This document discusses various contraceptive methods including natural, barrier, hormonal, and intrauterine devices. It focuses on hormonal contraception, describing how different hormonal methods work to prevent ovulation and fertilization. The main hormonal contraceptives discussed are oral contraceptive pills containing estrogen and progestin, as well as emergency contraceptive pills containing just progestin. The document outlines the types of oral contraceptive pills, how they work, possible side effects, benefits and risks. Emergency contraceptive pills are described as a backup method to prevent pregnancy after unprotected intercourse.

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