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1. CONTRACEPTION

2. objectives
At the end of this session each student should be able to,
• a) List contraceptive drugs
• b) Classify contraceptives
• c) List common examples of contraceptives
• d) Describe mechanism of action of contraceptives
• e) List routes of administration of contraceptives
• f)Describe drug-drug interactions of oral Contraceptives
• g) Describe adverse effect of oral contraceptives
• h) Prescribe contraceptives according to guideline

3. Classification of contraceptives
• Natural contraceptives e.g. abstinence, lactation,
calendar method
• Mechanical contraceptives e.g. male and female
condom, cervical cap
• Hormonal contraceptives e.g. IUD, injections,
pills, vaginal ring, skin patch
• Surgical contraceptives e.g. vasectomy and tubal
ligation

4. Hormone-based contraceptives
5 types of hormone based contraceptives
1) Oral contraceptives (pills)
2) Vaginal ring
3) Transdermal patch
4) Injected hormones
5) Hormonal IUDs

5. Mechanism of action
• Combined hormonal contraceptives were
developed to prevent ovulation by
suppressing the release of gonadotropins.
• They inhibit follicular development and
prevent ovulation as a primary mechanism of
action.

6. Mechanism of action….
• Progestogen negative feedback decreases the pulse
frequency of gonadotropin-releasing hormone(GnRH)
release by the hypothalamus, which decreases the release
of follicle-stimulating hormone(FSH) and greatly decreases
the release of luteinizing hormone(LH) by the anterior
pituitary.
• Inhibition of follicular development and the absence of a LH
surge prevent ovulation.
• Estrogen negative feedback on the anterior pituitary greatly
decreases the release of FSH, which inhibits follicular
development and helps prevent ovulation

7. 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


8. Types of oral contraceptives
1. Progestin-only pill (POP)
– Low dose of progestin and no estrogen
– For women who should not take estrogen
(breastfeeding, high B.P., at risk for blood clots,
smoke)
–usually norethindrone (a “mini-pill”),
2. Combined oral contraceptive pill (COC).
-Is made up of two hormones an estrogen and
progestrerone

9. Oral Contraceptives Classification
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10. OCP Drug-drug interaction
Enzyme-inducing drugs such as carbamazepine,
griseofulvin, phenobarbital, phenytoin, and rifampicin
may enhance the clearance of oral contraceptives.
Some antibacterial that do not induce liver enzymes
(e.g. ampicillin, doxycycline) may reduce the efficacy of
combined oral contraceptives by impairing the
bacterial flora responsible for recycling ethinylestradiol
from the large bowel.
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11. OCP Adverse effects
common adverse effects with estrogens are breast
fullness, fluid retention, headache, and nausea.
Increased blood pressure may also occur.
Progestin's may be associated with depression, changes
in libido, hirsutism, and acne.
Although rare, thromboembolism, MI, and stroke may
occur with use of OCP.
Weight gain,bleeding between periods
May clear up after 2-3 cycles on the pill
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12. OCP Adverse effects cont..
The incidence of cervical cancer may be increased
with OC, because women are less likely to use
additional barrier methods of contraception that
reduce exposure to HPV
Persistent headache is common with OCP.
Weight gain, nausea, mood changes and skin
pigmentation can occur with OCP.
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13. How to use oral contraceptives
• Different types of OCs will differ in how to begin,
and other instructions--read instructions carefully &
talk w/health care practitioner
• Don’t skip pills, regardless of whether or not you
are having sex
• Take pill at the same time each day
– If you miss 1 pill: take missed pill as soon as you
remember, and then take next pill at the regular time
– If you miss >1 pill: consult health care practitioner for
advice; use a backup method for remainder of your cycle

14. 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
• 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
– Side effect; skin irritation

15. Other hormonal methods (cont.)
• Injected Contraceptives
– Depo-Provera (prog.); Lunelle (prog.+est.)
– Injections: D-P every 12 weeks; Lunelle monthly
– Side effects; weight gain, bleeding, mood change, takes up to
10 months for a woman to get pregnant after stopping
injections
• Contraceptive Implants
– 1.5” rod is inserted under skin of upper arm
– Progestin-only
– Effective for up to 3 years
– Side effects; weight gain, bleeding, mood change.

