none of them is 100% effective and all are associated with some degree of risk.
Conception requires Juxtaposition of the male and female gametes at the optimal stage of maturation Transportation of the conceptus to the uterine cavity at a time when the endometrium is supportive of its continued development and implantation.
I. Oral contraceptives (1) Short-acting (2) Long-acting (3) Vacation pill II. Long-acting contraceptive injection III. Slow-releasing contraceptives IV. Transdermal patch Systemic Contraceptives Types of the systemic contraceptives
There is no doubt that the pill properly taken is the most efficient contraceptive available and is ideal for most healthy women under the age of 35.
For many women it has abolished the problems of dysmenorrhea and menorrhagia .It also seems likely the pill protects women against benign breast lesion , functinal ovarian cyst, ectopic pregnancy, ovarian cancer, endometrial cancer and pelvic inflammatory disease. The progression of endometriosis is suppressed.
Some women develop hypertension when taking the pill. Oral contraceptives may increase the release of renin precursors from the liver and result in hypertension in a small percentage of women. Therefor the blood pressure should be checked before starting it and at regular intervals while it is being taken.
Most women have a withdrawl flow ( anovulatory) periods, and usually ovulatory cycles return as soon as the pills are stopped. In a few women “postpill amenorrhea”occurs, and may persist for several months. This is seen particularly in women who had irregular menstrual cycles or episodes of amenorrhea before starting oral-contraceptives
Most of these patients will resume regular menstruation spontaneously within 6 months, and only a few will need treatment with clomiphne or gonadotrophins to induce ovulation and return to normal cycles.
This may be affected by both estrogen and progestogens. Women who have a history of cholestasis of pregnancy, or with abnormal liver function such as may follow hepatitis should not be give oral-contraceptives, until liver function tests have returned to normal. women who develop jaundice or itching with the pill must discontinue it.
Existing heart disease such as a congenital defect, is not necessarily a contraindication, but patients with pulmonary hypertension should not be given oral combined preparations. Pregestogen-only compounds may be an alternative.
Combined oral-contraceptives affect lactation in some women , reducing the volume and quality of the milk. Progestogen-only preparations, given either orally or by injection, may be prefered during breast feeding.
Most surgeons advise discontinuation of pills containing estrogen for 2 months before surgical operations to avoid any possible risk of thrombosis.
Systemic Contraceptives Contraindications 1. Malignant or precancerous diseases and patients with uterine or breast masses 2. Hematopathy and thrombotic diseases 3. Severe cardiovascular diseases 1) P->lipid metab ->coronary artherosclerosis 2) E->blood coagulation↑->myocardiac infarction 3) E->renin activity↑->hypertension
4. Endocrine diseases: diabetes, hyperthyroid dysfunction 5. Lactation 6. Oligohypomenorrhea or older than 45 years old 7. older than 35 years old smoking wemen 8. delivery within half a year or menses not recovery 9. Hepatitis and nephritis 10. Psychotic ( 精神病患者 ) Systemic Contraceptives Contraindications
3. Norethisterone Enanthate Injection 庚炔诺酮避孕针 Components: Norethisterone Enanthate 炔诺酮庚酸酯 200mg can be used in lactation menstrual disorder ↑ Long-acting contraceptive injection
in the first month : D5 and D12 next months: D10-D12 menstrual onset 12-16 days after injection side effcts: irregular bleeding , menorrhagia in the first 3 months treatment : hemostatic , estrogen, short –acting OC Long-acting contraceptive injection
1. Hypodermic implant ( 皮下埋植剂 ) (1) Norplant I (99.8%) (D- 炔诺孕酮埋植剂 I 、 左炔诺孕酮埋植剂 I) Levonorgestrel ( 左旋炔诺孕酮） 36mg×6 . For 5 years (2) Norplant II (D- 炔诺孕酮埋植剂 I 、 左炔诺孕酮埋植剂 I) LNG 70mg×2 . For 3 years no estrogen , can be used in lactation implanted on 7 days of menstrul cycle side effct: irregular blot bleeding , amenorrhea treatment : hemostatic , estrogen Slow-releasing contraceptives
IUDs 1. Timing 1) 3-7 days after completion of menstruation and no recent sexual intercourse. 2) Immediately after an artificial abortion (<10 cm) 3) 3 months after a normal vaginal delivery 4) 6 months after a cesarean section 5) Day 3 of menses for progestin containing IUD 2. Selection of IUDs: depending on space of uterine cavity Procedures
(3)Tumours of the reproductive tract or uterus malformation
(4) Cervical imcompetence, severe old laceration
of cervix and severe uterine prolapse
(5) Severe generalized diseases
(6) Polymenorrhea or menorrhagia
1 ) Uterine bleeding Mechanical compression injuries Increased PGs and activated fibrinolysis Indomethacin ( 消炎痛 ) 25-50mg tid po aminohexanoic acid ( 氨基己酸 ), 2-4g tip po 云南白药 , 0.4g tid po Severe menorrhagia causing anaemia and requiring removal of the device 2) Pain or discomfort Colicky pain may occur for a time after insertion, particularly if the device is large. If dysmenorrhoea occurs, prostaglandin synthetase inhibitors relieve the symptom. Otherwise the possibility that it is caused by infection must be thought. Adverse effects
When a patient comes with a request for sterilization, the most important duty of the gynaecologist is to ensure that her motives are clear, that she understands its risks and its probable irreversibility.
The patient must be told the side effects and complications, such as dysfunctional uterine bleeding, emotional regret, dyspareunia, decreased libido and dysmenorrhea.
The patient should understand that sterility can not be guaranteed.
If sterilization reversal is not success, in vitro fertilization is an alternative solusion.
Misoprostol ( 米索前列醇 ) 0.6mg on the 4 th day morning
Mechanism: Mifepristone competes with progesterone for P receptors on decidua ( 蜕膜 ). Misoprostol causes uterine contraction. Complete abortion rate: ≥ 90% Side effects and complications: (1) Digestive tract symptoms (2) Pain caused by uterine contraction (3) Bleeding usu. ＞ 14 days or even 2 months (4) Infection Drug induced abortion ( 药物流产 )