Contraception
Dr.Muhabat Salih Saeid MRCOG
Learning Objectives
 Recognize common adverse effects
of estrogen and progestin
 In a patient case be able to provide
a ...
Contraception Definition
 Contraception generally implies the
prevention of pregnancy following
sexual intercourse by
 i...
Commonly used methods
 Reversible contraception
 Oral contraceptives
 Long acting injectable or implantable
progestins
...
Properties of Contraceptive
Desired by Patients
 Highly effective
 Prolonged duration of action
 Rapidly reversible
 P...
Oral Contraceptives
 Introduced to the US in 1960
 Works through the manipulation of
normal physiologic feedback
mechani...
The Pill
Advantages
 Easy to use
 Dependable
 No additional appliances
 Can regulate menstrual flow and
decrease cramp...
Missed pills
 Missed 1 day:ASAP and next pill
at regular time
 Missed 2 days: 2 when she
remembers, 2 the next day, use
...
Contraindications
 History of cerebrovascular disease
 Uncontrolled hypertension
 DVT or PE
 Migraines worsened by est...
Estrogen
 Inhibits ovulation by suppressing of
pituitary release of FSH/LH (negative
feedback)
 Inhibits implantation by...
Estrogenic Side Effects
 Nausea
 Weight gain
 Fluid retention
 Pulmonary emboli
 Hypertension
 Thromboembolic compli...
Progesterone
 Inhibits ovulation by disruption of
HPO function and by modification of
mid-cycle FSH/LH surge
 Inhibits i...
Progestin Side Effects
 Increased appetite
 Depression, fatigue, lethargy
 Acne, oily skin
 Hirsutism
 Headache
 Wei...
Noncontraceptive benefits
 Relief from
menstruation-
related problems
 Decreased cramps
 Decreased
ovulatory pain
 Dec...
Contraindications
 History of cerebrovascular disease
 Uncontrolled hypertension
 DVT or PE
 Migraines worsened by est...
Transdermal Contraception
 Ortho Evra
 Norelgestromin and Ethinyl
Estradiol
 Similar to OC’s
 Not recommended in patie...
Ortho Evra
 If a patch comes
off????
 <24 hours
 Reapply
 use a new patch
 >24 hours
 apply a new patch
 use this d...
Implants
 Progestin only (Norplant)
 Prevents ovulation
 More effective than the Pill
Implant
 Advantages
 Convenience
 Eliminate user error
 No menses or very light
 Decreased cramping
Implant
 Problems
• Difficulty in
removing
 Side effects
•Similar to the
pill
•Changes in
menstrual
bleeding
•Headaches
...
Implant
 Contraindications
 Liver disease
 Breast cancer
 Cardiovascular disease
 Unexplained vaginal bleeding
 Preg...
Injectable Contraceptives
 Depo-Provera
 Medroxyprogesterone acetate
 150mg/ml
 Progestin only
 Inhibits ovulation fo...
Depo-Provera
 Advantages
 Highly effective
99.7%
 Increased compliance
 Amennorrhea
 Reduced risk of anemia
 Decreas...
Barrier Methods
 The condom
 Female condom
 Diaphragm
 Cervical cap
 Sponge
IUD
 Intrauterine device
 Copper and plastic (Copper T-380A)
10 years
 Plastic and Progesterone
(progestasert IUD) 1 ye...
Spermicides
 Nonoxynol-9
 Use in combination with barrier
methods of contraception
 Foam
 gel
 Film
 Creams, jellies...
Fertility Awareness Methods
 Calendar or rhythm method
 Midway in cycle
 Basal body temperature (BBT)
method
 Increase...
Sterilization
 For Women
 Tubal ligations
• Cut and seal the fallopian tubes
 Hysterectomy
• Removal of the uterus
 Fo...
Emergency Contraception
 Emergency Contraception Pill (ECP)
 Copper IUD
Emergency Contraception
 Indications:
 Unprotected
intercourse
 Condom
slipped/broke
 Missed pills
 Sexual assault
 ...
Patient Education
 Prescribing Info.
 First dose must be
taken within 72 hours
of unprotected
intercourse
 Second dose ...
Abortion
 Spontaneous abortion
(miscarriages)
 Induced abortion
Injectable Contraceptives
 Depo-Provera
 Medroxyprogesterone acetate
 150mg/ml
 Progestin only
 Inhibits ovulation fo...