16. Barrier & spermicide methods
• Include:
– Condoms (male & female)
– Spermicides (foam, sponge)
– Cervical barriers (diaphragm & cervical cap)
• Work by preventing sperm from reaching an
egg
• Only condoms provide protection against
STIs

17. Vaginal spermicides
• Include: foam, sponge, suppositories,
creams, film
• Is a non hormonal contraceptives.
• Spermicide: chemical that kills sperm
(nonoxynol-9)

18. Cervical barrier devices
• Covering the cervix is one of the oldest methods in
contraceptive
• Cervical cap: covers cervix only
• Diaphragm: covers upper vaginal wall behind cervix
underneath pubic bone
• Method is usually combined w/spermicide

19. Intrauterine Devices (IUDs)
• Small plastic objects inserted into
uterus
• 2 types
– Hormone-releasing
(progesterone)
– Copper-releasing
• Have fine plastic threads attached that hang slightly out
of cervix into vagina for removal
• Very high continuation rate (how many women are still
using it one year after starting) compared w/other
methods
progesterone

20. IUD Mechanisms of Action
Levonorgestrel-Releasing IUD
(LNG-IUS, Mirena®)
– Inhibits fertilization
– Thickens cervical mucous
– Inhibits sperm function
– Thins and suppresses the
endometrium
Copper-Releasing IUD
(ParaGard® T380A)
– Inhibits fertilization
– Releases copper ions (Cu2+) that
reduce sperm motility
– May disrupt the normal division
of oocytes and the formation of
fertilizable ova

21. Emergency Contraception
• Works mainly by preventing ovulation or fertilization
• In theory, can also interfere w/implantation
• EC is increasingly less effective with delay use.
• Oral contraceptive pills
– 95% effective within 24 hrs; 75% effective within 72 hrs
– Preven: 2 doses of combined estrogen & progesterone
– Plan B: 2 doses of progesterone
– Other combinations of oral contraceptives can
substitute for these

22. Sterilization
• Essentially permanent, although vasectomies are
sometimes reversible
• Does not affect hormones, desire, sexual functioning
• Female sterilization
– Tubal sterilization: fallopian tubes are severed to block
passage of sperm & eggs
– Transcervical sterilization: tiny coil inserted through cervix
into fallopian tubes
• Coil promotes tissue growth that, after 3 months, blocks fallopian
tubes
• Male sterilization (vasectomy)
– Safer, less expensive, fewer complications than female
sterilization
– Cutting and closing vas deferens (ducts that carry sperm)

23. Ex. of female sterilization procedure
• Laparoscope: narrow, lighted viewing instrument that is
inserted into abdomen to locate the fallopian tubes

24. Ex. of male sterilization procedure
• Vas deferens on
each side is cut;
small section is
removed, and the
ends are tied off or
cauterized

25. References
• British Medical Association and Royal
Pharmaceutical Society of Great Britain (2008).
British National Formulary (BNF) No. 78.UK:
Pharmaceutical Press.
• MoHCDEC (2017). Standard Treatment Guidelines
(STG’s) and The National Essential Drug List for
Tanzania, NEDLIST (cur ed.). Dar es salaam,
Tanzania: Ministry of Health.
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26. References
• British Medical Association and Royal
Pharmaceutical Society of Great Britain (2008).
British National Formulary (BNF) No. 78.UK:
Pharmaceutical Press.
• MoHCDEC (2017). Standard Treatment Guidelines
(STG’s) and The National Essential Drug List for
Tanzania, NEDLIST (cur ed.). Dar es salaam,
Tanzania: Ministry of Health.
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