Anda di halaman 1dari 37

Contraceptive Methods

Barrier methods Hormonal methods

Oral Contraceptives Vaginal rings Implants, Injectables


Behavioral methods

Withdrawal and Abstinence

The Basics
The female ovaries usually release one egg every month When the egg is released (ovulation) it makes its way to the uterus through one of the fallopian tubes. At the same time, the lining of the uterus becomes thicker and prepares for pregnancy.

The Basics
The female ovaries usually release one egg every month When the egg is released (ovulation) it makes its way to the uterus through one of the fallopian tubes. At the same time, the lining of the uterus becomes thicker and prepares for pregnancy.

BARRIER METHODS

Condom Cervical cap Leas shield Diaphragm

Contraceptives
Avoids unplanned pregnancies Among the most-used (prescribed) in the world Available from 1960s

Contraceptives
among the most effective drugs available
A wide variety : different components, doses, and side effects used in relatively young, healthy persons (in contrast to disease treating agents) side effects therefore are an important consideration

Contraceptives
have substantial health benefits . Should not directly conclude the adverse effects of hormonal contraceptives to HRT and vice versa Have low incidence of untoward effects for most women

Contraceptives
Estrogens + Progestins
Oral Contraceptive (~1% preg. Rate) Also useful to treat endometriosis

Progestins only

Action
Inhibit the hypothalamic pituitary axis, to inhibition of ovulation
Also affect
Cervical mucus Uterine endometrium Uterine tubes - Motility - Secretion

(-)

HYPOTHALAMUS
GnRH

(-)

PITUITARY
ACTH LH FSH, PRL LH FSH

Ad. Cortex

BREAST

GONADS

STEROIDS

Contraceptives
Estrogens + Progestins
Estradiol Ethinyl estradiol Mestranol Norethindrone Norgestrel Desogestrel Norgestimate

Contraceptives Regimen
Monophasic
Constant Dose of Est & Pro

Bi/Triphasic
Dosage of one/both changed

Pharmacological Effects
The Ovary Inhibition of follicle development The Uterus Hypertrophy polyp formation (with prolonged use) Thickening of cervical mucus The Breast.

Enlargement in most cases


The central nervous system.

Excitability?

Pharmacological Effects
The endocrine function.
inhibition of pituitary gonadotropin secretion alteration of adrenal structure and function

The blood. Lipid metabolism.


serious thromboembolic effects - reason unknown increase serum triglycerides, free and esterified cholesterol and HDL

Pharmacological Effects
Cardiovascular system.
small increase in cardiac output higher bp and heart rate.

Carbohydrate metabolism Skin.


progressive decrease in carbohydrate tolerance increase in skin pigmentation androgenic steroids may result in acne

Adverse Effects
Nausea mastalgia (pain in the breast) breakthrough bleeding edema
REMEDY:
lesser concentration of estrogens or substitution with drugs containing progestins with more androgenic effects.

Adverse Effects
Weight gain (common)
Dieting; drug containing more progestin.

Increased skin pigmentation, Acne


May be exacerbated by androgen-like progestins.

Hirsutism (Esp. 19-nortestosterone derivatives) Vaginal infections - common, difficult to treat

Do not use oral contraceptives in patients with: Thrombophlebitis

Thromboembolic phenomenon
Cerebrovascular disorders Known or suspected tumor of the breast or other estrogen-dependent neoplasm

Use oral contraceptives with caution in patients with: liver disease asthma eczema migraine diabetes hypertension optic neuritis convulsive disorders congestive failure

Contraception with Progestins alone


If estrogen administration is undesirable small doses of progestin oral or by implantation effectiveness is comparable to IUDs or to the combination of pills containing 20-30 mg of ethinyl estradiol.

Contraception with Progestins alone

Levonorgestrel Family (Gonanes)


Norethindrone Family (Estranes)


Norethindrone Norethindrone

SpironolactoneDerived
Drospirenone

Levonorgestrel Norgestrel Desogestrel Norgestimate Gestodene*

acetate Ethynodiol diacetate Lynestrenol*

Remember Yaz?

DEPO-PROVERA: The 3-MONTH SHOT

Synthetic Progesterone analog (no estrogen) Application


First shot - during or a few days after the start of the menstrual period. After 24 hours, the shot is effective for the next 13 weeks.

DEPO-PROVERA: The 3-MONTH SHOT Contraindications


Unexplained bleeding Known or suspected bleeding Planning to become pregnant Concerned being over weight With Liver Disease With Gallbladder disease With history of depression

Risks

Allergic reactions Increased risk of osteoporosis If becomes pregnant during use: Increased risk of premature birth

DEPO-PROVERA: The 3-MONTH SHOT Possible Side Effects


Headaches Nervousness Mood changes Bloating Hot flashes Decreased interest in sex Breast tenderness Acne Hair loss Back ache

Other Health Benefits of Contraceptives


ovarian and endometrial cancer
within 6 months of use lasts up to 15 years after discontinuation

regularity of menstrual cycle menstrual blood loss premenstrual tension dysmenorrhea incidence of pelvic inflammatory disease (PID) ectopic pregnancies may improve endometriosis

Plan BTM: Progestin Only Emergency Contraception


Levonorgesterol 0.75 mg

First Dose: within 72 hrs of unprotected intercourse Second Dose : Within 12 hrs of first dose

Emergency Contraceptives The morning after pill

Prevents the sperm-egg union


Blocks fertilized egg from implanting 90 95% effective

Side Effects - vomitting, bleeding - Heart attack, blood clots

Other Post-Coital Contraceptives

Conjugated estrogens: 10 mg/ 3 a day/ 5 days


Ethinyl Estradiol: 2.5 mg/ 2 a day/5 days Norgestrol (0.5 mg) + Ethinyl Estradiol (0.05 mg)

(Ovral, Preven) 4 tablets - 2 immediately - 2 after 12 hrs

Mifepristone (RU486)
A 19-Norsteroid binds progesterone receptor inhibits the progesterone activity

Major use : termination of early pregnancies


(less than 49 d after last cycle)

Mifepristone (RU486) - Dosage


400-600 mg/d for 4 days or

800 mg/d for 2 days


successfully terminates pregnancy in 85% of the women. Combination : single oral dose of 600 mg mifepristone

a vaginal pessary of 1 mg of prostaglandin E1


successfully terminates pregnancy in 95% of the women 7 wks after conception

Mifepristone (RU486) Adv. Effects

Vomiting Diarrhea Vaginal bleeding

Intra Uterine Devices - Hormonal

Mirena Releases progestin Effective for 5 yrs

Vaginal Rings - Contraceptive

Nuvaring Estrogen + Progest. Use 3 wks; Removal - menstruation

IMPLANTS

Progestin-only method 1 6 match-sized rods are implanted under the skin Release progestin slowly over time.
Stops ovulation Thickens cervical mucus to block sperm entry Thins uterine lining

IMPLANTS
consists of one or six match-sized rods inserted underneath the skin. the rods release a steady dose of one hormone only - progestin.

prevents the ovaries from releasing eggs (stops ovulation). Thickens cervical mucus, blocking sperm entry
Thins uterine lining, further reducing the chances of pregnancy.

CONTRACEPTION IN MEN
No suitable oral contraceptive for man has yet been developed.

Gossypol

Destroys the seminiferous epithelium

Does not affect the endocrine apparatus of the testis

CONTRACEPTION IN MEN RISUG Reversible Inhibition of Sperm Under Guidance Partially blocks vas deferentia Disrupts sperm that pass through

Currently in Phase III clinical trials in India