Hormonal and Surgical Contraception

Tod C. Aeby, MDJohn A. Burns School of Medicine

Department of Obstetrics, Gynecology and Women’s Health

Learning Objectives

• Combination Oral Contraceptive Pills• Progestin Only Contraceptive Pills• Injections and Implants• Patches and Rings• Emergency Contraception• Surgical Sterilization

Average Failure Rates (%) During the First Year of Use of a Contraceptive Method

Methods Average NORPLANT SYSTEM 0.05 Male sterilization 0.15 Female sterilization 0.5Depo-Provera (injectable progestogen) 0.3Oral contraceptives 5 IUD Progesterone 2.0 Copper T 380A 0.8Condom

(male) without spermicide 14 (female) without spermicide 21

Cervical cap Never given birth 20 Given birth 40 Diaphragm with spermicide 20 Spermicides alone 26 Periodic abstinence (all methods) 25 Withdrawal 19 No contraception (planned pregnancy) 85

Combination Oral Contraceptive Pills

• Components• Mechanisms of Action• Health Risks• Non-contraceptive Benefits

Formulations

Monophasicdosage constant

Triphasicestrogen and

progestin may change

sequentialsno longeravailable

Progestinand Estrogen21 active pills

+/- 7 placebo pills

Components through time

• Ethinyl Estradiol

• Norethindrone• Levonorgestrel• Desogestrel• Norgestimate• Gestodene 0

20406080100120140160

1960 1980 2000

EstrogenProgestin

Mechanism of Action

• Inhibition of ovulation• Cervical mucus changes• Endometrial changes• Tubal motility changes

Advantages

• Reliable• Convenient• Discreet

High Dose OCP Risk

• Heart Disease• Thromboembolic Disease (blood clots)• Glucose intolerance (diabetes)• Liver cysts• Breast and Cervix Cancer?

Modern Health Risks

• Slight increase in blood clot formation• Gallbladder disease• Heart disease in smokers over age 35

Non- contraceptive Benefits

• Menstrual regulation• Protects against cancer• Improves acne and hirsutism• Decreased breast and ovarian cysts• Better sex

Non- contraceptive side effects

• Nausea• Menstrual changes (spotting, amenorrhea)• ??weight changes??• Minimal impact on lactation

Progestin only Pill

• “The Mini Pill”• Less cycle control (often periods stop with

time)• Slightly higher failure rate• Fewer health risks

Depo Provera

• 150 mg shot every 12 weeks• Progestin only side effect profile• Duration unpredictable

Norplant

• Levonorgesterel• Surgically implanted

and removed• Good for 5 years• Same side effects as

other progestin only methods

Emergency Contraception

• Reduces risk of pregnancy after unprotected intercourse by at least 74%

• No medical contraindication (except pregnancy)

• Must be within 120 hours• 2 doses, 12 hours apart

• Preven: estrogen + progestin • Plan B: progestin only

IUDs

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Mirena Progestasert Paragard

Male Hormonal Contraception?

• Most methods suppress LH/FSH and then replace testosterone– GnRH or progestin– Implants, shots, pills

• Inject vas deferens with polymer• Anti-sperm compounds• Anti-sperm vaccine

Male Surgical Sterilization: Vasectomy

• Outpatient surgical procedure

• .1% failure rate• No impact on sexual

functioning• No known long term

health risks

Female Surgical Sterilization

• Electrocautery• Silastic band• Cut and tie• Clip• Springs

Average Failure Rates (%) During the First Year of Use of a Contraceptive Method

Methods Average NORPLANT SYSTEM 0.05 Male sterilization 0.15 Female sterilization 0.5Depo-Provera (injectable progestogen) 0.3 Oral contraceptives 5 IUD Progesterone 2.0 Copper T 380A 0.8Condom

(male) without spermicide 14 (female) without spermicide 21

Cervical cap Never given birth 20 Given birth 40 Diaphragm with spermicide 20 Spermicides alone 26 Periodic abstinence (all methods) 25 Withdrawal 19 No contraception (planned pregnancy) 85