Menstrual cycle (contraception (Intrauterine Device “IUD” (Copper-T…
Evra: The Patch
Estrogen and Progestin
1 Patch a week, for 3 weeks
4th week patch free, Menstruation
Usually worn lower abdomen or buttocks
Menstrual (Similar to the Pills)
Nothing to do on a daily basis
No disruption at time of intercourse
Mood Changes, depression, anxiety
No Protection against STI (Sexually Transmitted Infections), including HIV
Nausea, breast tenderness, especially in the first few cycles
Cannot use if breastfeeding
Nuva Ring: the Ring
Combined estrogen and progestin
Thin flexible transparent ring
Left in place in the vagina for three weeks and removed for a week to allow a menstrual period the fourth week.
Maintains a steady low
release rate while in place.
Only TWO TASKS:
Insertion/Removal 1x month
Steady even hormonal levels in blood are achieved
Privacy/No visible patch or pill packages
95% of women say they cannot feel device
Some women dislike placing/removing objects into/out of their vagina
Adverse side effects similar to the pill
Possible devise expulsion
Depo Provera “The Shot”
- Suppresses Ovulation
- Thickens cervical mucus
- Slows tubal and endometrial mobility
Less menstrual blood loss and anemia
After one year 50% of users will develop amenorrhea
80% will develop amenorrhea in 5 years
Only need to remember 1x every three months
Irregular menses during first several months
Unpredictable spotting and bleeding
Possible weight gain: Progressive-Significant (5.4 1st year, after 5 years 16.5)
Patient fear of pregnancy or build up of menses in uterus if not explained well
Fear of needles
Return to fertility is long average 10 months from last injection
Thin, flexible, plastic implant about the size of a matchstick.
Inserted under the skin by the bicep muscle.
Implanted in the arm for
Constantly releases progestin into the bloodstream
Thickens the cervical mucus
Insertion only takes a few minutes
Protection against pregnancy is immediate if you get the implant during the 1st five days of your period
Ability to get pregnant is immediate after removal
Gives continuous long-lasting birth control without sterilization
No medicine to take every day
Irregular bleeding is the most common side effect
Periods become lighter and may stop altogether or periods may become heavier and last longer
Some women will have longer heavier periods
Acne, change in appetite, or sex drive
Pain at the site of insertion
- GnRH (gonadotropin release hormone)
secreted from the hypothalamus
GnRH stimulates pituitary to release FSH (follicle stimulating hormone) and LH (luteinizing hormone)
LH is much more sensitive to changes in GnRH levels
- FSH (follicle stimulating hormone)
secreted by the anterior pituitary gland
essential for follicular growth until the antrum develops
secretion is highest and most critical during the first week of the follicular stage
induces estrogen and progesterone secretion at the level of the ovary
exerts negative feedback on GnRH secretion
induces the proliferation of granulosa cells and expression of LH receptors on granulosa cells
- LH (luteinizing hormone):
secreted by the anterior pituitary gland
required for both growth of preovulatory follicles and luteinization and ovulation of the dominant follicle
for the development of the antrum and maturation of the Graafian follicle
predominant at the end of the follicular phase
Estradiol, the most potent and abundant estrogen
secreted primarily by luteinized follicles
levels increase just prior to ovulation and peak five to seven days post-ovulation
During the luteal phase, progestins induce swelling and increased secretion of the endometrium
In a young adult:
approx. 3 cm long, 1.5 cm wide and 1 cm thick
Central vascular medulla (loose connective tissue)
Outer cortex (thicker, denser than the medulla)
Tinca albuginea – condensed connective tissue
Covering – a single layer of cuboidal cells – germinal epithelium
They grow at an average rate of 2mm per day until they reach 20-25mm in diameter, just before ovulation
- Follicular (proliferative) phase:
From the first day of menstruation to ovulation
initiated by a rise in FSH levels at the first day of the cycle
FSH stimulates the development of 15-20 follicles each month and stimulates follicular secretion of estradiol
As estradiol levels increase under the influence of FSH, estradiol inhibits the secretion of FSH and FSH levels decrease.
Estrogen levels peak towards the end of the follicular phase of the menstrual cycle.
At this critical moment, estrogen exerts positive feedback on LH, generating a dramatic preovulatory LH surge.
LH surge the primary oocyte enters the final stage of the first meiotic division and divides into a secondary oocyte and the first Barr body
The oocyte adheres to the ovary
muscular contractions of the fallopian tube bring the oocyte into contact with the tubal epithelium to initiate migration through the oviduct.
- Luteal (secretory) phase:
luteinization of the components of the follicle which were not ovulated
LH surge the granulosa cells, theca cells, and some surrounding connective tissue are all converted into the corpus luteum, which eventually undergoes atresia
High progesterone levels exert negative feedback on GnRH
As GnRH pulse frequency decreases, FSH and LH secretion also decreases
Lacking stimulation by FSH and LH, after 14 days corpus luteum undergoes atresia and begins evolving into the corpus albicans.
- At the beginning of each menstrual cycle, between 15 and 20 primordial follicles develop into primary follicles.
- Under the influence of gonadotropins and ovarian hormones, primary follicles grow, only one primary follicle develops into a Graafian follicle and the remaining follicles undergo atresia.
- The Graafian follicle is ovulated, expelling the oocyte and corona radiate into the peritoneum while the zona granulosa cells remain in the ovary.
- The zona granulosa and surrounding theca cells develop into the corpus luteum, which in turn becomes atretic after 14 days.
- After several months, the corpus luteum has fully devolved into the corpus albicans.
Genital cycle: ovarian, endometrial, cervical