to release FSH and LH, and without FSH and LH, follicles do not mature and thus ovulation is inhibited.

2. Under conditions in a normal cycle, the secretion of the endocervical glands is a thin watery mucus in the first 14 days when estrogen is present. Under the influence of progesterone, in the last half of the cycle, these secretions are thick and not optimal for sperm migration. The oral contraceptives which contain a progestin render these secretions a thick, scant fluid throughout the entire cycle.

3. As the oral contraceptives contain both estrogen and a progestin, the preparation of the endometrium is not optimal for implantation of a fertilized ovum.

57

Define the mechanism of action Low-dose progestin and Norplant and DepoProvera

1. Progestin inhibits the release of GNRH and thus ovulation.

2. The endometrium is not fully developed and is unsuitable for implantation.

3. Progestins alter the secretions of the endocervical gland to a scant, thick fluid not optimal for sperm migration.

57

Define the mechanism of action Low-dose progestin and Norplant and DepoProvera

1. Progestin inhibits the release of GNRH and thus ovulation.

2. The endometrium is not fully developed and is unsuitable for implantation.

3. Progestins alter the secretions of the endocervical gland to a scant, thick fluid not optimal for sperm migration.

57

Define the mechanism of action Low-dose progestin and Norplant and DepoProvera

1. Progestin inhibits the release of GNRH and thus ovulation.

2. The endometrium is not fully developed and is unsuitable for implantation.

3. Progestins alter the secretions of the endocervical gland to a scant, thick fluid not optimal for sperm migration.

58

In the last decade, the _____________ have gained popularity and the total dose of exogenous hormone is _______.

- phasic preparations
- reduced

58

In the last decade, the _____________ have gained popularity and the total dose of exogenous hormone is _______.

- phasic preparations
- reduced

58

In the last decade, the _____________ have gained popularity and the total dose of exogenous hormone is _______.

- phasic preparations
- reduced

59

How effective are the phasic preparations?

- Essentially 100% effective

59

How effective are the phasic preparations?

- Essentially 100% effective

59

How effective are the phasic preparations?

- Essentially 100% effective

60

How effective are progestin-alone agents?

- About 98% effective

60

How effective are progestin-alone agents?

- About 98% effective

60

How effective are progestin-alone agents?

- About 98% effective

61

When are progestin-alone preparations are most suitable ?

- in those individuals where estrogens are contraindicated (should not be used).

61

When are progestin-alone preparations are most suitable ?

- in those individuals where estrogens are contraindicated (should not be used).

61

When are progestin-alone preparations are most suitable ?

- in those individuals where estrogens are contraindicated (should not be used).

62

Define the norplant contraceptive

- is comprised of silicone tubes filled with L-norgestrel (a progestin) which are implanted under the skin.
- The drug is released over a period of five years and provides effective contraception during this time.
- The cost of the drug product and surgical placement is approximately $700, which is equivalent to using an estrogen-progestin combination product for three years.

63

Is the norplant contraceptive more or less expensive than using a estrogen-progestin combination product?

- Cheaper
- It last 5 years and is the same price as using a estrogen-progestin combination product for 3 years

64

Define the depoprovera contraceptive

- Injectable progestin injected every three months
- provides contraception for about 3 months.

65

True or False? The mechanism of action of estrogen-progestin combination oral contraceptives are essentially the same for the fixed ratio products and the phasic products.

True

66

What is the mechanism of action for Estrogen-progestin combinations?

1. The estrogen inhibits the release of GNRH from the hypothalamus. The pituitary is not stimulated to release FSH and LH, and without FSH and LH, follicles do not mature and thus ovulation is inhibited.

2. Under conditions in a normal cycle, the secretion of the endocervical glands is a thin watery mucus in the first 14 days when estrogen is present. Under the influence of progesterone, in the last half of the cycle, these secretions are thick and not optimal for sperm migration. The oral contraceptives which contain a progestin render these secretions a thick, scant fluid throughout the entire cycle.

3. As the oral contraceptives contain both estrogen and a progestin, the preparation of the endometrium is not optimal for implantation of a fertilized ovum.

67

Define the mechanism of action Low-dose progestin and Norplant and DepoProvera

1. Progestin inhibits the release of GNRH and thus ovulation.

2. The endometrium is not fully developed and is unsuitable for implantation.

3. Progestins alter the secretions of the endocervical gland to a scant, thick fluid not optimal for sperm migration.

68

In the last decade, the _____________ have gained popularity and the total dose of exogenous hormone is _______.

