HORMONAL CONTRACEPTION

ORAL CONTRACEPTIVES

Birth control pills (oral contraceptives) are prescription

medications that prevent pregnancy.

Birth control (contraceptive) medications contain

hormones (estrogen and progesterone, or progesterone
alone).

Birth control pills may also be prescribed to reduce

menstrual cramps or prevent anemia.

Some women experience various levels of side effects of

birth control pills.

HOW BIRTH CONTROL

MEDICATIONS WORK:

Hormonal birth control medications prevent pregnancy

through the following ways:

By blocking ovulation (release of an egg from the ovaries), thus

preventing pregnancy

By altering mucus in the cervix, which makes it hard for sperm to

travel further

By changing the endometrium (lining of the uterus) so that it

cannot support a fertilized egg

By altering the fallopian tubes (the tubes through which eggs

move from the ovaries to the uterus) so that they cannot
effectively move eggs toward the uterus

HOW DOES IT WORK?

AVAILABLE DOSAGE FORMS

Birth control (contraceptive) medications

contain hormones (estrogen and
progesterone, or progesterone alone).

The medications are available in various

forms, such as pills, injections (into a
muscle), topical (skin) patches, and slowrelease systems (vaginal rings, skin
implants, and contraceptive-infused
intrauterine devices

DRUGS AVAILABLE:

Estrogens

Ethinyl estradiol
Mestranol

Progesterones

Norethynodrel
Norethindrone
Norethindrone acetate
Norgestimate
Desogestrel
Ethynodiol diacetate
Norgestrel
Levonorgestrel
Drospirenone

HORMONE-CONTAINING CONTRACEPTIVES

Combination contraceptives, that is,

contraceptive medications containing both
estrogen and progesterone, are the most
effective means for contraception with the
exception of surgical sterilization.

Several types of combination birth control

pills exist, including monophasic pills,
biphasic pills, triphasic pills.

MONOPHASIC PILLS

Monophasic pills have a constant dose

of both estrogen and progestin in each
of the hormonally active pills
throughout the entire cycle (21 days of
ingesting active pills).

Several of the brands listed above

may be available in several strengths
of estrogen or progesterone, from
which doctors choose according to a
womans individual needs.

BIPHASIC PILLS

Biphasic pills typically contain 2

different progesterone doses. The
progesterone dose is increased about
halfway through the cycle.

TRIPHASIC PILLS

Triphasic pills gradually increase the

dose of estrogen during the cycle
(some pills also increase the
progesterone dose).
Three different increasing pill doses
are contained in each cycle.

YASMIN

How to Take Yasmin

Take one tablet by mouth at the same time every day. The
failure rate may increase when pills are missed or taken
incorrectly.
To achieve maximum contraceptive effectiveness, Yasmin
must be taken as directed, in the order directed on the
blister pack. Single missed pills should be taken as soon as
remembered.
How to Start Yasmin
Instruct the patient to begin taking Yasmin either on the first
day of her menstrual period (Day 1 Start) or on the first
Sunday after the onset of her menstrual period (Sunday
Start).

Day 1 Start
During the first cycle of Yasmin use, instruct the patient to take one
yellow Yasmin daily, beginning on Day 1 of her menstrual cycle.
(The first day of menstruation is Day 1.) She should take one yellow
Yasmin daily for 21 consecutive days, followed by one white tablet
daily on Days 22 through 28. Yasmin should be taken in the order
directed on the package at the same time each day, preferably after
the evening meal or at bedtime with some liquid, as needed. Yasmin
can be taken without regard to meals. If Yasmin is first taken later
than the first day of the menstrual cycle, Yasmin should not be
considered effective as a contraceptive until after the first 7
consecutive days of product administration. Instruct the patient to
use a non-hormonal contraceptive as back-up during the first 7
days. The possibility of ovulation and conception prior to initiation of
medication should be considered.

EMERGENCY HORMONAL CONTRACEPTION

Levonelle 1500 (one step)

Contains high dose progesterone
(levonorgesterel)
One 1500mcg tablet taken as soon as
possible after unprotected
intercourse (up to 72 hours after)
Preferably within 12 hours, no later
than 72 hours

Side effects:

A vaginal ring may not be suitable for women

experiencing vaginal irritation or ulcerations.
A ring may be accidentally expelled, for example, when it
has not been inserted properly, during tampon removal, or
while moving the bowels or straining, especially with
severe constipation.
If this occurs, the vaginal ring can be rinsed with cool to
lukewarm (not hot) water and reinserted promptly.
If the ring is not replaced within 3 hours of expulsion,
then a backup method, such as male condoms and
spermicide, should also be used following reinsertion of
the ring for at least 7 days.

WHO SHOULD NOT USE THESE

MEDICATIONS:
Women

with the following conditions should not use estrogen-containing

birth control medications:
Allergy to any component of the product
History of blood clot disorders
History of stroke or heart attack
Heart valve disease with complications
Severe hypertension
Diabetes that causes blood vessel problems
Poorly controlled diabetes
Severe headaches (for example, migraines)
Recent major surgery with prolonged bed rest
Breast cancer
Liver cancer (or liver disease)
Uterine cancer or other known or suspected estrogen-dependent cancers
Unexplained abnormal bleeding from the uterus
Jaundice during pregnancy or jaundice with prior hormonal contraceptive
use

DRUG INTERACTIONS

The effectiveness of COC, POP and EHC will

be reduced by interaction with drugs that
are enzyme inducers

Broad spectrum antibiotics may reduce

effectiveness of COC by altering the
bacterial flora of the bowel

SIDE EFFECTS

Nausea, breast tenderness, fluid retention,

weight gain, acne, breakthrough bleeding,
missed periods, headaches, depression,
anxiety, change in vision, other mood changes,
and lower sexual desire.
Additionally, the following more serious side
effects may occur:

