Steroidal contraceptives

1. STEROIDAL
CONTRACEPTIVES

4. COMBINED ORAL CONTRACEPTIVES
❑The most effective reversible method of contraception.
❑Common used Progestins are Levonorgestrel, Norethisterone
and the estrogens are principally confined to either
ethinylestradiol or mestranol.
❑Only MALA-N is available in market free of cost through
❑ government channels.
❑Fourth Generation- Drospirenone which is an analog of
spironolactone is used as a progestin. It has antiandrogenic and
antimineralocorticoid action.

5. MECHANISM OF ACTION
• Both the hormones synergistically act on the HP axis.
• Estrogens suppress FSH and prevent follicular growth and
progestins suppress LH and prevent ovulation.
• The release of GnRH is prevented through a negative feedback
mechanism.
• There is thus no pulsatile release of FSH Or LH, so follicular
growth is either not initiated or if initiated recruitment does not
occur.
• There is NO OVULATION.

6. MECHANISM OF ACTION
• There is stromal edema, decidual reaction and regression of the
glands making the endometrium non receptive.
• Alteration of the character of the cervical mucus so as to prevent
sperm penetration.
• Probably interferes with the tubal motility.
• Estrogens inhibit FSH rise and prevent follicular growth.
• Progestins primarily have anovulatory effect and counteract the
adverse effect of Estrogen on the endometrium.

7. HOW TO PRESCRIBE A PILL….?
• PATIENT INSTRUCTION-
• New users should ideally start their pill packet on Day 1 of their
cycle.
• One tablet daily at bedtime for consecutive 21 days.
• Then there is a break of 7 days.
• Next pack should be started on the eighth day irrespective of
bleeding.
• Thus a simple Regime of 3 weeks on and 1 week off is followed.
• 7 of the pills are dummy and contain either Iron or vitamin
preperations.

8. MISSED PILLS
• Normally there is return of pituitary ovarian follicular
axis during the pill free interval of 7 days.
• Breakthrough ovulation may occur which increases the
risk of pregnancy.
• When one pill is missed the woman should take take the
pill and continue the rest of the schedule
• When 2 pills are missed she should take 2 pills the next
day.
• If more than 2 pills are missed she should use another
form of contraception for the next 7 days.

9. Medical Eligibility
Criteria For
Contraceptive Use

11. Adverse Effects of
Combined Oral
Contraceptive
Pills.

12. • MINOR
• Nausea, vomiting
• Headache
• Mastalgia
• Weight Gain
• Breakthrough Bleeding
• Diminished Libido
• Leukorrhea
•MAJOR
• Depression
• Hypertension
• Venous Thromboembolism
• Cholestatic Jaundice
• Neoplasia
• Death

13. OCP’s
ADVANTAGES
• Highly effective
• Good cycle control
• Well tolerated
• Low dose Progestins
further reduce any risk
• Reversibility is prompt
DISADVANTAGES
•Requires education
and motivation
•Requires initial
checkup
•Risk of drug
interactions

14. TRIPHASIC PREPERATION
•In these preperations the hormonal doses of
each compound vary over the course of the
cycle.
•Minimum doses are provided for contraceptive
effect in the early part of the cycle and higher
doses in the later part of the cycle to prevent
breakthrough bleeding.

15. CENTCHROMAN (CHHAYA)
•A research product of CDRI Lucknow.
•A non steroidal compound with potent
antiestrogenic properties.
•Taken orally twice a week for first 3 months then
once a week.
•Creates asynchrony between developing zygote
and endometrium causing implantation failure.
•Does not prevent ovulation.

17. PROGESTOGEN
ONLY PILLS

18. •Devoid of any estrogen compound. It contains
very low dose of progestin in any one of the
following form, Levonorgestrel (75 ug),
Norethisterone (350ug) , Desogesteral (75ug)
•HAS TO BE TAKEN FROM THE FIRST DAY OF THE
CYCLE and then continuously.
•Works mainly by making cervical mucus thick
and viscous thereby prevents sperm
penetration.

19. ADVANTAGES
•Side effects attributed to estrogen are totally
eliminated.
•No adverse effect on lactation
•Easy to take as there is no On and Off regimen.
•May be prescribed in patients having HTN,
Fibroids, Diabetes HIV
•Reduce the risk of PID and endometrial cancer.

20. Injectable Progestins

21. • The preparations commonly used are
DMPA And NET-EN.
• Both are administered intramuscularly
within 5 days of the cycle.
• DMPA (150mg every 4 months)
• NET EN ( 200 mg every 2 months)

22. MECHANISM OF ACTION
•Inhibition of ovulation by suppressing the mid
cycle LH surge.
•Cervical mucus becomes thick and viscid thereby
preventing sperm penetration.
•Endometrium is atrophic

23. ADVANTAGE
• It eliminates regular medications as imposed by oral pill.
• Can be used safely during lactation.
• No estrogen related side effects.
• Menstrual symptoms are reduced.
• Protective against endometrial cancer.
• Can be used as an interim contraceptive before
vasectomy.
• Reduction in PID

24. DISADVANTAGES
•There is chance of irregular bleeding.
•Return of fertility is usually delayed.
•Loss of bone mineral density has been
observed with long term use.
•Other side effects are depression and
weight gain.

25. IMPLANTS
• Nexplanon is a progestin only delivery system containing
etonogesteral. It is a long term reversible contraceptive.
• It releases the hormone 60ug gradually reduced to 30ug
over a period of 3 years.
• It atrophies endometrium thickens the cervical mucus and
inhibits ovulation for the first year.
• Capsule is inserted subdermally in the non dominant arm
• High Pearl Index and is considered reversible sterilisation.

26. NORPLANT–II (Jadelle)
• Two rods of 4 cm length with diameter of 2.5 mm
are used.
• Each rod contains 75 mg of levonorgestrel.
• It releases 50 mcg of levonorgestrel per day.
• Contraceptive efficacy is similar to combined pills.
• Failure rate is 0.06 per 100 women years. It is used
for 3 years. The rods are easier to insert and
remove.

28. EMERGENCY CONTRACEPTIVES

29. PERMANENT
SURGICAL
CONTRACEPTION

30. MALE STERILIZATION
•VASECTOMY
• It is a permanent sterilisation operation done in males where
a segment of vas deference of both the sides are resected
and the cut ends are ligated.

32. ADVANTAGES
• The operative technique is simple and can be
performed with minimal training
• Can be done as an OPD procedure.
• Complications immediate or late are few.
• Failure rate is minimal.
• The overall expenditure is minimal.

33. DISADVANTAGES
• Additional contraceptive protection is needed for 2 to 3
months following operations. Till the semen becomes free
from sperm
• Frigidity or impotency when occur is mostly psychological
• SELECTION OF CANDIDATE
• Sexually active and psychologically adjusted husband
having the desired number of children is an ideal
candidate.

34. TUBECTOMY
•It is an operation where resection of a
segment of both the Fallopian tubes is
done to achieve permanent sterilisation.
•The approach may be
•ABDOMINAL
•VAGINAL

38. Thankyou