comprehensive Oral Contraceptives for .pptx

10/26/2024 Hormonal methods by Abas Ahmed 1
Hormonal methods
Prepared by Abas A(BSc.N and Candidate of MSc.)

Hormonal methods
Hormonal methods – Oral contraceptive pills, injectable $ implants
Oral contraceptive pills :-When taken orally, hormone level raises.
 Synthetic Preparation of estrogen and progesterone.
Negative feedback Effect act on Anterior Pituitary.
Inhibit Gonadotropins (FSH & LH) and ovulation.
Types of OCP:
1. Combined oral contraceptives
2. Progestin only pills

Providing Combined Oral Contraceptives
Combined oral contraceptives—Also called “the pill.”
It contain the hormones estrogen and progestin.
The pill is taken at the same time each day.
Mechanism of action
 Inhibits ovulation
 Prevents implantation
 Makes cervical secretion thick, viscid
Effectiveness:-When used correctly prevention rate greater than 99%

Indications
Nulliparous, Young, sexually active
Not at risk for STIs, including HIV
Desiring spontaneous intercourse
Non lactating postpartum
Desiring a reversible method
Bothered by heavy or painful periods

Advantages
Highly effective and Safe
Can be used at any age from adolescence to menopause
Fertility returns soon after stopping
Can be used as emergency contraceptive after unprotected sex
Reduction of acne and hirsutism
Regular, lighter monthly bleeding and fewer days of bleeding

Disadvantages
Not highly effective unless taken everyday
New packet of pills must be at hand every 28 days
Not recommended for breast feeding women:-
because it affect the quality and quantity of milk
It may cause mood changes (depression, less interest in sex)
Do not protect against STI including AIDS

Side effects
Common during the first three cycles and usually disappear
Breakthrough bleeding
Nausea
Breast tenderness
Dizziness and Mild headaches
Fluid retention, Weight gain
Depression
Amenorrhea

Contraindication
Breast-feeding, Age > 35 years and smoking
Risk factors for arterial CVD (Older age, smoking, DM, HTN)
Elevated blood pressure of 160/100 mmHg
Current or history of DVT or pulmonary embolism
Current or history of ischemic heart disease and Stroke
Complicated valvular heart disease, and Current breast cancer
Migraine with or without focal neurologic symptoms

Starting COC pills
It depends on women’s situation
Having menstrual cycles
 Any of the first 7 days after her menstrual bleeding starts
 Any other time if certain that she is not pregnant and should avoid
sex or also use condoms or spermicidal for the next seven days
Postpartum
 If breast feeding- after she stop breastfeeding/6 months after birth.
 If not breast feeding- 3-6 weeks after child birth
After miscarriage or abortion
 In the first 7 days after first or second trimester miscarriage
 Later any time it is reasonably certain that she is not pregnant

What to do after missing pills
Missing only one (white) hormonal pill
 Take the missed pill as soon as she remembers
 Take the next pill at the regular time. This may mean taking 2
pills on the same day or even 2 at the same time
 Take the rest of the pills as usual, one each day
Missing two or more (white) hormonal pills in any 7 days
 Most important: for 7 days use condom, spermicidal or avoid sex
 Take one (white) hormonal pill at once
 Count how many (white) hormonal pills are left in the packet

What to do after missing pills…
Seven or more (white) hormonal pills left
 Take all the rest of the pills as usual on each day or
Fewer than seven (white) hormonal pills left
 Take the rest of the white hormonal pills as usual
 Do not take any brown reminder pills
 Start a new pack on the next day after the last white hormonal pill

Progestin only pills
 Is an oral hormonal contraceptive, containing only progesterone.
Mechanism of action
 Thicken cervical mucous making it difficult for sperm to pass.
 Reduces development of the uterine lining
Effectiveness
 POPs are generally less effective than COCs
 If used correctly 5 in 1000 women pregnant in the first year
 In breast feeding women however, POP is nearly 100% effective

Indications
Breast feeding
Diabetic, Obese or thin
Have hypertension, Smoke cigarettes
Have developed other estrogen-related complications
In any age including adolescents and over 40
Have just had abortion or miscarriage
Have or not have children

