The Menstrual Cycle and     Contraception     MiniMedical School                          *
CASE STUDYA sexually active woman usually takes her birth control pillswhen she wakes up every morning for work at 7:00 AM...
The Menstrual CycleThe menstrual cycle is a series of physicalchanges that a fertile woman’s body goes throughfor the purp...
The Menstrual   Cycle has  Three Main    Phases•Follicular/Proliferative Phase (includesmenstruation)•Ovulatory Phase•Lute...
Conception can occur at ANY time during the   menstrual cycle!                          *
The Phases             *
The Follicular/Proliferative Phase•Includes menstruation, which is Day 1 (of 28) of the ovariancycle/menstrual cycle.•Estr...
Ovulatory Phase•Begins around Day 12 when Luteinizing Hormone (LH)surges and causes the ovary walls to weaken and allow fo...
Luteal/Secretory Phase•The Luteal Phase is characterized by a rise in progesterone thatis produced by the corpus luteum, w...
Fertile Days•Conception can occur at ANY time during the menstrualcycle (from Day 1 to Day 28).•Sperm can survive in the f...
Menstrual Cycle and Intro to       Contraceptiveshttp://www.youtube.com/watch?v=TExPlAh1tCA&feature=related               ...
Contraceptives•Contraceptives are used to either inhibit thefertilization of an ovum or prevent the implantation ofa ferti...
Behavioral Methods•Require no hormones ormedication.•Their moderateeffectiveness depends onconsistent adherence•Only risks...
Behavioral Method: Withdrawal•73 to 96% effective.•Man must recognize point of ejaculation and withdrawal.•This requires a...
Behavioral Method: Periodic       Abstinence (Rythmic Method)•75 to 88% effective•Women predict ovulation by (1) tracking ...
Behavioral Method: Lactational               Amenorrhea•95 to 98% effective•Women must bebreastfeeding exclusively,nursing...
Barrier Methods•Attempt to prevent the fertilization of an ovum by physicallypreventing sperm from entering the uterus.•Co...
Barrier Method: Male Condoms•85 to 98% effective for pregnancy prevention•A new condom must be used each time a couple eng...
Barrier Method: Female               Condoms•75 to 95% effective•It is a lubricated polyurethane pouchthat is inserted in ...
Barrier Method:         Diaphragm•84 to 94% effective•Must be fitted initially and prescribed byclinicians trained in thei...
Barrier Method: Spermicide•71 to 85% effective•Comes in several forms: gel, sponge, foam, inserts.•Must be inserted each t...
Hormonal           Contraceptives•Attempts to prevent fertilization of the ovum or ovulation itself via the use of progest...
Combined Contraceptives: “The Pill”•92 to 99% effective•Can be a monophasic or multiphasic pill•Usually 28 pills per pack ...
Combined Contraceptives: Patch•92 to 99% effective•Get three patches for each month. Must apply a new patcheach week. Each...
Combined Contraceptives: Ring•92 to 99% effective•Women insert a new ring for three weeks and take out the ring in the 4th...
Progesterone-only Contraceptives: Pill•The “minipill”•92 to 99% effective•MUST take the pill at the SAME TIMEeach day. Wom...
Progesterone-only Contraceptives:                 Injection•97 to 99% effective•Creates an intramuscular depot of medroxyp...
Progesterone-only Contraceptives:                Implant•99% effective•A single-rod contraceptive device inserted subderma...
Benefits of Hormonal                   Contraceptives•Continuous use of hormonal contraceptives eliminate menses and benef...
Intrauterine Devices (IUD)•These are devices placed in the uterus to prevent conceptionby suppressing ovulation and thicke...
Copper IUD•99% effective•Acts by disrupting sperm mobility anddamaging sperm so fertilization does nottake place.•Remains ...
Progestin IUD•99% effective•Acts by changing progesterone levels inthe uterine environment, therebydisrupting the menstrua...
Sterilization•Sterilization provides permanent,non-reversible protection againstpregnancy.•There are several procedures fo...
Tubal Sterilization•99% effective•Surgical procedure for sterilization in which a womansfallopian tubes are clamped and bl...
Vasectomy •99% effective •Provided permanent, non-reversible protection against pregnancy •Preformed using local anestheti...