Thromboembolism (blood clots)

Breast cancer
Cervical cancer
Benign liver tumors
Diabetes

MISSED DOSE

For monophasic, biphasic, triphasic, or quadriphasic cycles:

If you miss the first tablet of a new cycleTake the missed tablet as soon as you
remember and take the next tablet at the usual time. You may take 2 tablets in one day.
Then continue your regular dosing schedule. Also, use another birth control method until
you have taken seven days of your tablets after the last missed dose.
If you miss 1 tablet during the cycleTake the missed tablet as soon as you remember.
Take the next tablet at the usual time. You may take 2 tablets in one day. Then continue
your regular dosing schedule.
If you miss 2 tablets in a row in the first or second weekTake 2 tablets on the day that
you remember and 2 tablets the next day. Then continue taking 1 tablet a day. Also use
another birth control method until you begin a new cycle.
If you miss 2 tablets in a row in the third week; or
If you miss 3 or more tablets in a row at any time during the cycle

Using a Day-1 start: Throw out your current cycle and begin taking a new cycle. Also,
use another birth control method until you have taken seven days of your tablets after
the last missed dose. You may not have a menstrual period this month. But if you miss
two menstrual periods in a row, call your health care professional.

Using a Sunday start: Keep taking one tablet a day from your current pack until
Sunday. Then, on Sunday, throw out your old pack and begin a new pack. Also use
another birth control method until you have taken seven days of your tablets after the
last missed dose. You may not have a menstrual period this month. But if you miss
two menstrual periods in a row, call your health care professional.
If you miss any of the last seven (inactive) tablets of a twenty-eightday cycle, there is no

TOPICAL CONTRACEPTIVE PATCH

Norelgestromin/ethinyl estradiol (Ortho Evra)

The topical patch may be applied to clean, dry skin on the
shoulders, upper arms, buttocks, or abdomen.
It should not be applied to red or inflamed areas of the skin or
in areas where tight clothing may rub.
The patch may be less effective in women weighing more than
198 pounds (90 kg).
Use:
A new patch is applied on the same day of the week, each
week for 3 weeks in a row.
The first patch is applied either on the first day of the
menstrual period or on the Sunday following menses.

On the fourth week, no patch is applied.

Menstruation should begin during this time.
This 4-week period is considered 1 cycle.
Another 4-week cycle is started by applying a new patch
following the 7-day patch-free period.

VAGINAL RING

Etonogestrel/ethinyl estradiol (NuvaRing)

Use:

The ring is self-inserted into the vagina.

The vaginal ring must be inserted within 5 days of
the onset of the menstrual period, even if bleeding
is still occurring.
During the first cycle, an additional method of
contraception, such as male condoms or
spermicide, is recommended until after the first 7
days of continuous ring use.
The ring remains in place continuously for 3 weeks.
The ringis then removed for 1 week.
Menstruation should begin during this week.
The next ring is inserted 1 week after the last ring

DEPO-PROVERA INTRAMUSCULAR

This medication is used to preventpregnancy.

Medroxyprogesteroneis like a natural hormone made by
the body. It works mainly by preventing the growth and
release of an egg (ovulation) during your menstrual cycle.
It also makes vaginal fluid thicker to help preventsperm
from reaching an egg (fertilization) and changes the lining
of the uterus (womb) to prevent attachment of a fertilized
egg.
Medroxyprogesterone is also used to treatendometriosis.
It works by lowering the amount of certain hormones in the
body and decreasing the growth of abnormal tissues that
cause endometriosis. This helps reduce pain and other
symptoms.

IMPLANON(ETONOGESTREL IMPLANT) 68 MG

What is IMPLANON?
IMPLANON is a hormone-releasing birth
control implant for use by women to
prevent pregnancy for up to 3 years.
The implant is a flexible plastic rod
about the size of a matchstick that
contains a progestin hormone called
etonogestrel.

IMPLANON prevents pregnancy in several

ways. The most important way is by
stopping therelease of an egg from your
ovary. IMPLANON also changes the mucus in
your cervix and this change may keep
sperm from reaching the egg.IMPLANON
also changes the lining of your uterus.
When the IMPLANON implantis
placedcorrectly, your chance of getting
pregnant is very low

The implant is placed just under the skin on the inner

side of your upper arm.
The timing of insertion is important. Your health care
provider may:
Perform a pregnancy test before inserting IMPLANON
Schedule the insertion at a specific time of your
menstrual cycle (for example, within the first days of
your regular menstrual bleeding)
The site where IMPLANON was placed is covered with 2
bandages. Leave the top bandage on for 24 hours. Keep
the smaller bandage clean, dry, and in place for 3 to 5
days.

SUCCESS AND FAILURE RATE

Hormonal ImplantsOut of 100 Women Using Hormonal

ImplantsTypical Use: 1 or Fewer Women Become PregnantPerfect Use: 1
or Fewer Women Become Pregnant

Hormonal Injections Depo ProveraOut of 100 Women Using

Hormonal Injections:Typical Use: 6 Women Become PregnantPerfect
Use: 1 or Fewer Women Become Pregnant

Birth Control Pills CombinationOut of 100 Women Using

Combination Birth Control PillsTypical Use: 9 Women Become
PregnantPerfect Use: 1 or Fewer Women Become Pregnant

Birth Control Pills Progestin-OnlyOut of 100 Women Using

Progestin-Only Birth Control PillsTypical Use: 9 Women Become
PregnantPerfect Use: 1 or Fewer Women Become Pregnant