OB Reproduct Sys & Birth control
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What is the menstrual cycle? What is it influenced by? What two cycles is it composed of?
- The menstrual cycle occurs every 21-35 and menses (shedding of the functional layer of the endometrium) last 2-7 days
- It is influenced by illness, stress, fatigue, and environment
- Main influence is hormonal
- Composed of the ovarian cycle and the endometrial cycle (which overlap)
What hormones are involved in the menstrual cycle?
- Follicle stimulating hormone (FSH): increases with a decrease in estrogen (negative feedback loop). Stimultes follicle development, which in turn secrete estrogen and decrease FSH
- Luteinizing hormone (LH): surges 12-36 hrs prior to ovulation and peaks at ovulation (causes the ovum to "leave home" of the ovary at ovulation)
What are the phases of the ovarian cycle?
- Follicular Phase
- Ovulatory Phase
- Luteal Phase
Describe the Follicular phase
- Begins the first day of the menstrual cycle and lasts about 12-14 days
- Follicles develop under the influence of FSH and LH (causes ovulation)
- Several follicles develop, but one gets to be the "chosen one"
- Estrogen levels are high and the target tissue is the endometrium
- The length of this phase can vary
Describe the Ovulatory phase
- Surge in LH 12-36 hrs prior to ovulation
- Decrease in estrogen/increase in progesterone before surge of LH
Describe the Luteal Phase
- Begins with ovulation and lasts approximately 14 days (this is pretty accurate and can be counted backward to the end of the phase in order to determine the day of ovulation)
- Corpus luteum (shell from the ovulated egg) produces high levels of progesterone and low levels of estrogen that thicken the basal level of the endometrium in preparation for implantation of a fertilized egg
- If the woman is pregnant, the corpus luteum continues to release progesterone & estrogen
- If the woman is not pregnant, the corpus luteum degenerates
What phases make up the endometrial cycle?
- Menstrual Phase
- Proliferative Phase
- Secretory Phase
Describe the menstrual phase
- From the first 1-6 days: as the functional layer of the endometrium is sloughed off (woman gets her period due to lack of pregnancy)
- Estrogen levels are low and cervical mucus is scant
Describe the proliferative phase
- From days 7-14: Estrogen levels rise, endometrial cells grow in number, cervical mucus becomes clear, thin, & stretchy
- Ends with ovulation, about day 14
Describe the secretory phase
- days 15-28: estrogen decreases, progesterone dominates, endometrium becomes thick and lush, with increased vascularity.
- Rise in basal body temperature
- Pregnancy- the endometrium will continue to develop
- Not pregnant- endometrial tissue deteriorates
What are some signs of ovulation?
- amount of cervical mucus increases
- mucus becomes thin, clear & stretchy
- Ferning pattern of mucus under microscope
- Spinnbarkeit (increasing elasticity of mucus)
- Mittleschmertz (unilateral abdominal pain associated with ovulation)
- Rise is basal body temperature
What factors influence the choice of using birth control?
- Social and cultural beliefs
- Socioeconomic level
- Previous experience
- Self esteem/touching self
What determines birth control's method of effectiveness?
- BASED ON CORRECT USAGE (bc cannot be effective if not used or if not used correctly)
- Rate of effectiveness is determined by the number of pregnancies per 100 women per year of use
What are the different types of contraceptives?
- Long Acting
- Family Planning
What are two barrier methods of contraceptives and what types of birth control fall into these categories?
- Mechanical Barriers:
- 1. Diaphram
- 2. Cervical cap
- 3. Vaginal Sponge
- 4. Condom- male/female
- Chemical Barriers:
- 1. Spermicides
- 2. Foam
- 3. Cream suppository
*mechanical and chemical barriers are usually used in combination
How long is sperm viable? How long is an ovum viable?
- Sperm is viable about 72 hours after ejaculation
- Ovum is viable for about 24 hours after ovulation
What are some types of hormonal birth control?
- Oral combination contraceptives
- Progestin only oral contraceptive
- Depot Medroxyprogesterone Acetate
- Vaginal Ring
- Contraceptive Patch
- Long Acting reversible contraceptives
What is the difference between the combination and the progestin only pill?
- Combination: reduces fertility primarily by inhibiting ovulation. Secondary mechanism is the thickening of cervical mucus and alteration of the endometrium (reduces implantation.
- Progestin only "mini pill": reduces fertility primarily by increases the thickening of the cervical mucus (acts as a barrier) and altering the endometrium to prevent implantation (many women do not get their period). This is a weak inhibitor of ovulation
What is the biggest safety concern for oral contraceptives?
- These have the broadest spectrum of adverse effects, ranging from weight gain to blood clot and stroke.