*
Emergency Contraceptives•Lower the risk of pregnancy following unprotectedintercourse.•There are four types:    • Progesti...
Progestin-only (Levonorgestrel) Pill•Taken within 72 hours, this method reduces the risk ofpregnancy by 89%.•This method d...
Estrogen/Progestin Pill•Taken within 72 hours, this method reduces the risk ofpregnancy by 75%.•This method does not disru...
Copper IUD•Nearly 100% effective up to 5 days after intercourse•Prevents fertilization and implantation.•Most effective em...
Selective Progesterone Receptor         Modulator (Ulipristal) Pill•Taken within 5 days of unprotected sex, it reduces the...
Method vs. ActualEffectiveness•Methodeffectiveness is howeffective the methodis, if usedappropriately andcorrectly, inprev...
CASE STUDYA sexually active woman usually takes her birth control pillswhen she wakes up every morning for work at 7:00 AM...
CASE STUDYA sexually active woman usually takes her birth control pillswhen she wakes up every morning for work at 7:00 AM...
CASE STUDYA sexually active woman usually takes her birth control pillswhen she wakes up every morning for work at 7:00 AM...
CASE STUDYA sexually active woman usually takes her birth control pillswhen she wakes up every morning for work at 7:00 AM...
CASE STUDYA sexually active woman usually takes her birth control pillswhen she wakes up every morning for work at 7:00 AM...
Questions?             *
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Contraception

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Contraception

  1. 1. The Menstrual Cycle and Contraception MiniMedical School *
  2. 2. CASE STUDYA sexually active woman usually takes her birth control pillswhen she wakes up every morning for work at 7:00 AM. Onthe weekends, she sets her alarm clock for 7:00 AM, takesher pill, and then goes back to sleep. A.Is this weekend ritual necessary? B.What would happen if she slept through her alarm clock and she took her pill at 7:30 AM? C.At 11:00 AM? D.If she continually sleeps in, should she switch her birth control methods? *
  3. 3. The Menstrual CycleThe menstrual cycle is a series of physicalchanges that a fertile woman’s body goes throughfor the purpose of sexual reproduction. *
  4. 4. The Menstrual Cycle has Three Main Phases•Follicular/Proliferative Phase (includesmenstruation)•Ovulatory Phase•Luteal/SecretoryPhase *
  5. 5. Conception can occur at ANY time during the menstrual cycle! *
  6. 6. The Phases *
  7. 7. The Follicular/Proliferative Phase•Includes menstruation, which is Day 1 (of 28) of the ovariancycle/menstrual cycle.•Estrogen levels gradually rise, causing: • The cessation of menstruation (end of sloughing off of endometrium) • The formation of a new endometrium • The production of cervical mucus which indicates the near release of an ovum (egg).•During this time, the follicle (proto-egg) is also developing afterstimulation via Follicle Stimulating Hormone (FSH) and will soon beready to be released from the ovary (ovulatory phase) into thefallopian tubes.•This phase usually lasts for about 12 days.•The last two days of this phase is a peak time of fertility for mostwomen as it proceeds the ovulatory phase, when an ovum (egg) isreleased. *
  8. 8. Ovulatory Phase•Begins around Day 12 when Luteinizing Hormone (LH)surges and causes the ovary walls to weaken and allow forthe release of the ovum from the follicle.•The follicle ruptures and the ovum releases and is ready tobe fertilized, usually in the ampulla of the fallopian tubes(widest part).•During any given Ovarian Cycle, an ovum can come fromeither the left or right ovary. Occasionally, an egg can bereleased from both ovaries in the same cycle and, ifconception occurs, can lead to fraternal twins.•This phase usually lasts for two days (until Day 14).•These two days are also considered a peak time of fertilityfor most women *
  9. 9. Luteal/Secretory Phase•The Luteal Phase is characterized by a rise in progesterone thatis produced by the corpus luteum, which is the remnants of thefollicle released during the cycle.•As Progesterone levels rise, they cause: • Successful implantation of a fertilized egg (if conception occurs) • Increase in body temperature (an indicator of fertility•If conception does not occur, the corpus luteum degenerates andprogesterone levels decrease, thus triggering menstruation onDay 28.•This phase usually lasts for 14 days after the release of theovum.•The first two days of the cycle (up to 48 hours after the release ofthe ovum), is also a peak time of fertility for most women. *
