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81 Cards in this Set
- Front
- Back
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What is the most commonly used form of contraception overall in the US?
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Sterilization
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What is the most commonly used form of contraception by women in the US who want children?
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Hormonal contraceptives
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What are hormones contained in hormonal contraceptives?
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Estrogen and Progestin or Progestin-only
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What are the ways in which hormonal contraceptives are adminstered?
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Pills
Injections Implantable capsules Intrauterine devices (IUDs) Vaginal ring Patch |
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What are hte two actions of estrogen contraceptives?
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1. Inhibits ovulation through inhibiting production of GnRH at the hypothalamus
2. Increases the rate of ovum transport through the oviduct |
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What are the five actions of progestin in contraceptives?
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1. Prevents ovulation by inhibiting LH and FSH production in the anterior pituitary
2. Stimulates the production of a thick, pasty cervical mucus 3. Inhibits capacitation of sperm 4. Slows the rate of ovum transport through the oviduct 5. Prevents adequate build-up of the endometrium such that implantation is unlikely |
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What is capacitation?
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An enzyme-initiated change in sperm that typically occurs inside the woman’s body and is required before fertilization can occur
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If a contraceptive contains both estrogen and progestin, what is the net effect of the rate of ovum transport through the oviduct?
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the estrogen speeds transport but the progestin slows it down so the net result is no effect on the rate of transport, but the progestin is stronger than estrogen, so would slow
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Which is more effective: a contraceptive containing only progestin or one containing both progestin and estrogen?
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both highly effective: 98-100%
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What are the risks of estrogen in contraceptives?
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Increased risk of blood clots, stroke and heart attack
Effect on risk of breast cancer unclear |
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What are the risks of progestin -containing contraceptives?
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increased risk of cardiovascular disease (CVD) due to plasma lipids
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What is Yasmin?
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A combination oral contraceptive that uses a different progestin that has an anti-androgenic and anti-mineralcorticoid effect
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What is a risk associated with Yasmin?
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The new progestin used can result in elevated potassium levels, which can have adverse effects in someone who already has potassium levels or who has kidney or liver problems
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What are the advantages of hormonal contraceptives?
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1. reduce risk of ovarian cancer
2. Non-intrusive during sex 3. Easy to use 4. Highly effective 5. Reduction of menstrual blood loss 6. Reduced dysmenorrhea |
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What are the disadvantages of hormonal contraceptives?
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1. No protection from STDs
2. May cause irregular menses or amenorrhea (particularly progestin-only contraceptives) 3. Reduced estrogen levels may reduce bone density |
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What are two forms of emergency contraception?
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Hormonal and IUD
(pills + plan B) |
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When must emergency contraception pills be taken in order to be effective?
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Within 72-120 hours of unprotected sex
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When must an IUD be inserted to be effective as an emergency contraceptive?
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within 5 days of unprotected sex
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What is involved in the hormonal form of emergency contraception?
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Taking several doses of certain oral contraceptives or higher doses of specific contraceptive hormones
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How does hormonal emergency contraception work?
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1. Prevents ovulation
2. Changes rate of ovum transport 3. Reduces endometrial buildup, making the endometrium unsuitable for implantation |
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If a fertilized ovum has already implanted, will emergency contraception work?
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No- only works before implantation
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What is the primary side effect of emergency contraception?
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Can result in severe nausea
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How is an intra-uterine device (IUD) inserted into the uterus
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It is inserted through the cervical os during menses by a medical professional
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What is an IUD made of?
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flexible plastic; some have a metal coating and some contain progestin
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How long can an IUD be left in place?
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10-12 years depending on the IUD
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How do IUDs work, and what is added to the ones marketed in the US?
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1. Create localized inflammatory reaction which inhibits implantation
2. The US ones add direct or indirect hormonal actions |
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What hormone is added to the Mirena IUD?
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Progestin
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What are the contraceptive actions of copper in an IUD?
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1. Increases inflammatory reaction to the IUD
2. Decreases sperm viability 3. slows ovum transport 4. interferes with the actions of estrogen on the endometrium - prevents build up |
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What are the advantages of IUDs?
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1. 95-99% effective
1. Non intrusive during sex 3. Long term effectiveness |
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What are the disadvantages of IUDs?
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1. Danger of uterine perforation on insertion/removal
2. Increased menstrual blood loss 3. Increased dysmenorrhea 4. increased risk of PID, which can lead to infertility 5. May increase risk of vaginal infections 6. No protection from STDs 7. may increase susceptibility to STDs during first 3 months 8. Inflammation may increase risk of infertility |
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What substance is absolutely necessary to use with a diaphragm or cervical cap in order to prevent pregnancy?
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Spermicide
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How effective are diaphrams and cervical caps with spermicide?
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80-90%, varies with user
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What are some advantages of diaphragms and cervical caps?