- phasic preparations
- reduced

69

How effective are the phasic preparations?

- Essentially 100% effective

70

How effective are progestin-alone agents?

- About 98% effective

71

When are progestin-alone preparations are most suitable ?

- in those individuals where estrogens are contraindicated (should not be used).

72

What are some adverse events associated with Low-dose progestin (mini-pill) --> DepoProvera is similar.

- Menstrual bleeding between periods occurs frequently. This is called breakthrough bleeding.
- Some progestins alter the profile of the plasma lipids. There is an increase in low density lipoproteins (bad cholesterol) and a decrease in high density lipoproteins (good cholesterol).
- The overall result is a small increase in the risk of coronary vascular disease. It should be noted that some of the newer agents do not adversely affect the plasma lipids.


73

What are some adverse events (side effects) associated with the norplant contraceptive?

- Bleeding irregularities – that is, changes in the duration of menstrual bleeding and breakthrough bleeding occurs in about 27% of patients in the first year.
- Weight gain
- Headache, nervousness and anxiety have been observed by some patient
- Acne can occur in some patients.
- Muscular pain, breast discharge and abdominal discomfort have been reported by 5% of patients during the first year.
-
-

74

What does the contraceptive Norplant demand that patients be carefully selected and counselled before implanting Norplant.

- The potential side effects

75

When is it important that Estrogen-progestin combinations be examined for toxicities?

- About 20 million girls in North America take them everyday

76

What are some mild adverse events (side effects) associated with Estrogen-progestin combinations?

- Nausea – caused by the estrogen component and usually abates after one or two cycles.
- Edema – the estrogen and progestin cause water retention.
- Headache – migraine is more severe. If headache is severe, the drugs must be stopped.
- Headache – migraine is more severe. If headache is severe, the drugs must be stopped.
- Headache – migraine is more severe. If headache is severe, the drugs must be stopped.
- Weight gain
- Increased skin pigmentation – estrogen produces increased skin pigmentation which can be a problem.
- Acne and hirsutism – the progestin is believed to cause these two response
- Acne and hirsutism – the progestin is believed to cause these two response
- Post-drug amenorrhea – occurs in a few patients and may persist for months.
- Cholestatic or obstructive jaundice has been reported.
- Changes in carbohydrate metabolism with an increase in glucose tolerance.
- There is a decrease in folate absorption, but only a few patients develop anemia.

77

What are some serious adverse events (side effects) associated with Estrogen-progestin combinations?

- Thromboembolic disease ( increase the tendency of blood to form clots in veins)
- Myocardial infarct (heart attacks):
- Cerebrovascular disease(stroke):
- Hypertension
- Cancer

78

Define 100,000 woman years

- 100,000 women taking the drug for one year

79

True or false? Cardiovascular disease in users of oral contraceptives is more prevalent in women over 25 years of age.

- False
- Should be 35 instead of 25

80

Estrogen-progestin combinations increases the risk of endometrial and ovarian cancer

- False
- Reduce the risk

81

Estrogen-progestin combinations decrease the risk of breast cancer.

- False
- It has no effect on the risk of breast cancer

82

What though to be the causes of most of the side effects associated with Estrogen-progestin combinations? What did they do to try and prevent this?

- majority of the toxicities were thought to be associated with estrogen
- use the lowest acceptable dose (50 mg/day or less)
- Recently it has been suggested that progestin also plays a role

83

What are some contraindications for Combined Estrogen-Progestin?

1. Thromboembolic disease.
2. Cerebrovascular disease.
3. Impaired liver function.
4. Carcinoma of the breast or estrogen-dependent neoplasia.
5. Undiagnosed bleeding.
6. Pregnancy or suspected pregnancy. Oral contraceptives during pregnancy may be associated with congenital limb deformation, masculinization and crytochism (undescended testes).

84

What is Antiprogestins (Mifepristone) and how does it work?

- The drug can be taken after a “missed period” to bring on menstruation
- Progesterone maintains the endometrium in the last half of the cycle and during pregnancy, should pregnancy occur.
- Mifepristone blocks the effect of progesterone on the endometrium and the endometrium then lacks the support of progesterone and the lining is sloughed

85

Define Post-Coital Contraceptives? How do they work?