  10. 10. Fertile Days•Conception can occur at ANY time during the menstrualcycle (from Day 1 to Day 28).•Sperm can survive in the female reproductive tract up tofive days (average is usually 2-3 days).•The ovum is able to be fertilized 1-2 days after its release.•Therefore, the most fertile days during the cycle are, onaverage, five days before and two days after the ovum isreleased from the ovary (Days 10-16 if you follow theaverage 28 day cycle with a Day 14 ovulation).•Sexual intercourse during these days of high fertility isdiscouraged if conception is not desired and if using certaincontraceptive measures. *
  11. 11. Menstrual Cycle and Intro to Contraceptiveshttp://www.youtube.com/watch?v=TExPlAh1tCA&feature=related *
  12. 12. Contraceptives•Contraceptives are used to either inhibit thefertilization of an ovum or prevent the implantation ofa fertilized egg in the endometrium.•The following are the types of availablecontraceptives: • Behavioral Methods • Barrier Methods • Hormonal Contraceptives • Intrauterine Devices • Sterilization • Emergency Contraceptives *
  13. 13. Behavioral Methods•Require no hormones ormedication.•Their moderateeffectiveness depends onconsistent adherence•Only risks areinconvenience and failure asa contraceptive•Theses methods include: • Withdrawl • Periodic Abstinence (Rythmic Method) • Lactational Amenorrhea *
  14. 14. Behavioral Method: Withdrawal•73 to 96% effective.•Man must recognize point of ejaculation and withdrawal.•This requires a high level of trust and self control.•NOTE: Pre-ejaculate can contain live sperm and reducethe effectiveness of this method. It is recommended that theman urinates before intercourse to reduce the amount oflive sperm in pre-ejaculate. *
  15. 15. Behavioral Method: Periodic Abstinence (Rythmic Method)•75 to 88% effective•Women predict ovulation by (1) tracking body temperature,(2) checking consistency of cervical mucus, (3) chartingmenstrual cycles on a calendar.•Couples abstain from intercourse or use barrier methodfrom 5 days before ovulation to 2 days after ovulation *
  16. 16. Behavioral Method: Lactational Amenorrhea•95 to 98% effective•Women must bebreastfeeding exclusively,nursing at least ever 4hours during the day andat least every 6 hoursduring the night.•Discontinue this methodif (1) a menstrual periodoccurs, (2), it has been 6months since the birth ofthe infant, or (3) the infantnurses less often. *
  17. 17. Barrier Methods•Attempt to prevent the fertilization of an ovum by physicallypreventing sperm from entering the uterus.•Condoms and spermicide are available without prescription•Latex and polyurethane condoms protect against HIV and otherSTDs•Successful use of the barrier method as contraception requiresconsistency and discipline.•All barrier methods are safe for use during lactation.•Types of barrier methods: • Male Condoms • Female Condoms • Cervical Caps (not in USA) • Diaphragm • Spermicide *
  18. 18. Barrier Method: Male Condoms•85 to 98% effective for pregnancy prevention•A new condom must be used each time a couple engagesin intercourse•Can prevent transmission of HIV and STDs•Can help with premature ejaculation•Disadvantages include (1) Latex allergies, (2) loss ofsensation, (3) inconvenience/interruption of sexualintercourse, (4) slippage and breakage *
  19. 19. Barrier Method: Female Condoms•75 to 95% effective•It is a lubricated polyurethane pouchthat is inserted in the vagina duringsex.•A new condom must be used eachtime a couple engages in intercourse•Can prevent transmission of HIV andSTDs•Disadvantages include (1)friction/noise during intercourse, (2)loss of sensation, (3)inconvenience/interruption of sexualintercourse, (4) slippage and breakage(higher incidence than male condom) *
  20. 20. Barrier Method: Diaphragm•84 to 94% effective•Must be fitted initially and prescribed byclinicians trained in their use.•Must be filled and coated with spermicideand inserted before intercourse.•More spermicide should be inserted with anapplicator for each session of intercourse.•Does not prevent HIV transmission•Disadvantages include (1) possible skinirritation, (2) possible increased risk ofbladder infection, (3) possible increased riskof HIV transmission (spermacide mayactually increase the risk of HIVtransmission. *