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1. readily reversible
2. reduce transmission of STDs like gonorrhea and chlamydia, may reduce transmission of HIV 3. can be inserted before intercourse- doesn't have to interfere |
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What are some disadvantages of diaphragms and cervical caps?
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1. Must remember to use each time you have intercourse, and add new spermicide to the vagina in between each incidence of intercourse in a bout of sexual activity
2. Must remain in place for hours after sex 3. must be fitted by a trained professional 4. Diaphragm- increase UTIs 5. Cervical cap- increase risk of abnormal cervical cells 6. Latex or spermicide allergy would prevent usage |
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How does the sponge work as contraception?
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It is made of polyurethane foam and impregnated with spermicide, and placed near the cervix to kill sperm as they enter the cervix
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Why has there been renewed interest in the male condom in recent years?
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Prevents transmission of STIs including HIV
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How effective is the male condom?
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85-90%
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What is the difference between a male condom and a female condom?
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1. Female condom- only made out of polyurethane vs. male condom made out of primary latex
2. Female-worn inside vagina by woman 3. Female effectiveness 70-85% vs. 85-90@ with male condom (harder to use) 4. Female- less well known than male |
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What is monitored on a daily basis when using Natural Family Planning or Fertility Awareness?
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1. Basal Body Temp
2. Cervical Changes |
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When during the cycle does basal body temp increase?
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Just after ovulation as progesterone increases
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What does SHOW mean and when does it happen?
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SHOW happens before and during ovulation when the women is fertile.
S= soft (cervix softens) H= high (cervix rises in the body, estrogen causes the uterus to move forward) O= Open (the cervical os widens) W= wet (cervical mucus becomes slippery and wet) |
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When using NFP or FA as a birth control method, is it OK to skip one day of monitory?
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NO!!!
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What is necessary to use NFP and FA effectively?
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1. Patience
2. Assertivness and self control 3. Special Training |
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How is male sterilization performed?
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1. By cutting and clamping, tying, or burning the vas deferens
2. doctors office procedure with local anesthetic |
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How is female sterilization performed?
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1. By cutting and clamping, tying or burning th eoviducts
2. Requires general or local anesthesia in a hospital or surgical clinic |
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In what group is regret the highest after sterilization?
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Young women who were uncertain about being sterilized, or who are no committed to not having more or any children
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Approx how many unintended pregnancies end in abortion?
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Approx half of all unintended pregnancies end in abortion
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Is the risk of death from childbirth more or less from early abortion?
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The risk of death from childbirth is higher:
1/5800 births vs. 1/530,000 |
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What are the two main types of abortion?
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medical and surgical
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How long after the start of the last menses can a medical abortion be performed?
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the first 49 days from the start of the last menses
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What are the two drugs involved in a medical abortion and how are thy administered?
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1. Mefepristone (RU 486)
2. Misoprostol (prostaglandin) The are administered in pill form |
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Describe how the two drugs work in a medical abortion
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1. Mefepristone: anti-progestin which results in the deterioration of the endometrium
2. Misoprostol: causes contractions of the uterus to expel contents |
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What must the patient agree to before undergoing a medical abortion and why?
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To have a surgical abortion if the medical abortion is not effective, because a medical abortion will induce a complete abortion 92-99% of the time
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What are the three types of surgical abortions and when are they performed?
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1. Manual Vacuum aspiration: up to 10 weeks after start of last menses
2. Vaccuum Aspiration: 6-14 weeks after start of last menses 3. Dialation and Evacuation: used after 14 weeks. *Abortion is not used after 24 weeks except when there are serious health risks for the woman |
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What is the difference between manual vacuum aspiration and vacuum aspiration abortions?
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Manual uses a manual device to gently suck out the uterine contents, while a cacuum aspiration uses a machine based aspiration with gentle scraping of the uterine walls with a curette
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Dilation and Evacuation abortion involved more use of ______ and ______ to remove contents from the uterus.
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instruments and suction
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What are the most common psychological reactions of women who have voluntary abortions?
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Mild reaction overall, more distress before than after, relief after
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How are psychological reactions different for abortions for medical or eugenic reasons?
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- medical (health of mother) is followed by guilt
- eugenic (health/development problems with fetus) often followed by depression |
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What factors have been found to be associated with increased risk of negative outcomes after voluntary abortion?
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Previous psychiatric problems
Mid-trimester abortion low self esteem poor prior knowledge of contraception ambivalence about decision pregnancy highly meaningful to woman not making own decision |
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What do women do if they are denied an abortion and what are the frequencies of each?
