2. Hormonal contraceptives
Hormonal means of contraception include the
following:
Injectable depomedroxyprogesterone acetate.
Progestin-only oral contraceptives.
91-day combination oral contraceptives.
Combination patch contraceptive.
Contraceptive vaginal ring.
3. Combined hormonal contraceptives
The Combined Oral Contraceptive Pill, usually called simply
‘the Pill’, contains two hormones, oestrogen and
progestogen. The main way the Pill works is by stopping a
woman’s ovaries from releasing an egg each month, which
means that a pregnancy cannot begin.
With perfect use the Pill is 99.7% effective. Providing
there are no medical reasons not to take the Pill, women
can safely use the Pill up to the age of 50.
4. Formulations:
Oral contraceptives come in a variety of
formulations. The main division is between
combined oral contraceptive pills, containing
both estrogen and progestin and progestin only
pills. Combined oral contraceptive pills also
come in varying types, including varying doses
of estrogen, and whether the dose of estrogen
or progestin changes from one week to the
next.
5. Prevention of ovulation is considered the
dominant mechanism of action, with the
combination of the 2 steroids creating a
synergistic effect that greatly increases
their antigonadotropic and ovulation-inhibitory
effects; these contraceptives also
alter the consistency of cervical mucus,
affect the endometrial lining, and alter
tubal transport
6. Formulations:
Oral contraceptives come in a variety of
formulations. The main division is between
combined oral contraceptive pills, containing
both estrogen and progestin and progestin only
pills. Combined oral contraceptive pills also
come in varying types, including varying doses
of estrogen, and whether the dose of estrogen
or progestin changes from one week to the
next.
7. Absolute contraindications
Breastfeeding <6 weeks postpartum.
Smoking 15 cigarettes/day and age 35. Multiple risk factors for
cardiovascular disease, Hypertension: systolic pressure 160 or
diastolic 100 mmHg, Hypertension with vascular disease, Current
or history of deep-vein thrombosis/pulmonary embolism, Major
surgery with prolonged immobilization, Known thrornbogenic
mutations.
Current or history of ischaemic heart disease and or strok,
Complicated valvular heart disease.
Diabetes for 20 years or with severe vascular disease or with
severe nephropathy, retinopathy or neuropathy.
Active viral hepatitis, Severe cirrhosis.
Current breast cancer, Benign or malignant liver tumors.
Migraine with aura.
8. Relative contraindications
Multiple risk factors for arterial disease, Hypertension: systolic blood pressure
140-159 or diastolic pressure 90-99 mmHg, or adequately treated to below
140/90 mml-Ig
Some known hyperlipidaemias, Current or medically treated gallbladder
disease, Mild cirrhosis, History of cholestasis related to combined oral
Contraceptives.
Obesity, Diabetes mellitus with vascular disease.
Smoking (<15 cigarettes/day) and age 35 years.
Migraine, even without aura, and age 35 years.
Breast cancer with >5 years without recurrence, Breastfeeding until six months
postpartum, Postpartum and not breastfeeding until 21 days, after childbirth.
Taking rifampicin (rifampin) or certain anticonvulsants.
9. Commonly reported side effects of COC
Central nervous: Depressed mood, System Mood swings,
Headaches, Loss of libido.
Gastrointestinal Nausea: Perceived weight gain, Bloatedness.
Reproductive system: Breakthrough bleeding, Increased
vaginal discharge.
Breasts: Breast pain, Enlarged breasts.
Miscellaneous: Chloasma (facial pigmentation which
worsens with time on COC), Fluid retention, Change in
contact lens.
10. A patient's choice of contraceptive method involves
factors such as efficacy, safety, no contraceptive
benefits, cost, and personal considerations.
About 222 million women who want to avoid
pregnancy in developing countries are not using a
modern birth control method. Birth control use in
developing countries has decreased the number
of maternal deaths by 40% (about 270,000 deaths
prevented in 2008) and could prevent 70% if the full
demand for birth control were met.
11. Combined hormonal vaginal rings
A combined contraceptive vaginal ring is licensed in the UK.
It is made of latex-free plastic and has a diameter of 54 mm.
It releases a daily dose of ethinyl estradiol 15 pg and etonorgestrel 120 pg.
The ring is worn for 21 days and removed for 7 days, during which time a
Withdrawal bleed occurs.
Insertion and removal of the ring is easy and it does not need to it in any
special place in the vagina.
The cycle control is excellent and probably better than with COC. As with
combined patches, the vaginal ring has the same risks and benefits as COC but
is more expensive.
12. Progestogen-only
contraception
Progestogen-only contraception avoids
the risks and side effects of oestrogen.
The current methods of progestogen-only
contraception are:
•progestogen-only pill, or ‘mini-pill’
•subdermal implant (Implanon)
•injectables (Depo-Provera®,
Noristerat®)
•hormone-releasing intrauterine system
(Mirena)
All progestogen-only methods work by:
Local effect; on cervical mucus, and on
the endometrium, preventing
implantation and sperm transport.
• Central effect; by and inhibiting
ovulation.
Nova ring
13. Subdermal implants
Irnplanon consists of a single silastic rod that is
inserted subdermally under local unaesthetic, into
the upper arm. It releases the progestogen
etonogestrel 25-70 mg daily (the dose released
decreases with time), which is metabolized to the
third-generation progestogen desogestrel. Irregular
bleeding is very common and is the major reason
for early discontinuation. There is a rapid return of
fertility when it is removed.
norplant
14. Injectable:
I depot medroxyprogesterone acetate 150 mg (Depo-
Provera/DMPA);
2 norethisterone enanthate 200 mg (Noristerat).