Depo-Provera
 Advantages
 Highly effective
99.7%
 Increased compliance
 Amennorrhea
 Reduced risk of anemia
 Decreas...
Implantable Contraception
 Norplant
 Subdermal progestin implant
 6 implantable capsules filled
w/ levonorgestrol
 Req...
Norplant
 Advantages
 Convenience
 Highly effective
 Decreased
menstrual cramps
 Fertility rapidly
returns
 Disadvan...
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Gynecology 5th year, 1st & 2nd lectures (Dr. Muhabat Salih Saeid)

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The lecture has been given on Nov. 10th & 22nd, 2010 by Dr. Muhabat Salih Saeid.

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Gynecology 5th year, 1st & 2nd lectures (Dr. Muhabat Salih Saeid)

  1. 1. Contraception Dr.Muhabat Salih Saeid MRCOG
  2. 2. Learning Objectives  Recognize common adverse effects of estrogen and progestin  In a patient case be able to provide a recommendation for symptom management  Identify contraindications to contraceptive options
  3. 3. Contraception Definition  Contraception generally implies the prevention of pregnancy following sexual intercourse by  inhibiting viable sperm from coming into contact with a mature ovum  by preventing a fertilized ovum from successfully implanting in the endometrium.
  4. 4. Commonly used methods  Reversible contraception  Oral contraceptives  Long acting injectable or implantable progestins  Combined estrogen patch  Condoms, spermicides, diaphragms, withdrawal, periodic abstinence, and IUD’s
  5. 5. Properties of Contraceptive Desired by Patients  Highly effective  Prolonged duration of action  Rapidly reversible  Privacy of Use  Protection against STD’s  Easily accessible
  6. 6. Oral Contraceptives  Introduced to the US in 1960  Works through the manipulation of normal physiologic feedback mechanisms of the menstrual cycle by varying amounts of estrogen and/or progestin.  Proven to be a very effective and popular method of birth control.
  7. 7. The Pill Advantages  Easy to use  Dependable  No additional appliances  Can regulate menstrual flow and decrease cramps and other symptoms of menses
  8. 8. Missed pills  Missed 1 day:ASAP and next pill at regular time  Missed 2 days: 2 when she remembers, 2 the next day, use back up until her next period  More than 2 days: Restart and use a back up method
  9. 9. Contraindications  History of cerebrovascular disease  Uncontrolled hypertension  DVT or PE  Migraines worsened by estrogen  Estrogen dependent neoplasm  Ischemic heart disease  IDDM w/ complications  Breast Cancer  Impaired liver function  Smokers>35y/o
  10. 10. Estrogen  Inhibits ovulation by suppressing of pituitary release of FSH/LH (negative feedback)  Inhibits implantation by altering secretions within the uterus  Accelerates ovum transport  Induction of luteolysis: degeneration of corpus luteum prevents normal implantation and placental attachment
  11. 11. Estrogenic Side Effects  Nausea  Weight gain  Fluid retention  Pulmonary emboli  Hypertension  Thromboembolic complications  Stroke  Increase in bile cholesterol
  12. 12. Progesterone  Inhibits ovulation by disruption of HPO function and by modification of mid-cycle FSH/LH surge  Inhibits implantation by suppressing the endometrium  Production of thick cervical mucus  Prevention of sperm penetration  Slows ovum transport
  13. 13. Progestin Side Effects  Increased appetite  Depression, fatigue, lethargy  Acne, oily skin  Hirsutism  Headache  Weight gain  Decreased libido  Increased LDL, decreased HDL  Hypertension
  14. 14. Noncontraceptive benefits  Relief from menstruation- related problems  Decreased cramps  Decreased ovulatory pain  Decreased menstrual blood loss  Disease prevention  Ovarian and endometrial cancer  Ovarian cysts  Ectopic pregnancy  Pelvic inflammatory disease  Benign breast disease
  15. 15. Contraindications  History of cerebrovascular disease  Uncontrolled hypertension  DVT or PE  Migraines worsened by estrogen  Estrogen dependent neoplasm  Ischemic heart disease  IDDM w/ complications  Breast Cancer  Impaired liver function  Smokers>35y/o
  16. 16. Transdermal Contraception  Ortho Evra  Norelgestromin and Ethinyl Estradiol  Similar to OC’s  Not recommended in patients >198lbs, less effective  Applied every 7 days for 3 weeks followed by patch free week  Convenience, increased compliance