  21. 21. Barrier Method: Spermicide•71 to 85% effective•Comes in several forms: gel, sponge, foam, inserts.•Must be inserted each time a couple has intercourse.•Disadvantages include (1) possible skin irritation, (2)possible increased risk of HIV transmission (spermacidemay actually increase the risk of HIV transmission. *
  22. 22. Hormonal Contraceptives•Attempts to prevent fertilization of the ovum or ovulation itself via the use of progesteroneand estrogen (combined contraceptives) or just progesterone.•Combined contraceptives (progesterone/estrogen) • Act by preventing ovulation • Can be dispensed via pill (daily), patch (weekly), or vaginal ring (monthly) • Benefits include: improvement of menorrhagia, acne, reduced risk of ovarian cancer, quick return to fertility with discontinued use. • Side effects can include: nausea, spotting, • Contraindications for use: Migraine with aura, smoking, stroke, ischemic heart disease, liver disease, major surgery with immobilization, hypertension, breast cancer, deep vein thrombosis. • Types: Pill “The Pill”, Patch, Ring•Progesterone-only contraceptives • Act by thickening cervical mucus, thus becoming a barrier to sperm entering the uterus. • Can be dispensed via pill (daily), injection, intrauterine device, or implant. • Well-suited to women who cannot take estrogen (breastfeeding, etc.) • Common side effects include: spotting, hair or skin changes, weight gain, headaches, depression, decreased libido. • Types: Pill “The Mini Pill”, Injection, *
  23. 23. Combined Contraceptives: “The Pill”•92 to 99% effective•Can be a monophasic or multiphasic pill•Usually 28 pills per pack with 21-24 active pills and 7-4placebo pills for menstruation. The decrease inprogesterone causes the sloughing off of the endometriumand the commencement of menses. *
  24. 24. Combined Contraceptives: Patch•92 to 99% effective•Get three patches for each month. Must apply a new patcheach week. Each patch releases enough hormones to last 9days, so if a day or two late changing patch, not much riskof unintended pregnancy.•NOTE: the patch is less effective in women who are morethan 198 pounds.•Additional side effects are skin irritation and an increasedrisk of thromboembolic complications due to it’s higher levelof estrogen (compared to the pill and ring) *
  25. 25. Combined Contraceptives: Ring•92 to 99% effective•Women insert a new ring for three weeks and take out the ring in the 4th week.•NOTE: since each ring contained enough hormones for 35 days, if women donot take out their ring for 10 to 15 days after 3 weeks, there is little chance ofinterrupted contraception.•The ring can be used for extended cycling (no ring-free interval). However, it isrecommended, that menstruation should occur at least every 3 months.•Women can remove the ring during intercourse for up to 3 hours per daywithout loosing contraceptive efficacy.•Some side effects included increased vaginal discharge and about 2% ofwomen find the ring is expelled spontaneously. *
  26. 26. Progesterone-only Contraceptives: Pill•The “minipill”•92 to 99% effective•MUST take the pill at the SAME TIMEeach day. Women who take the pillmore than 3 hours late should use aback-up method (barrier method) for 1week. *
  27. 27. Progesterone-only Contraceptives: Injection•97 to 99% effective•Creates an intramuscular depot of medroxyprogesteron acetate (DMPA)•Women receive an injection in a medical office or in a self-administered formevery 12 to 14 weeks.•Progesterone injection lowers the risk of ovarian and endometrial cancer.•After 2 or more cycles, many women become amenorrheic (no longer havemenses)•Progesterone injections cause a temporary decrease in bone density. Bonedensity stabilized after 2 years of use and returns to baseline levels after themethod is discontinued.•Side effects and lowered fertility may be present for months after womendiscontinue use. *
  28. 28. Progesterone-only Contraceptives: Implant•99% effective•A single-rod contraceptive device inserted subdermally inthe upper arm. It releases entnogestrel for 3 years.•It must be inserted and removed by a clinician trained in itsuse.•Fertility returns quickly when implant is removed. *
