T2 L5 Fertility Control

Question 1

What mechanisms will create temporary, reversible infertility in a female?

Answer 1

Stopping ovulation

Stopping LH surge

Question 2

Why are levels of progesterone high during pregnancy?

Answer 2

They stop LH surge to stop ovulation. Prevents you getting pregnant again

Question 3

What are the effects of giving progestogens?

Answer 3

Prevent ovulation by stopping LH surge
Thicken cervical mucus
Hostile endometrium

Question 4

Why does giving progestogens cause a hostile endometrium?

Answer 4

Progesterone causes thickening of the endometrium to cease and not become secretory.
If the endometrium remains very thin it will be hostile

Question 5

What is the risk of pregnancy with a progesterone-only contraception?

Answer 5

5%

Question 6

What is the risk of pregnancy if using no contraception?

Answer 6

80% in the first year

Question 7

What is the risk of pregnancy with the combined oral contraceptive pill?

Answer 7

0.03% per year provided it is taken correctly

Question 8

What happens during the 7 pill free days?

Answer 8

The thin endometrium breaks down causing a withdrawal bleed

Question 9

What is the purpose of the withdrawal bleed?

Answer 9

Acts as a pregnancy test

Thought that it would help prevent endometrial cancer but there the evidence for this is slim

Question 10

What happens if you miss a pill when taking COCP?

Answer 10

If the pill is missed in the middle of the pack, chances of pregnancy are very low
If the pill is missed at the start or end there is an increased risk of pregnancy

Question 11

Why does missing a pill at the start / end increase the risk of pregnancy?

Answer 11

You’ll have 9 or 10 drug-free days so Graafian follicles can develop and the ovum starts to mature causing risk of ovulation

Question 12

Give some examples of progesterone-only oral contraceptives

Answer 12

Norethisterone
Levonorgestrel
Desogestrel

Question 13

Describe how progesterone-only oral contraceptives work

Answer 13

Inhibit ovulation by suppressing LH surge

Thicken cervical mucus and render the endometrium hostile

Question 14

What are the adverse effects of progesterone-only oral contraceptives?

Answer 14

Menstrual irregularities
Nausea
Vomiting
Headache
Breast discomfort
Weight changes
Changes in libido

Question 15

Describe how COCP works

Answer 15

Mixture of oestrogen and progesterone
Oestrogen prevents follicular development by suppression of FSH
Progesterone inhibits ovulation by suppressing LH surge, thickening cervical mucus and rendering endometrium hostile

Question 16

What are the adverse effects of combined-oral contraceptives?

Answer 16

Nausea
Vomiting
Abdominal cramps
Fluid retention
Changes in body weight
Hepatic impairment
Cardiovascular changes
Breast tenderness
Cervical erosion
Exacerbation of migraine
Chloasma
Mood changes

Question 17

Describe intrauterine non-hormonal contraception

Answer 17

Piece of plastic that causes local sterile inflammatory response so the fertilised ovum can’t implant into the uterus
IUDs are the most effective form of contraception
IUS is an IUD that releases progestogen into the uterus

Question 18

Describe implants

Answer 18

Solid rings that release progestogen
Inserted under the skin
Release progestogen over a period of 3 years
No drug-free period
Very reliable method and there are no issues with drug absorption

Question 19

Describe vaginal contraception

Answer 19

Silicon ring that releases hormones
Left in for 21 days, taken out for 7 days for a withdrawal bleed then put back in
Can be taken out for up to 3 hours

Question 20

What are the 2 types of emergency contraception?

Answer 20

Levo-norgestrel

Ulipristal

Question 21

Describe the use of levo-norgestrel

Answer 21

Take for 2 days which blocks LH surge
70-80% effective depending on the day used
-if ovulation has already occurred then it is too late
-won’t prevent a pregnancy if ovulation has occurred so if intercourse has taken place in day 12-16. However, they can disrupt implantation

Question 22

Describe the use of ulipristal

Answer 22

Blocks progesterone receptor but has slight agonist properties (partial agonist)
More effective as it prevents the endometrium from developing

Question 23

What drug is used to induce abortion?

Answer 23

Mifepristone

Question 24

Describe the use of mifepristone

Answer 24

Progesterone antagonist which means the endometrium can’t support pregnancy so the pregnancy is terminated

Question 25

What mechanisms will create temporary, reversible infertility in a male?

Answer 25

Block sperm production
Give testosterone to block FSH and LH
Give oestrogen or progesterone to block LH which stops production of testosterone

Question 26

How long will a drug that blocks testosterone take to stop sperm production?

Answer 26

3 months as sperm takes 3 months to develop

It’ll take 3 months after stopping treatment for sperm production to return to normal

Question 27

What can happen if you give progesterone to men?

Answer 27

It will block LH and testosterone so it can cause loss of male secondary sexual characteristics:

• male pattern pubic hair
• muscle development
• sperm production

Question 28

How can male secondary sexual characteristics be conserved when giving progesterone?

Answer 28

Also give testosterone to make up for the loss of endogenous testosterone