Contraception Handout

8/4/2019 Contraception Handout

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Contraceptive Methods

Barrier methods Hormonal methods

Behavioral methods

Oral Contraceptives Vaginal rings

Implants, Injectables

Withdrawal and Abstinence


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The female ovaries usually release oneegg every month

When the egg is released (ovulation) it

makes its way to the uterus throughone of the fallopian tubes.

At the same time, the lining of the uterus

becomes thicker and prepares forpregnancy.

The Basics


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The female ovaries usually release oneegg every month

When the egg is released (ovulation) it

makes its way to the uterus throughone of the fallopian tubes.

At the same time, the lining of the

uterus becomes thicker and prepares forpregnancy.

The Basics


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Condom

Cervical cap Leas shield

Diaphragm

BARRIER METHODS


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Avoids unplannedpregnancies

Among the most-used(prescribed) in theworld

Available from 1960s

Contraceptives


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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


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have substantial health benefits

Should not directly conclude the adverse effects

of hormonal contraceptives to HRTand vice versa

Have low incidence of untoward effects

for most women

.

Contraceptives


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Estrogens + Progestins

Progestins only

Contraceptives

Oral Contraceptive (~1% preg. Rate)Also useful to treat endometriosis


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Inhibit the hypothalamic pituitaryaxis, to inhibition of ovulation

Action

Also affect

Cervical mucus

Uterine endometrium Uterine tubes

- Motility

- Secretion


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HYPOTHALAMUS

PITUITARY

GONADS

STEROIDS

GnRH

LHFSH

(-)

(-)

Ad. Cortex BREAST

LHFSH, PRL

ACTH


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Estradiol

Ethinyl estradiol Mestranol

Contraceptives

Estrogens + Progestins

Norethindrone

Norgestrel Desogestrel Norgestimate


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Constant Dose of Est & Pro

Contraceptives -

Regimen Monophasic

Dosage of one/both changed

Bi/Triphasic


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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?


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

The blood. serious thromboembolic effects

- reason unknown Lipid metabolism.

increase serum triglycerides, free andesterified cholesterol and HDL



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Cardiovascular system.

small increase in cardiac output higher bp and heart rate.

Carbohydrate metabolism

progressive decrease incarbohydrate tolerance

Skin. increase in skin pigmentation androgenic steroids may result in acne



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Nausea

mastalgia (pain in the breast)

breakthrough bleeding

edema

lesser concentration of estrogens or substitution with drugs containing progestins with more

androgenic effects.

Adverse Effects

REMEDY:


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Weight gain (common)

Dieting; drug containing more progestin.

Increased skin pigmentation, Acne

May be exacerbated byandrogen-like progestins.

Hirsutism

(Esp. 19-nortestosterone derivatives) Vaginal infections

- common, difficult to treat

Adverse Effects


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Do not use oral contraceptives in patients with:

Thrombophlebitis

Thromboembolic phenomenon

Cerebrovascular disorders

Known or suspected tumor of the breastor other estrogen-dependentneoplasm


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liver disease asthma

eczema migraine diabetes hypertension

optic neuritis convulsive disorders congestive failure

Use oral contraceptives with cautionin patients with:


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If estrogen administration isundesirable

small doses of progestin oral or by implantation effectiveness is comparable to IUDs

or to the combination of pillscontaining 20-30 mg of ethinyl

estradiol.

Contraception with Progestins alone


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Contraception with Progestins alone

LevonorgestrelFamily

(Gonanes)

LevonorgestrelNorgestrel

Desogestrel

Norgestimate

Gestodene*

NorethindroneFamily

(Estranes)

Norethindrone Norethindrone

acetate

Ethynodiol

diacetate

Lynestrenol*

Spironolactone-Derived

Drospirenone

Remember Yaz?


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DEPO-PROVERA: The 3-MONTH SHOT

Synthetic Progesterone analog (no estrogen)

Application

First shot - during or a few days after thestart of the menstrual period.

After 24 hours, the shot is effective for the next13 weeks.


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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


Contraindications


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Headaches

Nervousness

Mood changes Bloating

Hot flashes

Decreased interest in sex

Breast tenderness Acne

Hair loss

Back ache


Possible Side Effects


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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


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Plan BTM: Progestin Only

First Dose: within 72 hrs of unprotectedintercourse

Second Dose : Within 12 hrs of first dose

Emergency Contraception

Levonorgesterol0.75 mg
http://images.google.com/imgres?imgurl=ec.princeton.edu/Pills/planb.jpg&imgrefurl=http://ec.princeton.edu/Pills/planb.html&h=356&w=757&sz=291&tbnid=fSbHFn-fz70J:&tbnh=65&tbnw=138&prev=/images?q=Plan+B+Emergency+Contraception&hl=en&lr=&ie=UTF-8&oe=UTF-8


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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

Emergency Contraceptives


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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

Other Post-Coital Contraceptives


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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)


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Combination :

single oral dose of 600 mg mifepristone

a vaginal pessary of 1 mg of prostaglandin E1

Mifepristone (RU486) - Dosage

successfully terminates pregnancy in85% of the women.

400-600 mg/d for 4 days or

800 mg/d for 2 days

successfully terminates pregnancy in95% of the women 7 wks afterconception


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Vomiting

Diarrhea Vaginal bleeding

Mifepristone (RU486) Adv. Effects


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MirenaReleases progestinEffective for 5 yrs

Intra Uterine Devices - Hormonal


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NuvaringEstrogen + Progest.Use 3 wks;Removal - menstruation

Vaginal Rings - Contraceptive


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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


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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.

IMPLANTS


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EP E


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CONTRACEPTION IN MEN

RISUG Reversible Inhibition of SpermUnder Guidance

Partially blocks vas deferentia

Disrupts sperm that pass through

Currently in Phase III clinical trials in India

Contraception Handout

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