COLLAB 2D03 Lecture Notes - Lecture 11: Yuzpe Regimen, Medical Abortion, Cervix
2 Jan 2019
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Chapter 11 Contraception & Abortion
HISTORICAL PERSPECTIVES
• Greek and Roman women used absorbent materials to absorb semen
• Sheaths;
– Linen
– Animal intestines
– rubber
• Crocodile dung, honey and sodium bicarbonate
• Some roman catholic churches hold negative views, but some Catholics and even priests have liberal views
• Read History of Birth Control p. 268
What are some birth control myths?
• sperm can be rinsed out of uterus “douching”?
• Coca-cola kills sperm?
• position during sex can affect pregnancy?
• Withdrawal prevents pregnancy?
• Pregnancy during menstruation?
• Others?
ABORTION
• Purposeful termination of a pregnancy before the embryo or fetus is capable of sustaining independent life
• Historical and Legal Perspectives
• Read p. 305
Methods of Contraception
Oral Contraception (the Pill)
• Hormones of different doses
o Combination pills: synthetic forms of hormones estrogen and progesterone
o Minipill: progesterone
▪ Progesterone- increases thickness of cervical mucus → barrier
• Estrogen inhibits FSH →follicles don’t mature
• Progesterone inhibits LH→ no ovulation
• Takes for 21 days of a 28 day cycle, when not taken, drop in hormones causes endometrium to shed
• Failure rate is low when used correctly -0.5%, typical use 3%
• Advantages: almost 100% effective when used properly, sexual spontaneity, regulates the cycle
• Disadvantages: PID, cysts, no STI protection, woman must plan several weeks ahead before going on
the pill,
• Should be avoided by women with circulatory problems
Emergency Contraception- The Morning After
• Taken after unprotected intercourse, contraception fails, or the condom breaks
• Levonorgestrel- Progestin only (plan B)- more effective, not an abortion pill because it can’t terminate a
pregnancy, it prevents conception
• Yuzpe regimen- Estrogen and progesterone
• Not effective for women over 80kg- 176lbs
• Can be over the counter
Patch
• Delivers estrogen and progesterone to prevent ovulation and implantation
• Ortho ereva- thin, 5cm
• Can be worn anywhere not on the breasts
• 1 week of hormones, worn for 3 weeks, taken off the 4th week to allow for menstruation
The Vaginal Ring
• Delivers hormones through the skin
• Shaped like a diaphragm, contains a combination of estrogen and progestin
• Inserted and left in for 3 weeks, after one week of menstruation, a new ring is inserted
• Can’t really be felt
Injectable Contraception
• Depo-provera
• Injectable hormone available by prescription- IM every 12 weeks
• Prevents pregnancy for 3 months
Intrauterine Devices (IUD)
• Small plastic device with a string is placed in a uterus
• Copper and levonorgestrel IUDs, last 5 years
• Pelvic inflammatory disease, can build scar tissues that block fallopian tubes →infertility, ectopic
pregnancy
Diaphragm
• Shallow cup or dome made of latex rubber
• Must be prescribed and fitted to the individual
• Inserted and removed by the woman, inserted against the cervix
• Higher failure rate
• Used in conjunction with spermicides
Cervical cap
• Dome shaped rubber cup, smaller than a diaphragm, caps off the cervical opening, with a spermicide
• Should be left inside for 8 hours, provided continuous protection for 48hours
• Higher failure rate
Spermicides
• Kill sperm by chemical action
• Should be used with another form of contraceptive
• Doesn’t actually prevent against HIV
Sponge
• Soft disposable device, barrier that holds a spermicide,
• Absorbs sperm, has spermicide in the sponge
Male Condom
• Latex reduces the risk of HIV and STI
• Polyurethane- more effective in preventing pregnancy and STIs, break easier
• Lambskin, have pores large enough for HIV transmission
• Is not effective unless it used before ejaculation
• Large protection against STIs
Document Summary
Historical perspectives: greek and roman women used absorbent materials to absorb semen, sheaths; Abortion: purposeful termination of a pregnancy before the embryo or fetus is capable of sustaining independent life, historical and legal perspectives, read p. 305. The vaginal ring: delivers hormones through the skin, shaped like a diaphragm, contains a combination of estrogen and progestin, can"t really be felt. Inserted and left in for 3 weeks, after one week of menstruation, a new ring is inserted. Injectable contraception: depo-provera, prevents pregnancy for 3 months. Injectable hormone available by prescription- im every 12 weeks. Intrauterine devices (iud: small plastic device with a string is placed in a uterus, copper and levonorgestrel iuds, last 5 years, pelvic inflammatory disease, can build scar tissues that block fallopian tubes infertility, ectopic pregnancy. Diaphragm: shallow cup or dome made of latex rubber, must be prescribed and fitted to the individual, higher failure rate, used in conjunction with spermicides.
