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9 Cards in this Set

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Levonorgestrel-releasing IUD
protection for 5 years, prevents fertilization via sterile inflammation and sperm destruction by PMNs., inhibits ovulation, Prog decrease menstrual bleeding, no milk prod. inhibition.

Risk of pelvic infectin during first 3 weeks.
Norplant
rods inserted in the skin of the arm, 5 yr protection, has levonorgesterel in the rods.

supress ovulation (80%), thickents cervical mucous, thins endometrial lining
Depo-Provera
shot every 3 years, can be used during lactation, Weight gain, INCREASE BONE LOSS W/ USE > 2 YEARS.
Oral contraceptives
Increased risk of Thromboembolism.

Mortality increaes with smokers, esp over 35 y of age.

inhibits midcycle surge of LH (surpess ovulation)
cervical mucous thickened.
uterine and tubal motility
decreased glycogen production

Prog only pill do not consistently inhibit ovulation.

Increased risk of cervical dysplasia and cancer
Vaginal Ring
in vagina for 3 weeks and removed for one week.
Emergency Oral contraceptives
Plan B, Preven, LoOvral, all must be taken within 72 hrs after intercourse.

Will not work if implantation has already occured.
Clomiphene citrate
a SERM, similar to DES. Binds hypothalamic E receptors to retard receptor replenishement, hence decreasing the neg E feedback tone, and increase in GnRH.

Net effect of GnRH favors FSH release over LH.

Conttraindicated after conception has occured (fetal malformation).

Used for anovulatory women, increase risk of twinning.
Exogenous Gonadotropins: LH and FSH
not dependant on pituitary function, and gives better response than clomiphen citrate.

Used with Assisted Repro Tech (ART) and IVF.

LHR on theca cell and FSHR on granulosa cells

Used for induction of ovulation

Complications multiple gestation, twins, triplets etc.
GnRH Agonist
initial injection causes a flar of agonistic activity. The endogenous GnRH has a short life so it's able to pull this agonistic acitivity. But GnRH agonist is longer life, and after the initial flare, there is down regulation of pituitary gonadatrophs followed by desensitization.

Net result: significantly reduce pituitary gonadotropin secretion.

Clinical use: "flare" used in ART

Down regulation used to prevent premature lutenization (ovulation).

Useful in endometriosis, uterine myoma (E sensitive tumors).

Side effect: short term use only due to issues with hypoestrogenism (decreased bone density, lipid profile advers).