Progesterone

Reduces the tone of uterine contractions

Granulosa luteal cells

Ans. is a, b and c i.e. Sufficient estrogen; Normal ovarian function; Intact endometrium; and Intact pituitary axis

Note : Friends it is quite difficult to understand the above chart in one go, you will have to go through it 3 – 4 times to understand it well.

Also revise the various compartments of menstruation from Q.No. 3 for better and complete understanding.

Ans. is d i.e. PCOD          

If a patient is having positive progesterone challenge test it means

Uterus is sufficiently primed with estrogen i.e. estrogen production is normal so, hypopituitarism (option “c”)

Uterus with its endometrial lining is normal i.e. Ashermann syndrome (option “a”)and Endometrial TB (option “b”) ruled out.

Outflow tract is normal.

The defect lies in production of progesterone (as when progesterone is supplemented from outside it results in withdrawl bleeding) and since progesterone is produced mainly by corpus luteum so, the defect is anovulation. The main cause of Anovulation in a case of 2° amenorrhea is polycystic ovarian disease (option “d”)

Ans. is b i.e. Anovulation

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Ans. is c i.e. Levonergesterol

The progeserone of choice for emergency contraception is Levonorgesterel. Dose of Levonergesterol for emergency contraception= 0.75mg

Adavntages

• It has no estrogenic side effects
• Can be given to hypertensive, cardiac and diabetic women.
• Can be given to lactating women

Single dose therapy (i.e. 2 tablets taken as a single dose) can be given. It is contraindicated in women with H/O thrombophelebitis and migraine.

Ans. is b i.e. Metrorrhagia

Irregular menstrual bleeding

Failure rate is equal to that seen with OCP’s

Micro pill

b and c

Corpus luteum

Levonorgestrel [Ref: Novak’s Gynaecology I4/e, p 283-285; Hormones in Obstetrics and Gynaecology by V. Zutshi 2/e, p 142-150; Fertility Control by Chaudhuri 6/e, p 190-197; Dutta Obstetrics 6/e, p 549­550]

Levonorgestrel alone, 0.75 mg stat F/B another 0.75 mg 12 hrs later, taken within 72 hrs of unprotected intercourse is the method of choice _.for emergency contraception

• Emergency contraception is also k/a postcoital morning after contraception. Basically the methods used interfere with the physiological events before implantation, for e.g. inhibition or delaying of ovulation or interference with postovulatory events necessary for implantation & longevity of the blastocyst.
• Agents used for emergency contraception are known as ‘interceptives’.

Unprotected intercourse without regard to the time of the month carries an 8% incidence of pregnancy, an incidence that can be reduced to 2% by the use of emergency contraceptives within 72 hours of unprotected intercourse.

• Estrogen-progestin Combinations
• Antiprogestins and selective progestin-receptor modulators
• Copper-containing intrauterine devices within 5 days after unprotected intercourse

The course of the asthma in pregnancy is unpredictable.

In about 20%, the condition improves, in 30%, it deteriorates and in 50%, it remains unchanged.

Ref:  Textbook of Obstetrics by D. C. Dutta, 6th Edition, Page 302

Failure rate of combined OCP is 0.2/100 women years, whereas failure rate of progesterone only pill is about 0.5 – 2 per 100 women years of use.

Progesterone only pill acts by thickening cervical mucous, causing atrophy of endometrium or by inhibiting ovulation.

Ans. is ‘b’ i.e., Ulipristal

o Ulipristal is a SPRM approved for use as an Emergency Contraceptive.

o SPRM (selective progesterone receptor modulators) : Asoprisnil, ul ipristal, onapristone, mifepristone.

Ans. C > A: Irregular bleeding and prolonged anovulation > Weight gain

There is return in return of fertility but 80% are expected to conceive by end of 1 year. With DMPA, ovulation returns in 5 months, and with NETO, within 3 months of the last injection

The side effects of weight gain, depression, bloated feeling and mastalgia can occur with the injectable progestigen

Pregnanediol is an inactive metabolic product of progesterone. A test can be done to measure the amount of pregnanediol in urine, which offers an indirect way to measure progesterone levels in the body.

The principal pathway of the metabolism of progesterone is believed to be progesterone → pregnanedione  → pregnanolone  → pregnanediol, although small amounts of the corresponding allopregnane compounds are formed.

Ans. is ‘b’ i.e., Inhibits LH secretion

Ans. is ‘c’ i.e., Increased progesterone

Puberty is triggered by a release of gonadotropins (FSH and LH) from pituitary gland.

These hormones act as signals to the gonads (testes/ovaries) that trigger the production of –

i) Estrogen, progesterone and some testosterone in women.

ii) Testosterone in men.

Leptin facilitates release of gonadotropin releasing hormone (GnRH), thereby helping in pubertal onset.

Ans. is .b  i.e., Hemorrhagic uveitis

Keratic precipitates (KPs)

• KPs are proteinaceous cellular deposits occurring at the back of cornea (corneal endothelial deposits). Keratic precipitates are formed by the aggregation of polymorphonuclear cells, lymphocytes, and epitheloid cells. In the setting of uveitis, the bimicrosopic appearance of KP may yeild important diagnostic clues for the identification of the underlying inflammatory disorder :‑

Mutton fat KP :- Large, yellowish KPs, are characteristic ofgranulomatous uveitis. These are composed of epitheloid cells and macrophages. They are large, thick fluffy, lardaceous KPs, having a greasy or waxy appearance.

Small or medium KPs (granular KPs):- These are composed of lymphocytes and are characteristic of non- granulomatous uveitis. These are small, round and whitish precipitates

Red KPs :- Composed of RBCs and inflammatory cells. These are seen in hemorrhagic uveitis.

Old KPs :- In healed uveitis. The above described KPs shrink, fade, become pigmented and irregular in shape with crenated margins.

Ans. is ‘d’ i.e., Progesterone 

• Progesterone can be given in the form of subdermal implant.
• Subdermal contraceptive implants involve the delivery of a steroid progestin from polymer capsules or rods placed under the skin.
• The hormone diffuses out slowly at a stable rate, providing contraceptive effectiveness for 1-5 years. 
• The period of protection depends upon the specific progestin and the type of polymer.
• Advantages of progestin implants include long term contraceptive action without requiring the user’s or provider’s attention, low dose of highly effective contraception without the use of estrogen, and fertility is readily reversible after the removal of implants.
• The levonorgestrel implant Norplant R system is the only one that has been approved for distribution.
• The contraceptive efficacy of Norplant is the highest observed amongst the most effective methods with an annual pregnancy rate of 0^.2 during the first and second year and 1 1 on the fifth year. Menstrual problems are the main reason for the discontinuation of Norplant and 9% of women stopped using it during the first year of treatment.