For All medical students

1. CONTRACEPTION

2. CLASSIFICATIONS
A. Natural Methods
 Periodic abstinence
 Withdrawal
 Lactational Amenorrhea Method
B. Barrier Methods
C. Hormonal
D. Intrauterine Devices
E. Sterilization

3. CHOOSING THE BEST CONTRACEPTIVE
 Effectiveness - statistics show two numbers:
 Failure rate: # of women per 100 who become
pregnant after 1 yr. when using a b.c. consistently &
correctly
 Typical use failure rate - takes into account
improper or inconsistent use
 Factors that contribute to improper use include: lack of
partner involvement, forgetfulness, feeling guilty about sex,
poor communication w/partner, not wanting to appear
“easy”
 About half of all unintended pregnancies occur
among women using contraceptives
 Cost
 Ease of use
 Side effects

4. HORMONAL CONTRACEPTION

5. TYPES OF HORMONAL CONTRACEPTIVES
 Combined pills
 Progestin pills (minipills)
 Subdermal patches
 Injections
 Vaginal ring

6. HOW HORMONAL
CONTRACEPTIVES
WORK
FSH & LH trigger
ovulation
Gonadotropin releasing
hormone (GnRH) triggers
release of gonadotropins
FSH & LH
Estrogen & progesterone in
hormonal contraceptives
inhibit LH, FSH, and GnRH
secretion, preventing ovulation

Progesterone also:
•thickens cervical mucus to prevent
Passage of sperm into the uterus
•changes uterine lining to inhibit implantation


7. ORAL CONTRACEPTIVES
World wide used
very convenient method
Reversible methods

8. TYPES OF ORAL CONTRACEPTIVES
 Constant-dose combination pill
 Contains both estrogen and progestin
 Dose of each is constant throughout cycle
 Amount of estrogen in pills has decreased from approx. 175
micrograms in 1960 to avg. of 25 micrograms today
 Triphasic pill
 Levels of hormones (estrogen & progestin) fluctuate during cycle
 Seasonale
 Reduces the # of menstrual periods to 4 instead of 13 per year
 Has lower dose of estrogen and progestin
 Progestin-only pill
 Low dose of progestin and no estrogen
 For women who should not take estrogen (breastfeeding, high
b.p., at risk for blood clots, smoke)

9. COMBINED
 Composition
- Combination of Estrogen & Progesterone
- Ethinyl Estradiol (most commonly used nowadays)
- Levonorgestrel, Norethindrone
 Intake
- 21 days: 1 pill/day
- Last 7 days: free
 Mini pills; Used for 28 days, no breaks
- Same time of the day

10. SIDE EFFECTS
Mostly caused by progestin
 Nausea
 Breast tenderness
 Fluid retention
 Depression
 Headache
 Acne
 Weight gain
 Decreased sexual interest
 Vaginal bleeding

12. METABOLIC EFFECTS
combined chemical clinical
HDL increase cardiovascular
disease ?
LDL decrease
TG increase
Progestin only
HDL decrease
LDL increase
TG decrease

13. POSSIBLE CONTRAINDICATIONS
 Women who should not take OCs:
 history of blood clots, strokes, heart/circulation
problems, jaundice, breast or uterine cancer,
liver disease
 Women considered risky for taking OCs:
 Women who smoke, have migraines,
depression, high b.p., epilepsy,
diabetes/prediabetes, asthma, varicose veins

14. NONCONTRACEPTIVE BENEFITS
 BENEFITS FROM ANTIESTROGENIC EFFECTS OF
PROGESTERON:
1-decrease menses blood loss & improve anemia
2- risk of adeno CA of uterus
3- estrogen receptors in breast so risk
begnin breast disease ?
 BENEFITS FROM INHIBITION OF OVULATION
(dysmenorrhea ) use as therapy of severe dysmenorrhea
 OTHER BENEFITS: risk (PID, Rhumatoid and bone loss)

15. OTHER HORMONAL METHODS
(CONTAIN BOTH ESTROGEN AND PROGESTIN)
 Vaginal ring (Nuvaring)
 2” ring inserted into the vagina during period
 Worn for 3 weeks, removed for 1 week, then
replaced with new ring
 Very expensive
 Pros: no daily pill; spontaneity
 Cons: no STD protection, not effective for
women over 90kg.
 Transdermal patch (Ortho Evra)
 Patch is placed on buttock, abdomen, outer
upper arm, or upper torso
 Replaced weekly for 3 weeks, then a patch-free
week
 Quite expensive
 Pros: no daily pill; spontaneity
 Cons: no STD protection, skin irritation

17. OTHER HORMONAL METHODS (CONT.)
 Injected Contraceptives
 Depo-Provera, Norethisterone (prog.)
 Injections: D-P every 12 weeks; Norethisterone
monthly
 Pros: no daily pill; spontaneity
 Cons: no STD protection, weight gain, bleeding,
mood change, frequent clinic visits
 D-P: takes up to 10 months for a woman to
get pregnant after stopping injections
 Contraceptive Implants - Jadell
 1.5” rod is inserted under skin of upper arm
 Progestin-only
 Effective for up to 5 years
 Cost not yet known
 Pros: no daily pill; spontaneity
 Cons: no STD protection, weight gain, bleeding,
mood change, surgical procedure

18. EMERGENCY CONTRACEPTION

19. Emergency contraception (EC)
is any method of contraception
which is used after intercourse
and before the potential time
of implantation

20. From fertilization to
implantation about 6 days

21.  As these methods work prior to
implantation, they are not abortifacients.
 Emergency contraception is a backup
method for occasional use, and should not
be used as a regular method of birth control.

22.  There are 2 methods of emergency
contraception:
1. Hormonal methods, which involve the use
of emergency contraceptive pills (ECPs),
and
2. The post-coital insertion of a
copper intrauterine device (IUD).

23.  Two hormonal preparations are:
1. One contains only the progestin levonorgestrel,
while the other is a
2. Combined preparation containing both ethinyl
estradiol and levonorgestrel.

24. LEVONORGESTREL

25. MECHANISM OF ACTION
 prevent pregnancy by having several
effects:
1. Ovulation is inhibited or delayed .
2. Fertilization is impaired by altering tubal
transport of sperm or ova .
3. Endometrial changes that prevent a
fertilized egg from implantation .
4. Cervical mucus is thickened.

26. MODE OF ACTION
"The effect of treatment depends on when in the
female's cycle it is used."
Corpus luteum… disrupted
formation … interfe-rence with
its function
Cervical mucus… alteration in it
sperm entrapped or
impaired function
Before ovulation… disrupt normal
follicular development & maturation
interference in ovulation , with deficient/
impaired luteal function & delay in LH surge
Fertilization…
direct inhibition
Sperm… interferes with its
migration & function in the
genital tract

27. CONTRAINDICATIONS AND SIDE EFFECTS
 The only absolute contraindication to the use of
emergency hormonal contraception is known
pregnancy
 Vomiting
 Nausea
 Menstral disruption
 Fatigue
 Headache
 Dizziness and breast tenderness