Gynecology and Family planning

1. Combined Oral contraceptive
pills

2. • Gynaecological benefits
• Menstrual benefits
• Others
• Non gynaecological benefits
• Cancer protection

3. Menstrual benefits
• Regularises menses
• Reduces menstrual blood loss
• Reduce Fe deficiency anemia
• Reduce dysmenorrrohea
• Reduce PMS

4. Other gynaecological benefits
• Decrease functional ovarian cyst
• Reduces chance of fibroid
• Reduces acute PID
• Rx of perimenopausal change
• Rx of PCOS (Reducing acne and hirusitism and
regularising bleeding)
• Rx of DUB
• Beneficial in endometriosis

5. Non gynaecological benefits
• ↑ bone mass
• Reduces
▫ Fibrocystic breast disease
▫ Fibroadenoma
▫ Acne
▫ RA

6. Cancer protection
• Ca Endometrium
• Ca Ovary
• Colorectal Ca
• Longlasting protection against Ca endometrium
and hereditory epithelial carcinoma ovary
• Protective effect increases with duration of use
• Effect lastes upto 10- 15 years after
discontinuation

7. Benefits Vs Risk
• Benefits outweigh risks
• Recommended for all women unless
contraindicated

8. Mode of Administration
• 1 Pack- 21 or 28 tablets
• First pack
▫ Starts from day1
▫ Continued for 21 days
▫ Pill free interval 7 days
• Next pack
▫ Starts after 7 days irrespective of menstruation
▫ Menstruation usually commences after 2-4 days of
discontinuation of pill
• Some cases last 7 days contain placebo
• In that case, restart next pack without gap

9. Missed Pills
• One pill missed
▫ Take the missed as soon as remembers
▫ Then continue with pill taking
▫ No need of backup contraceptive method
• 2 pills missed
▫ Take 2 pills on the next 2 consecutive nights
▫ Continue with the rest of the pack as usual
▫ Backup contraceptive like barriers for one week
▫ Continue with next pack without gap
▫ If placebo present, skip that and start new pack

10. 1. Pills containing drospirenone
2. Pills containing Cryproterone Acetate
3. Pills with extended cycle length- Seasonale
4. Ultra-low-dose pills

11. 1. Pills Containing Drospirenone
• Drospirenone- spironolactone analogue
▫ 3 mg Drospirenone = 25 mg spironolactone
▫ major effect- Antimineralocorticoid action
▫ Also- Antinadrogenic effect
▫ Hence resembles natural progesterone
• Combination available contain
▫ Ethinyl oestradiol 20-35 µg
▫ Drospirenone 3mg

12. • Brands
▫ Yasmin- First made
▫ Tarana
▫ Crisanta
• Advantages
▫ Drospirenone counteracts the mineralocorticoid
action of estrogen
 i. e. Ethinyl estradiol increases angiotensinogen
production, which acts on RAS causing Na and water
retention. It is reversed by drospirenone

13. • Advantages- cntd.
▫ Less side effects like Weight gain, bloating,
headache etc.
▫ Doesn’t cause HTN
▫ Useful in acne and hirusitsm due to antiandrogenic
effect
▫ Useful in PCOS
▫ Relief from PMS
• Contraindications
▫ Women with hepatic, renal or adrenal problems 
ppt. hyperkalemia
▫ Women taking ACE inhibitors, K sparing diuretics
and aldosterone antagonists

14. 2. Pills containing Cyproterone Acetate
• Cyproterone Acetate- Synthetic progesterone
derived from 17- hydroxyprogesterone
• Has antigonadotrophic and antiandrogenic
activity
• So firstly used in men to treat BPH
• MOA
▫ Competitive inhibiton of testosterone and
dihydrotestosterone
▫ Also reduces 5 alfa reductase activity

15. • Available combination
▫ Ethinyl estradiol 35 µm
▫ Cyproterone acetate 2mg
• Brand names in India
▫ Diane 35
▫ Krimson 35
▫ Mypil
• Advantage
▫ Antiadrogenic effect
• Useful in women with
▫ Hirusitsm
▫ Acne
▫ PCOS

16. 3. Pills with extended cycle length-
Seasonale
• Seasonale- Combination of
▫ Ethinyl estradiol
▫ LNG
• Consist of 12 weeks of medication, i.e 84 week
tablets+ 1 week of placebo
• Advantage
▫ Only 4 periods in one year
• Useful in
▫ Women desire lower no. of periods.
 Lifestyle
 Endometriosis
 Coagulopathy
 Anticoagulant therapy
 Dysmenorrhoea, menorrhagia, pms

17. 4. Ultra-low-dose Pills
• Combination
▫ Ethinyl estradiol 15µg
▫ Gestodene 60µg
• Clinical trials are ongoing
• Available abroad as “MINESSE”

18. Progesterone only Pills

19. • Contains no estrogen
• Formerly, contained 1G and 2G progesterone
• Currently, only available formulation containing
Desogestrel, the 3G progesterone
• Brand name- Cerazette: Recommended for
breast feeding woman

20. Mode of Action
• Depends on the dose of formulation
• 60% cases- ovulation inhibited
• Others- Alteration of cervial mucous,
Endometrial atrophy interfere implantation
• 20%- complete inhibition of follicular
development  total amenorrhoea
• Remaining – Irregular bleeding

21. Administration
• Must be taken daily
• No free pill interval
• Must be taken at the same time
• If late by 3hrs, backup method must be used
• In breastfeeding women, pills only starts after
6wks post partum
• In other cases, pill must start on 1st day of period

22. Effectiveness
• Used effectively in breastfeeding women, failure
rate 0.5%
• Typical failure rate: 3-5%

23. Indications
• Breastfeeding- Most common
▫ No ADE in volume or composition of milk
• Perimenopausal women
▫ Reduced fecundity adds to the effectiveness of
POP
• Conditions where Estrogen contraindicated
▫ SLE
▫ Cardiovascular diseae

24. Side Effects
• Major
▫ Disruption of menstrual pattern
• Reason for discontinuation- Irregular bleeding
• Amenorrhoea
• Minor
▫ Acne
▫ Breast tenderness

25. Thank You