Advantages
No estrogen side effects
Can be used by nursing mothers starting 6 weeks after childbirth
Women take one pill everyday with no break
Can be very effective during breastfeeding
Disadvantages
Should be taken at about the same time to work best
Lack of protection against STIs including HIV
Ectopic pregnancy as a result of mini pill failure
Interaction with anticonvulsants

Side effects
Menstrual cycle disturbances like:-
Breakthrough bleeding,
Prolonged bleeding,
Spotting and
Amenorrhea
Headache
Acne
Mood changes

Starting POPs
Breastfeeding: as early as 6 weeks after childbirth
After child birth if not breast feeding: Immediately
Or any time in first 4-6 weeks after childbirth.
After miscarriage or abortion: Immediately
Or in the first 7 days after 1st
/2nd
trimester abortion.
Having menstrual cycles it is certain that she is not pregnant.
If not starting in the first 5 days of menstrual period back up
method is needed or avoid sex for at least the next 48 hours

What to do after missing pills
 Take most recent missed pill as soon as possible
 Abstain or use back up method for 48 hours
 Take next pill at regular time

Injectable contraceptives
The most common type known as Depo-provera (3 months apart)
Mechanism of action
Mainly stops ovulation (release of eggs from ovaries)
Thickens cervical mucus, making it difficult for sperm to pass
Effectiveness:-Very effective 0.3 px per 100 women in 1st
year
Indications:- Women who
Are breastfeeding and Smoke cigarettes
Are any age, including adolescents and over 40
Have just had abortion or miscarriage

Advantage
Long term effective contraceptive
Does not interfere with sex
No daily pill taking
Allows some flexibility in return visits.
Can return from 2 weeks early $ 2 weeks late for next injection
Can be used by nursing mothers 6 weeks after childbirth
No estrogen side effects
Helps prevent uterine fibroids and ectopic pregnancies

Disadvantages
 Delayed return of fertility
 Requires another injection every 3 months
 Does not protect against STIs including HIV/AIDS
Side effects
Menstrual cycle disturbance
Light spotting or bleeding, Heavy bleeding can occur at first
Amenorrhea, normal especially after first year of use
May cause weight gain, headaches, breast tenderness, moodiness,
nausea, hair loss, loss of sex drive and/or acne in some women

Starting Depo
Having menstrual cycles
Any time it is reasonably certain that she is not pregnant
If starting during the first 7 days after menstrual bleeding starts,
No back up method is needed for extra protection
If she is starting on or after day 8 of her menstrual period,
She should use condoms or spermicidal or
Avoid sex for at least the next 48 hours

Breast feeding
As early as 6 weeks after childbirth
If menstrual periods have returned, she can start depo any time
After childbirth if not breast feeding
Immediately or at any time in the first 6 weeks after child birth
After 6 weeks any time it is certain that she is not pregnant
After miscarriage or abortion
Immediately or in first 7 days after 1st
or 2nd
trimester abortion
Later any time it is reasonably certain that she is not pregnant

Implants (sub-dermal implants)
 Is a highly effective, long acting, reversible, low dose, POC.
 Very effective- the failure rate in the first year is 0.1-0.2
Mechanism of action
Implant inhibits ovulation
Thickens cervical mucus making it difficult for sperm to pass
Causes changes in the uterine lining
6-Rod Norplant 2-Rod Jadelle 1-Rod Implanon

Indications
For women who
Want a long term contraceptive method
Desire a method that is not coital related
Prefer method that neither taken daily nor need frequent supply
Have number of children they want, but not wish to be sterilized
Should not estrogen containing contraceptive
Have problems remembering to take oral contraceptive

Advantages
Very effective,
Long term protection, but reversible
No need to do anything at time of sexual intercourse
Nothing to remember
Fertility returns almost immediately after capsules are removed
Can be used by nursing mothers starting 6 weeks after child birth
No estrogen side effect
Help prevent iron deficiency anemia, ectopic pregnancies,
endometrial cancer

Disadvantages
Minor surgical procedures required
Discomfort for several hours to one day after insertion
Do not protect against STIs including HIV/AIDS
Local inflammation or infection at the site of implants
Its effectiveness lowered by anti seizure medicines and rifampicin
Common side effects
Change in menstrual bleeding including:
Light spotting or bleeding between monthly periods,
Prolonged bleeding, amenorrhea

THANKS TO YOU!!!
GALATOOMA!!!

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