Acts by inhibiting ovulation with the suppression of
follicle-stimulating hormone (FSH) and LH levels and by
eliminating the LH surg.
side effects of Depo-Provera include:
weight gain of around 2-3 kg in the first year of use; delay in return
of fertility.
persistently irregular periods.
higher risk of osteoporosis in later life. Bone density seems to
recover when Depo-Provera is stopped.
15. Progestin-only oral contraceptives:
they contain the second-generation progestogen
norethisterone or norgestrel (or their derivatives) and the
third-generation progestogen desogestrel.
Mechanisms of action:
(1) suppression of ovulation;
(2) a variable dampening effect on the midcycle peaks of LH
and FSH;
(3) an increase in cervical mucus viscosity; (4) a reduction in
the number and size of endometrial glands; and (5) a
reduction in cilia motility in the fallopian tube Particular
indications for the POP include:
breastfeeding;
older age;
cardiovascular risk factors, for example high blood pressure,
smoking or diabetes.
16. •91-day combination oral contraceptives - Reduce the number of menstrual cycles
per year
•Combination patch contraceptive - Releases estrogen and progesterone directly
into the skin
•Contraceptive vaginal ring - Hormones are absorbed directly by the reproductive
organs
The common side effects of progestogen-only
methods include:
•erratic or absent menstrual bleeding;
•simple, functional ovarian cysts;
•breast tenderness;
acne
17. The current intrauterine devices (IUD)
are small devices, often 'T'-shaped,
often containing either copper or
levonorgestrel, which are inserted into
the uterus. They are one form of long-acting
reversible contraception which
are the most effective types of
reversible birth control.
Failure rates with the copper IUD is
about 0.8% while the levonorgestrel IUD
has a failure rates of 0.2% in the first
year of use.
18. It is generally believed that an IUD prevents
the sperm meeting and fertilizing an egg cell
as well as implantation of the fertilized egg
cell.
The most widely used form of reversible
contraception, with more than 180 million
users worldwide (IUDs).
An important discovery was that the
reliability of IUDs is greatly improved by
adding copper.
19. Copper T
polyethylene IUD with
fine copper wire
wrapped around the
vertical stem,
(250-370)
20. Nova T
• Nova T 380 is an intrauterine
device made of polyethylene
and wound with copper wire
with a silver core.
• The surface area of the copper
is 380 mm².
• The polyethylene body, shaped
as a modified T is impregnated
with barium sulphate.
• Removal threads, pigmented
with iron oxide are attached to
the base of the vertical arm of
the T.
21. multiloud
It is a small plastic rod, called stem,
with two small flexible side-arms.
The plastic is a mixture of high
density polyethylene, ethylene vinyl
acetate copolymer and barium
sulphate in a weight ratio 44/36/20.
A copper wire is wound around the
stem.
A nylon thread with two ends is
attached to the bottom end of the
stem.
multiloud
Dalcon
22. Mirena - Skyla
T-shaped, polyethylene
IUD with a reservoir
that contains
levonorgestrel, a
progesterone
23. Barrier methods of contraception
They prevent pregnancy
by creating a physical
barrier to the sperm
reaching and fertilizing
the egg. They can be used
in conjunction with a
hormonal method or IUD
to give personal
protection against
infection and to increase
contraceptive efficacy.
Condoms
24. Spermicides Emergency contraceptive methods:
sometimes misleadingly referred to as
"morning-after pills" or devices used
after unprotected sexual intercourse
with the hope of preventing pregnancy.
They work primarily by preventing
ovulation or fertilization.
A number of options exist, including high
dose birth control pills, levonorgestrel,
mifepristone, ulipristal and IUDs.
Levonorgestrel pills, when used within 3
days, decrease the chance of pregnancy
after a single episode of unprotected
sex or condom failure by 70% (resulting
in a pregnancy rate of 2.2%)
They all contain the
active ingredient
nonoxynol-9.
Spermicides are
designed to be used
with another barrier
method to make them
more
effective.
25. Withdrawal
• Other forms of :
male contraception
Are in various stages of
research and development.
These include methods like
RISUG/VasalGel (which has
completed a small phase II
clinical trial in humans in India),
and ultrasound (with results so
far obtained in experimental
animals.
withdrawal, or coitus
interruptus, is a
widespread
practice and obviously
does not require any
medical
advice or supplies.
Unfortunately, it is not
particularly reliable, as
pre-ejaculatory
secretions may
contain millions of sperm
and young men often find
it hard to judge the timing
of withdrawal.
26. Sterilization tubal ligation for women
and vasectomy for men
During a tubal ligation, the fallopian tubes are cut or blocked to
permanently prevent pregnancy. A tubal ligation disrupts the movement of
the egg to the uterus for fertilization and blocks sperm from traveling up
the fallopian tubes to the egg.
A tubal ligation can be done at any time, including after childbirth or in
combination with another abdominal surgical procedure, such as a C-section.
It's possible to reverse a tubal ligation — but reversal requires
major surgery and isn't always effective.
During a vasectomy, the vas deferens from each testicle is clamped, cut,
or otherwise sealed. This prevents sperm from mixing with the semen
that is ejaculated from the penis.