  29. 29. Benefits of Hormonal Contraceptives•Continuous use of hormonal contraceptives eliminate menses and benefit women with the belowconditions: • Menorrhagia • Dysmenorrhea • Premenstrual syndrome (PMS) • Endometriosis • Menstrual migraines • Irregular menses • Iron-deficiency anemia, • Menstrual flares of rheumatoid arthritis, coagulation defects, (menstrual porhyria).•Combined Hormonal Contraceptives also alleviation the below nonmenstrual conditions: • Acne • Hirsutism • Polycyctic ovarian syndrome • Preimenopause•Combined Hormonal Contraceptives also reduce the risk of: • Ovarian cancer • Endometrial cancer • Osteoperosis • Colorectal cancer *
  30. 30. Intrauterine Devices (IUD)•These are devices placed in the uterus to prevent conceptionby suppressing ovulation and thickening cervical mucus.•They are highly effective, well tolerated, long-acting andreversible.•For women who do not plan on becoming pregnancy in thenext two years, IUD’s are the most cost-effectivecontraceptive.•Suited for women who cannot take estrogen, for those whohave never born a child, and for those with STDs•There is a risk of uterine perforation, infection and expulsionwithin the first year.•Fertility returns quickly after removal.•There are two types available: • Copper IUD • Progestin IUD *
  31. 31. Copper IUD•99% effective•Acts by disrupting sperm mobility anddamaging sperm so fertilization does nottake place.•Remains effective for 10 to 12 years.•Often causes heavier, more painfulperiods the first few cycles. Less often, itcauses irritation of partner’s penis duringintercourse (this problem can be fixed bycutting the IUD string shorter.•It can be used as an emergencycontraceptive up to five days afterintercourse. *
  32. 32. Progestin IUD•99% effective•Acts by changing progesterone levels inthe uterine environment, therebydisrupting the menstrual cycle and evenpreventing menstruation all together(most women become amenorrhetic after6 to 12 months).•Common side effects include: spotting,irritation of partner’s penis duringintercourse, bloating, nausea,headaches, breast pain *
  33. 33. Sterilization•Sterilization provides permanent,non-reversible protection againstpregnancy.•There are several procedures formen and women•Male sterilization procedures costless and carry less risk thanfemale sterilization, however, inthe US, female sterilization ispreformed more often than malesterilization.•Female Procedure: TubalSterilization•Male Procedure: Vasectomy *
  34. 34. Tubal Sterilization•99% effective•Surgical procedure for sterilization in which a womansfallopian tubes are clamped and blocked, or severed andsealed, either method of which prevents eggs fromreaching the uterus for fertilization.•These techniques can be preformed laproscopically,abdominally, hysteroscopically, or transvaginally.•Risks include infection and bleeding during the procedure•Post procedural regret is highest among young women,and so young women should look to long lasting devices,like IUD’s,•Women who have undergone this procedure and wish toconceive can undergo microsurgical repair of their fallopiantubes or in vitro fertilization. *
  35. 35. Vasectomy •99% effective •Provided permanent, non-reversible protection against pregnancy •Preformed using local anesthetics with incision or no-incision techniques. •Risks include: infection, bleeding, scrotal pain or swelling at time of procedure •It DOES NOT increase the risk of testicular or prostate cancer. •Twelve weeks after the procedure, men should undergo a semen analysis to insure complete sterilization. Until the semen analysis shows aspermia, other forms of contraceptives should be used. •Post procedural regret is highest among young men. In about 70% of the cases, microsurgery can be used to reverse the procedure within 3 years of the procedure with decreasing rates of reversal the longer its been since the initial surgery. *
  36. 36. *
  37. 37. Emergency Contraceptives•Lower the risk of pregnancy following unprotectedintercourse.•There are four types: • Progestin-only (levonorgestrel) Pill • Estrogen/Progestin Pill • Copper IUD • Selective Progesterone Receptor Modulator (ulipristal) Pill *
