Contraception and Birth Control for USMLE Step 2

Simple handwritten Contraceptive (Birth Control) lecture for medical students taking the USMLE. Will be looking at how contraceptives work and the pharmacology. Also the different contraception methods, such as Oral contraceptive, Intrauterine Devices, Implants.
Contraception is a method of females to prevent pregnancies. There are several contraceptive methods, however, there is no 100% full proof method. Tier 1 failure rate is less than 1%, Tier 2 have a contraceptive failure rate 2-3% and finally tier 3 is the barrier method and they are about 80% effective.
Tier 1 is made up of Intrauterine devices (mirena, Copper), DMPA, Implanon (subcutaenous) and sterilization (tubal ligation or vesectomy). Tier 2 are the Oral Contraceptive Pills, Patches and Rings, and they are made up of comboniation or just progesterone. Tier 3 is the barrier methods include condoms, diaphragm and the spermicidies which prevents implantation. Can also prevent STDs and HPV.
Intrauterine devices are implantedin the uterus. They are made up of mirena and copper. Mirena secretes levonogestrel which is a type of progesterone that has three effects. Thickens the cervical mucosa which prevents sperm form ascending into the uterus. The endometrial wall is also thickened that decreases the chance of implantation. Increase tubal motility so it is not in blastocyst and it can't implant into endometrium. Copper Intrauterine device leads to inflammation response which causes the same effects. Mirena can work up to five years, whereas copper can work for 10 years. In Mirena there will be decrease bleeding and cramping. However, Copper can increase bleeding and cramping. Contra-indications to Intrauterine Devices is pregnancy, history of breast cancer, leiomyomas, any uterine infection such as PID and endometritis, especially chlamydia. Any bleeding where the cause is unknown. Relative complications are anatomical uterine anomalies (size and shape), Heart Disease because sometimes perforates and then bleeding can affect the heart. Any history of ectopic pregnancy. Finally there may be complications such as expulsion of the device within 1 month. Perforation, ectopic pregnancy, infection (PID) which usually happens within first 2 months.
Sterilization and generally irreversible. Tubal ligation and vesectomy are the two methods. Vesectomies are more effective.
TIER 2 are the hormonal methods there are two types which are known as combined and progesterone only. In combined there is pill patch and ring. In Progesterone only there is pill injection and implant. No LH surge means there is no ovulation and there is atrophy of the endometrium and therefore there is no implantation possible. Cervix becomes thick and edematous and prevents sperm from coming in.
Combined method is when there is estrogen and progesterone. The pill can begin any day however effects won't begin for 7 days. 21 days and 7 days off. Off days are for the withdrawal bleed. Also helps regulate and normalize the menstrual cycle. The nuvaring enters the vagina and slowly releases estrogen and progesterone. Every three weeks it needs to be removed for 1 week. Patch also slowly release estrogen and progesterone under the skin which gives 60% greater than pills.
Progestin only method in pill form is a daily pill that is continuous which causes irregular breakthrough bleeding. Injection form Depo-Medroxyprogesterone Acetate (DMPA) is injected into the skin and slowly released and it lasts for three months. Implanon is implanted subcutaneously and slowly releases etanogestrol and lasts for 3 years.

[@emoobss]

Thanks for the video!. BTW, Mirena does not thickens the wall (progesterone), it keeps it thin as there is no proliferation of the wall due to lack of estrogen. It keeps it thin (no bleeding)

[@sharoncain2510]

Thank you for the clarification because I was wondering if I was wrong.

[@melchorchipoco1632]

Mirena does not thicken the endometrium nor thicken the cervical mucosa. Also progesterone DECREASE tubal motility

[@angiechen2912]

Thank you so much for the video. Contraception finally makes sense after listening to your lecture.

[@stubbornaneed]

thank you for the video
a possible correction on mirena mechanisme of action:
"There are several progestin-mediated mechanisms by which
LNG-IUS may prevent pregnancy. The progestin renders the
endometrium atrophic; it stimulates thick cervical mucus that
blocks sperm penetration into the uterine cavity; and it may decrease tubal motility, thereby preventing ovum and sperm
union. T e progestin may also inhibit ovulation, but this is not
consistent (Nilsson, 1984)."
williams gynecology 3rd ed.

[@yashtindwani4114]

Nice clear physiological aspect of contraception explained , keep it up !!

[@TheX7mood]

Thank you very much but i hope if you can at the end of the video you just show us the whole page so we can screenshot it ❤️🙏🏻

[@desmondseahtm]

In biphasic and triphasic combination oral contraceptive, the Ethinylestradiol (EE) is usually kept constant while only varying the dose of progestin. 17:08

[@dafiel-amin4799]

I thought levonorgestrel thins the endometrium (instead of thickens), hence doesn't allow the blastocyst to implant? Let me know if you can verify this! Thank you :)
(EDIT: yes, I thought that that's why mirena is used in dysmenorrhoea because it thins the endometrium, hence lighter bleeds etc.)
Very thorough video :) Well done! Suggestions for improvement: state why you'd use combined/progesterone-only contraception, but yes, very good - keep it up!

[@keshanREd2Y]

+Dafi El-Amin So that part in this video is incorrect? The IUD thins the endometrium and not thickens it to prevent implantation? :o

[@younussm]

+Sylarr yes. Endometrium atrophy occurs as a result implantation fails.

[@sharonkoh8927]

Yes, same thoughts here. The endometrium should be thin and atrophic, preventing implantation and sperm transport. Pls correct me if I'm wrong.

[@paramvaidya]

Awesome video. Thanks a ton. Keep posting.

[@AriAevary]

Thank You so much for this tutorial, Very helpful!

[@nadika]

simple and clear..thank you very much..

[@kyndell050403]

Great lecture, thank you.

[@thestudyspot]

+Beckee Lucas Your Welcome!

[@chetanchetan23]

great video.Thanks

[@khaledelsabaa7802]

great video, thank you

[@lenahabdelgadir5194]

Thank you... appreciated

[@janetrenfrow7646]

very good. Thanks

[@thestudyspot]

+Janet Renfrow Your Welcome

[@husnasattar6029]

Good one...

[@thestudyspot]

+Husna Sattar Thanks!

[@daniloninop.5545]

great! what program did use? :)

[@b2650]

For combined pills, don’t we take 21 days on? I’m not sure if it’s 24 days

[@wf_9235]

Thanks Sir .. that was helpful :)

[@josephinefanny2980]

Can i ask a question? What is the name of hormonal drug birth control for male? Thankyou

[@neemamoffat8464]

Thanks Sir

[@paramvaidya]

The primary mechanism of action of levonorgestrel as a progestogen-only emergency contraceptive pill is, according to (FIGO), to prevent fertilization by inhibition of ovulation and thickening of cervical mucus.

[@anandsasidharan2462]

param vaidya nope. The primary action of POP is mainly alteration of cervical mucus.. Only one POP called cerazette has the MOA of inhibiting ovulation..

[@rubyannrosellon4724]

excellent thank you

[@thestudyspot]

Ruby Ann Rosellon Your Weloome!

[@mohitagrawal8035]

incorrect information

[@larrykibe3407]

the endometrium thins to reduce implantation