- When used in healthy women, OC produces no greater morality than other forms of bc
What are some adverse effects for oral contraceptives and hormonal contraceptives?
What are the absolute contradictions for the use of combination contraceptives?
- Thrombolytic disorders
- Cardiovascular disease
- Abnormal liver function
- Known or suspected breast cancer
- Undiagnosed abnormal vag bleeding
- Known or suspected pregnancy
- Smokers over the age of 35
What are the relative contraindications for combination contraceptives?
- Cardiac Disease
- Uterine Leiomyoma
- Gallbladder Disease
- Hist of cholestatic jaundice of pregnancy
What are the side effects for progestin only oral contraceptives?
- These are slightly safer than the combo pill, but less effective
- Most common side effect (most common cause of discontinuation as well)-irregular bleeding
- Taken continuously
- Recommended for breast feeding women as it does not have an effect on lactation (depo-provera shot can be given to mother's at postnatal discharge)
Describe the use of the transdermal contraceptive patch and the vaginal contraceptive ring
- These provide the same hormonal method of contraception as oral bc, but in a different way. Therefore, they carry the same risks and side effects
- Transdermal contraceptive patch: applied weekly for three weeks to lower abdomen, buttocks, upper outer arm, or upper torso for 3 weeks, then off for 1 week (do not place on fatty tissue such as breasts or on red, irritated, or cut skin). Higher risk of pregnancy for women over 198lbs
- Vaginal Contraceptive Ring: remains in place around cervix for three weeks, 1 week off
In what situations would you use emergency contraception (morning after pill)?
- Unprotected sex
- Sexual assault
- Contraceptive failure
Within what time frame must emergency contraception be taken in order to be effective?
- within 72% after intercourse
- ECP mostly prevents pregnancy by interfering with ovulation, fertilization or implantation and will NOT cause an abortion of existing pregnancy
List the different types of emergency contraception
- Progestin only (Plan B one step and PLan B next choice)
- Ulipristal Acetate
- Cooper IUD
What are the two types of progestin only emergency contraception and how does it work?
- Plan B One-step: delays or inhibits ovulation or inhibiting fertilization (will not terminate pregnancy). This is OTC for women 15 or older. Best to initiate within 72 hours, but may be effective up to 5 days after intercourse
- Plan B and Next Choice: 1st tablet within 72 hrs and second dose 12 hrs later
How effective is Ulipristal Acetate?
- This is highly effective up to 5 days after intercourse
- Available by prescription only
How does a copper IUD work and what are the risk factors?
- The released copper makes the environment hostile to sperm and prevents a fertilized egg from implanting
- Risks include vaginitis, PID, and expulsion of the IUD
How effective is a copper IUD?
If placed within 5 days, may be 99% effective
How is mifeprestone different from other emergency contraceptives?
- Also known an 486 and can prevent pregnancy within the first 5 days
- If used after 5 days, it can terminate a pregnancy and is not approved for emergency conception
What are two long acting contraceptives and how do they work?
- Subdermal Eronogestrel Implant (Nexplanon): Most effective contraceptive available. One single 4 cm rod implanted subdermally and is effective for 3 yrs
- Depot Medroxyprogesterone Acetate (Depo-Provera):IM or Sub cut injection q3mo. Safe for breastfeeding and while it is recommended 6 weeks postpartum, they can give it at postpartum discharge
What are the two types of IUDs and how do they work?
- Copper T 380A: Inhibits implantation and can last for 10 yrs. Monthly bleeding may be increased
- Levonorgestrel-releasing: produces a harmless, local inflammatory response that is spermicidal and decreases monthly bleeding. Can stay for 5 yrs
What are some ways to achieve natural family planning?
- By using fertility awareness-based methods such as abstinence, withdrawal, lactation amenorrhea, basal body temperature, cervical mucus assessment, and OTC ovulation predictor kits
- These are best suited for women who have a regular menstrual cycle
What are some ways to achieve permanent contraception?
- Vascectomy: blocking or severing of the vas deferens to prevent ejaculation of sperm
- Tubal Ligation: severing of fallopian tubes from uterus
- Essure: Small spring like devices are inserted into the fallopian tubes which create scar tissue and result in infertility
What are the two ways to clinically interrupt a pregnancy?
With Medication or with surgery
What three medications are used to interrupt pregnancy and how do they work?
- Mifeprestone & Misoprostol: used up to 49 days after LMP. Mifeprestone blocks actions of progesterone, which alters the endometrium. Followed by a does of Misoprostol in 1-3 which then induces contractions
- Methotrexate & Misoprostol (Cytotec): is effective up to 49 days after conception and may be used in the second trimester. It stops cell division
- Carboprost (Hemabate) & Dinoprostone (Prostaglandin E2): are used in the second trimester only
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