Contraception

Question 1

Which type of contraception is most effective?

A) Sterilization

B) Informed Planning

C) Hormonal

D) IUD

E) Barrier

Answer 1

A & D

Question 2

Which type of contraception is least effective?

A) Sterilization

B) Informed Planning

C) Hormonal

D) IUD

E) Barrier

Answer 2

B & E

Question 3

Answer 3

Question 4

• What methods of contraception fall under the umbrella of “Informed Planning”?
• What are some of the pros and cons of these methods?

Answer 4

Abstinence

• Pros: 100% safe and effective, protects against STDs
• Cons: Very difficult to implement

Withdrawal

• Cons: not sufficient in itself, doesn’t protect against STDs, 80% effective

Natural Family Planning (see image)

Fertility awareness methods (see image)

Question 5

What is the general purpose of hormonal forms of contraception?

Answer 5

To provide low levels of constant hormonal input such that the HPO axis is inhibited and FSH and LH levels are not high enough to result in ovulation. These methods of birth control alter the female reproductive tract such that it is inhospitable to implantation and/or fertilization because the normal cycle of follicular growth and endometrial growth are disrupted.

Question 6

How do hormonal contraceptives produce the effect of contraception?

Answer 6

Constant low levels of Estrogen and/or Progesterone that feedback and inhibit anterior pituitary and hypothalamus so FSH and LH are not high enough to result in ovulation and endometrial changes.

Question 7

Combined Oral Contraceptives

• How effective are these?
• What are some of the pros?
• What are some of the cons?
• What are some of the absolute and relative contraindications?

Answer 7

• 91-99% effective, depends largely on adherence
• Pros
  
  • Easy to dispense and store
  • Inexpensive
  • Establish regular periods in those with dysmenorrhea and menorrhagia
  • Reduces acne
• Cons
  
  • Increased risk of venous thromboembolism
• Absolute risks
  
  • See slide, but additionally for pregnancy - absolute risk b/c could cause miscarriage
• Relative risks, see slide, but additionally:
  
  • Post-partum = hypercoagultive state, don’t want to give these b/c that will really increase risk of VTE
  • Breast cancer - due to estradiol in pills

Question 8

• By what mechanisms do combined oral contraceptives cause contraception?
• What are some of the side effects?

Answer 8

Question 9

Progestin Only (mini pill)

• Mechanisms by which causes contraception
• Indications

Answer 9

Question 10

Non-Oral Contraceptives (Implants and injectables that are NOT IUDS)

• What are the 2 types we should know in this category?
• What are the benefits of these methods?
• What are the contraindications of these methods?
• What are the adverse effects?

Answer 10

Question 11

Emergency Contraception

• What are the methods available for emergency contraception?
• When are these taken?
• What mechanism do they utilize to prevent pregnancy?

Answer 11

Question 12

Answer 12

A

Question 13

IUDs

• What are these devices?
• When are they easiest to insert?
• How effective are they?
• Are they reversible?
• Short or long acting?
• Adverse effects?
• Contraindications?

Answer 13

• T-shaped devices inserted into uterus to prevent pregnancy
• Post natural childbirth
• > 97%
• Yes
• Long
• See image
• See image

Question 14

Copper vs. Progestin IUDs

• Length of time they’re effective?
• Effectiveness?
• Mechanisms of contraception?

Answer 14

• Copper = 10 years, progestin = 5 years
• Copper = 99% Progestin = 98%
• Copper
  
  • Act on endometrium to produce compounds that are spermatotoxic and act as spermicide to prevent fertilization
• Progestin
  
  • Release levonorgestrel locally resulting in thickened cervical mucus, downregulation of estrogen receptors, decreased endometrial proliferation

Question 15

Compare and contrast oral progestin pills with progestin IUD.

Answer 15

Question 16

Barrier Methods

• What types of contraception consitute “barrier methods”?
• What are the mechanisms that these use to prevent pregnancy?
• What are the pros/cons?
• What are the contraindications?

Answer 16

• Spermicides, male and female condoms, diaphragms, cervical caps
• Block fertilization by preventing sperm and egg from combining, spermicide specifically - surfactant destroys sperm cells membranes
• Pros
  
  • STD protection
  • Cheap
  • OTC
  • Spermicide specifically - No systemic absorption
• Cons
  
  • Allergy to latex or chemicals in spermicide
  • Irritation
  • Spermicide specifically - alters vaginal flora
• Contraindications - see image

Question 17

Answer 17

Q1 - emergency contraceptive pills

Q2 - B & C

Question 18

Answer 18

Question 19

Answer 19

E