  17. 17. Ortho Evra  If a patch comes off????  <24 hours  Reapply  use a new patch  >24 hours  apply a new patch  use this day as the new patch change day  use a back up method until 7 consecutive days  Patient Education  Similar side effects to OC’s  Same incidence of drug interactions  Apply to abdomen, buttock, upper outer arm, and upper torso  Back up method should be used until after the first 7 days of consecutive administration
  18. 18. Implants  Progestin only (Norplant)  Prevents ovulation  More effective than the Pill
  19. 19. Implant  Advantages  Convenience  Eliminate user error  No menses or very light  Decreased cramping
  20. 20. Implant  Problems • Difficulty in removing  Side effects •Similar to the pill •Changes in menstrual bleeding •Headaches  Side effects •wt. gain •Acne •breast tenderness •hair growth •ovarian cysts
  21. 21. Implant  Contraindications  Liver disease  Breast cancer  Cardiovascular disease  Unexplained vaginal bleeding  Pregnant  Smokers
  22. 22. Injectable Contraceptives  Depo-Provera  Medroxyprogesterone acetate  150mg/ml  Progestin only  Inhibits ovulation for 3 months  IM injection 5 days w/in onset of menstrual bleeding and Q12 weeks
  23. 23. Depo-Provera  Advantages  Highly effective 99.7%  Increased compliance  Amennorrhea  Reduced risk of anemia  Decreased menstrual cramps/pain  No drug interactions w/ anticonvulsants  Disadvantages  Break through bleeding  Weight gain  Headache  Depression  Decreased HDL  Risk of ectopic pregnancy  Contraception reversible in 4- 13months
  24. 24. Barrier Methods  The condom  Female condom  Diaphragm  Cervical cap  Sponge
  25. 25. IUD  Intrauterine device  Copper and plastic (Copper T-380A) 10 years  Plastic and Progesterone (progestasert IUD) 1 year  90-96 % effective in use  Increased risk of PID
  26. 26. Spermicides  Nonoxynol-9  Use in combination with barrier methods of contraception  Foam  gel  Film  Creams, jellies and suppositories
  27. 27. Fertility Awareness Methods  Calendar or rhythm method  Midway in cycle  Basal body temperature (BBT) method  Increase in body temperature  Cervical Mucous Method  Clear slippery mucous  Symptothermal method  Combination of BBT and Cervical Mucous methods
  28. 28. Sterilization  For Women  Tubal ligations • Cut and seal the fallopian tubes  Hysterectomy • Removal of the uterus  For Men  Vasectomy  Vas deferens are cut and sealed
  29. 29. Emergency Contraception  Emergency Contraception Pill (ECP)  Copper IUD
  30. 30. Emergency Contraception  Indications:  Unprotected intercourse  Condom slipped/broke  Missed pills  Sexual assault  Preven  50µg EE and 0.25mg levonorgestrel  Plan B  0.75mg levonorgestrel
  31. 31. Patient Education  Prescribing Info.  First dose must be taken within 72 hours of unprotected intercourse  Second dose is 12 hours later  Side Effects  Nausea  Vomiting  Breast Tenderness  Reglan(metoclopramide) 1 hour prior can reduce n/v  Repeat dose if vomiting occurs w/in 1 hr of admin.
  32. 32. Abortion  Spontaneous abortion (miscarriages)  Induced abortion
  33. 33. Injectable Contraceptives  Depo-Provera  Medroxyprogesterone acetate  150mg/ml  Progestin only  Inhibits ovulation for 3 months  IM injection 5 days w/in onset of menstrual bleeding and Q12 weeks
  34. 34. Depo-Provera  Advantages  Highly effective 99.7%  Increased compliance  Amennorrhea  Reduced risk of anemia  Decreased menstrual cramps/pain  No drug interactions w/ anticonvulsants  Disadvantages  Break through bleeding  Weight gain  Headache  Depression  Decreased HDL  Risk of ectopic pregnancy  Contraception reversible in 4- 13months
  35. 35. Implantable Contraception  Norplant  Subdermal progestin implant  6 implantable capsules filled w/ levonorgestrol  Requires physician administration  Effective for 5 years  Every 3 yrs for women weighing >154lbs
  36. 36. Norplant  Advantages  Convenience  Highly effective  Decreased menstrual cramps  Fertility rapidly returns  Disadvantages  Irregular period  Headache  Depression  Weight gain  Pain/itching @ site  Site infection  Ectopic pregnancy  Removal difficulties
  37. 37. TTTTT

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