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1. seek abortion elsewhere (most)
2. continue pregnancy and keep the baby (6-19%), very few relinquish baby for adoption 3. Spontaneous abortion/miscarriage (4-18%) this is very high, and at a point in pregnancy when miscarriage rates are very low |
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Define open adoption and closed adoption
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OA= the woman relinquishing is involved in selecting the family in some way and may receive news of the child via letters or face to face contact after birth
CA= done anonymously through an agency and the woman usually has little contact with the child post birth and does not know anything about the family she is relinquishing to |
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What are two similarities between women relinquishing in an open versus a closed adoption (Lauderdale and Boyle study)?
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1. Both report avoiding developing attachment during pregnancy
2. Most relinquish their child due to pressure from others or due to financial problems |
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Women relinquishing in closed adoptions are more likely to ________ than women relinquishing in open adoptions
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1. have been pressured by others
2. Have less contact with infant after birth 3. have poorer pre-natal care 4. Initiate the search for the child years later |
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Women relinquishing in open adoptions are more likely to _______ than women relinquishing in closed adptions?
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1. More likely to admit pregnancy to others
2. Desire child to contact them but don't initiate search |
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In interviews with women who had relinquished their child what were some things they desired to make the adoption process better?
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1. The women preferred moderately open adoptions.
2. Of the women who relinquished in closed adoption, most of them wanted to receive info about their child through the agency |
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In current, typically open, adoptions, what are the psychological effects of relinquishing a child?
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Mainly positive, most have no grief and fell relieved
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Contraceptive actions of copper are ______, ________, _______, _______
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1. increases inflammatory reaction to the IUD
2. Decreases sperm viability 3. Slows ovum transport b/c anti-estrogen 4. interferes with the actions of estrogen on the endometrium (prevents endometrial buildup) * copper can cause infertility but increases effectiveness and IUD actions |
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What is Paragaurd?
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non hormonal IUD. plastic wrapped with copper. Inflammatory action + copper actions (4).
Effectiveness= 12 years; 95-99% |
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What are risks of Paragaurd?
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1. same as for other IUDs (risk of perforation of the Uterus).
2. increases menstrual blood loss and dysmenorrhea. - this may reduce over time due to anti-estrogen effect of copper (less and less endometrial buildup over time) |
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What are risks of IUDs in general?
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1. Uterine perforation
2. Increased risk of PID which can lead to infertility 3. increased risk of vaginal infection 4. increased risk of STD transmission Inflammation may cause blocked oviducts due to scar tissue build up, which results in fertility |
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What is Mirena?
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IUD. Progestin-only.
Progestin + inflammatory action of IUD which causes sperm to die more quickly and endometrium unhappy so that implantation cannot occur |
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What are the Progestin only emergency contraceptive methods?
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Plan B
Mirena some pills |
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How do emergency contraceptive methods work?
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1. prevent ovulation by inhibiting GnRH or inhibiting LH/FSH (progestin-only)
2. Change rate of ovum transport through oviduct to reduce liklihood of conception 3. Reduce endometrial buildup (unsuitable for implantation) 4. Change rate of sperm transport |
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actions of Progestin in hormonal IUDS?
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1. Slows ovum transport
2. Slows sper transport 3. Hostile cervical mucus production 4. inhibit capacitation 4. inhibit endometrial buildup |
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Types of hormonal contraceptives for men (3) and non-hormonal (1)?
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1. Androgen only
2. progestin with androgen replacement 3. GnRH antagonist w/ androgen replacement 4. Adjudin: non-hormonal |
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Actions of Progestin in hormonal contraceptives? (5)
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*primary action to prevent ovulation:
1. inhibits LH and FSH production at anterior pituitary (no LH means no estrongen, no FSH means no follice growth) 2. stimulates production of thick, pasty cervical mucus 3. inhibits capacitation of sperm 4. slows rate of ovum transport through oviduct |
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What is capacitation?
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enzyme actions on sperm in female uterus such that sperm are able to fertilize ovum. *When inhibited, the number of enzymes is reduced so that sperm are not made able to fertilize ovum
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Actions of Estrogen in hormonal contraceptives?
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1. inhibits GnRH production which prevents ovulation b/c without GnRH the levels of FSH, LH, estrogen are very low and follice growth does not occur
2. Estrogen increases rate of ovum transport through oviduct |
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What is the reason for slowing (progestin) or speeding (estrogen) of the ovum transport through the oviduct?
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It is a backup method b.c timing of ovum transport is critical to implantation. If ovum moes to fast, uterus is not going to be prepared for implantation. If too slow, the endometrium and uterus will wait and then fall apart b/c ovum did not arrive in right time period
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How is ovulation prevented in contraception?
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synthetic progestin: The stopping of follicle growth through the inhibition of FSH, inhibiting estrogen production by inhibiting LH.
synthetic estrogen: inhibits GnRH production, which then inhibits LH and FSH produciton |
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Mirena is what?
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an IUD that has the localized inflammatory response plus the effects of progestin
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