  38. 38. Progestin-only (Levonorgestrel) Pill•Taken within 72 hours, this method reduces the risk ofpregnancy by 89%.•This method does not disrupt an implanted pregnancy•This method prevents or delays ovulation•Available without prescription in the us to women over theage of 17.•Side effects include: Nausea, spotting, change in timing ofmenstruation•If vomiting occurs less than 2 hours after taking theemergency contraception, you may need to repeat thedose. *
  39. 39. Estrogen/Progestin Pill•Taken within 72 hours, this method reduces the risk ofpregnancy by 75%.•This method does not disrupt an implanted pregnancy•This method prevents or delays ovulation•Causes more nausea than the progestin-only emergencycontraceptive pill•Side effects include: Nausea, vomiting, spotting, change intime of menstruation.•If vomiting occurs less than 2 hours after taking theemergency contraception, you may need to repeat thedose. *
  40. 40. Copper IUD•Nearly 100% effective up to 5 days after intercourse•Prevents fertilization and implantation.•Most effective emergency contraceptive and best methodfor women who desire an IUD for long-term contraception *
  41. 41. Selective Progesterone Receptor Modulator (Ulipristal) Pill•Taken within 5 days of unprotected sex, it reduces the riskof pregnancy by 90%•Mechanism of action is uncertain, however, it is believed towork by delaying ovulation and through endometrial effects.•Side effects includes: headache, dizziness, abdominalpain.•If vomiting occurs less than 3 hours after taking theemergency contraception, you may need to repeat thedose. *
  42. 42. Method vs. ActualEffectiveness•Methodeffectiveness is howeffective the methodis, if usedappropriately andcorrectly, inpreventingpregnancy (i.e.Lowest ExpectedRate).•Actualeffectiveness (ishow effective themethod is for allthose who intendedto use it to preventpregnancy (i.e.Typical Use Rate). *
  43. 43. CASE STUDYA sexually active woman usually takes her birth control pillswhen she wakes up every morning for work at 7:00 AM. Onthe weekends, she sets her alarm clock for 7:00 AM, takesher pill, and then goes back to sleep. A.Is this weekend ritual necessary? B.What would happen if she slept through her alarm clock and she took her pill at 7:30 AM? C.At 11:00 AM? D.If she continually sleeps in, should she switch her birth control methods? *
  44. 44. CASE STUDYA sexually active woman usually takes her birth control pillswhen she wakes up every morning for work at 7:00 AM. Onthe weekends, she sets her alarm clock for 7:00 AM, takesher pill, and then goes back to sleep. A.Is this weekend ritual necessary? YES B.What would happen if she slept through her alarm clock and she took her pill at 7:30 AM? C.At 11:00 AM? D.If she continually sleeps in, should she switch her birth control methods? *
  45. 45. CASE STUDYA sexually active woman usually takes her birth control pillswhen she wakes up every morning for work at 7:00 AM. Onthe weekends, she sets her alarm clock for 7:00 AM, takesher pill, and then goes back to sleep. A.Is this weekend ritual necessary? YES B.What would happen if she slept through her alarm clock and she took her pill at 7:30 AM? NOTHING C.At 11:00 AM? D.If she continually sleeps in, should she switch her birth control methods? *
  46. 46. CASE STUDYA sexually active woman usually takes her birth control pillswhen she wakes up every morning for work at 7:00 AM. Onthe weekends, she sets her alarm clock for 7:00 AM, takesher pill, and then goes back to sleep. A.Is this weekend ritual necessary? YES B.What would happen if she slept through her alarm clock and she took her pill at 7:30 AM? NOTHING C.At 11:00 AM? She would need to use alternative birth control methods (e.g. barrier) to insure proper birth control. D.If she continually sleeps in, should she switch her birth control methods? *
  47. 47. CASE STUDYA sexually active woman usually takes her birth control pillswhen she wakes up every morning for work at 7:00 AM. Onthe weekends, she sets her alarm clock for 7:00 AM, takesher pill, and then goes back to sleep. A.Is this weekend ritual necessary? YES B.What would happen if she slept through her alarm clock and she took her pill at 7:30 AM? NOTHING C.At 11:00 AM? She would need to use alternative birth control methods (e.g. barrier) to insure proper birth control. D.If she continually sleeps in, should she switch her birth control methods? YES *
  48. 48. Questions? *

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