- Large doses of estrogen taken after coitus (intercourse)
- Estrogen and a progestin are taken, usually within 24 hours, but no later than 72 hours after coitus
- The large dose of estrogen (3 X the amount in an oral contraceptive tablet) either delays ovulation or inhibits ovulation.
- The major problem is the nausea caused by the estrogen. Examples are Preven and Plan B.

86

How many times greater is the estrogen in Post-Coital Contraceptives compared to oral contraceptives?

- 3 times

87

Name 2 Post-Coital Contraceptives. What is a major problem?

- Preven and Plan B
- Major problem with the nausea cased by estrogen ( 3 times the amount that is in normal oral contraceptives)

88

Define IUD. How does it work? Are they highly effective?

- A coil is introduced into the uterus
- It is generally believed that the presence of a foreign object causes a local tissue reaction and prevents implantation of the fertilized ovum.
- In addition, the IUD increases contractions of the uterus and the fertilized ovum is expelled before it can be implanted.

89

True or False? Some IUDs have progestins embedded in them and the hormone is released slowly over time.

True

90

What are 4 problems associated with IUD

1. Heavy menstrual flow
2. Heavy menstrual flow
3. About 10-15% are expelled spontaneously (usually during first two months).
4. There is an increase in the incidence of uterine infections.

91

Define what a Diaphragm and Spermicidal Jelly is.

- The diaphragm is a cap filled with an agent which destroys sperm and is placed over the cervix and acts as a physical and chemical barrier to prevent sperm from reaching the ovum.
- Pregnancy rate 10/100 women years

92

What are some disadvantages to diaphrams and spermicidal jelly?

- They must be properly fitted and properly used.
- They must be inserted before coitus and may interrupt the sex act.
- They must remain inserted for 6-8 hours after coitus to allow the spermicide to act.

93

Define a condom? What is an advantage and disadvantage? What is the pregnancy rate?

- The condom is a physical barrier worn over the penis
- Advantage: A good latex condom will prevent the spread of sexual transmitted diseases.
- Disadvantage: They can interfere with the sex act.
- The pregnancy rate is 15/100 woman years; condoms can tear or break and thus lead to contraceptive failure.

94

What is a female condom? Name an advantage and disadvantage.

- This is a physical barrier (sleeve) inserted into the vagina. - - They are not as acceptable as the male condom, nor as effective.
- Advantages: Prevention of sexually transmitted diseases and pregnancy.
- Disadvantage: Ease of insertion and user acceptability. There is a tendency for these devices to dislodge. Although available for about 25 years this product has not had wide acceptance.

95

What is the Rhythm Method?

- Abstinence a few days before and after ovulation.
- There is an increase in body temperature at ovulation and this is often used to time the period of abstinence.
- The reason for failure is that time of ovulation is extremely variable and couples must adhere to the abstinence plan.
- The pregnancy rate is 25/100 woman years.

96

Define Coitus Interruptus? Why may it not be effective? What is the pregnancy rate?

- Removal of the penis before ejaculation
- This method is not effective since some sperm are released before ejaculation and sperm may migrate into the vaginal tract if ejaculated near the vaginal opening
- The pregnancy rate is 25/100 woman years.

97

Is the vaginal douche an effective method of birth control?

- No
- It actually may hasten sperm migration

98

What is Tubal Ligation?

- Permanent form of contraception and is best described as tying the fallopian tubules so that the ovum cannot migrate to the uterus
- There is no loss of hormonal balance, thus there should be no effect on sex drive.

99

True or False? Some of the newer surgical techniques have been able to reverse the process tubal ligation

True

100

What is a Vasectomy?

- This is a simple operation in which the sperm ducts are tied off so that sperm cannot reach the penis.
- This is considered a permanent form of contraception, except in the odd case where the sperm duct appears to regenerate or the surgery is not done properly.
- New microsurgery techniques have improved the success rate for reversal of the procedure.

101

True or False new microsurgery techniques have improved the success rate for reversal of a vasectomy.

True

102

Why hasn't male drug contraceptives taken orally or injected reached the Canadian market? What hormone releasing antagonist is showing promising evidence?

- It is difficult and most of the drugs have had only an 80% infertility rate
- The gonadotropin releasing hormone antagonists, which would block both sperm and androgen production, are showing some promise as a male contraceptive.

103

What is gossypol?

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