This document provides information on various newer approaches to female contraception that are being evaluated globally. It begins by outlining the need for newer contraceptive methods due to unintended pregnancies and non-compliance with existing options. It then evaluates several newer methods including newer pills with modified formulations and dosages, implants, patches, rings, injectables, intrauterine devices, and gene-based and immune-based approaches. Key criteria used to evaluate the methods include efficacy, side effects, ease of use, duration of action, manufacturing costs, and additional health benefits. The document focuses on innovations to existing hormonal methods, particularly a 24+4 regimen oral contraceptive pill containing drospirenone that has demonstrated increased ovulation inhibition,
The comparison of dinoprostone and vagiprost for induction of lobar in post t...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Role of Dydrogesterone in Threatened Abortion Dr Sharda Jain Lifecare Centre
*EXPERINCE SHARING By EXPERTS*
Dr Uma Rai(DGF *E*)
Dr Sangeetaa Gupta(DGF *E*)
Dr Neerja Varshney(DGF *E*)
Dr Surjeet Kapoor(DGF *E*)
Dr Rupam arora(DGF *E*)
Dr Meenakshi Ahuja(DGF *S* )
Dr.Harsha khullar(DGF *C* )
Dr Mamta mittal(DGF *N*)
Dr Leena Sreedhar(DGF *D*)
Dr.Dipti Nabh(DGF *E*)
Dr. Shama Batra(DGF *E*)
Dr Poonam Paul(DGF *SW*)
PAN DGF ( DELHI GYNAECOLOGIST FORUM) CME ON DYDROGESTERONE ON 3/2 /22
The comparison of dinoprostone and vagiprost for induction of lobar in post t...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Role of Dydrogesterone in Threatened Abortion Dr Sharda Jain Lifecare Centre
*EXPERINCE SHARING By EXPERTS*
Dr Uma Rai(DGF *E*)
Dr Sangeetaa Gupta(DGF *E*)
Dr Neerja Varshney(DGF *E*)
Dr Surjeet Kapoor(DGF *E*)
Dr Rupam arora(DGF *E*)
Dr Meenakshi Ahuja(DGF *S* )
Dr.Harsha khullar(DGF *C* )
Dr Mamta mittal(DGF *N*)
Dr Leena Sreedhar(DGF *D*)
Dr.Dipti Nabh(DGF *E*)
Dr. Shama Batra(DGF *E*)
Dr Poonam Paul(DGF *SW*)
PAN DGF ( DELHI GYNAECOLOGIST FORUM) CME ON DYDROGESTERONE ON 3/2 /22
Abstract— Cervical ripening is an essential factor for initiation of normal labour for vaginal delivery. Prior to onset of spontaneous labour the cervix undergoes a gradual process of ripening. But in certain cases it does not occur spontaneously at term and sometimes induction of labour is required. Then cervical ripening means high bishop score in essential for successful induction of labour. This comparative study was conducted at Bikaner to compare induction of labour by vaginal prostaglandin E1 tablet (tablet Misoprostol 25 µg 4 hourly) and Intra cervical Dinoprostone gel 0.5 mg. For this purpose 100 clients were given vaginal prostaglandin E1 tablet (tablet Misoprostol 25 µg 4 hourly) and 100 clients were given Intra cervical Dinoprostone gel 0.5 mg. It was observed in this study that Dinoprostone gel is more efficacious for cervical ripening and labour induction in cases of nulliparous & primiparous at term with unfavourable cervix with intact membranes, as compared to misoprostol in terms of shorter total duration of labour, shorter mean induction delivery interval, more spontaneous vaginal deliveries, and reduced incidence of LSCS as well as instrumental deliveries.
Update (2021) Oral Contraceptive Pill : Dr. Jyoti Agarwal Dr Sharda Jain Lifecare Centre
Update (2021) Oral Contraceptive Pill : Dr Sharda Jain
7 Billion 2011 & increasing a rate of 150 million per year
INDIA
Today – 1.3 billion 2050 – 1.628 expected
Effects of intrauterine retention and postmortem interval on body weight following intrauterine death: implications for assessment of fetal growth restriction at autopsy
J Man, JC Hutchinson, M Ashworth, AE Heazell, S Levine and NJ Sebire
Volume 47, Issue 11; Date: November, pages 574–578
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.16018/full
Organ weights and ratios for postmortem identification of fetal growth restriction: utility and confounding factors
J Man, JC Hutchinson, M Ashworth, I Jeffrey, AE Heazell, and NJ Sebire
Volume 48, Issue 5; Date: November, pages 585–590
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.16017/full
PANEL DISCUSSION ON PRACTICAL APPROACH TO ENDOMETRIOSISWith FOCUS ON DINOGESTLifecare Centre
PANEL DISCUSSION ON PRACTICAL APPROACH TO ENDOMETRIOSISWith FOCUS ON DINOGEST
UMA RAI
RAJ BOKARIA
JYOTI AGARWAL
JYOTI BHASKER
RENU CHAWLA
DIPTI NABH
VANDANA GUPTA
Since the first formal description of LPD in 1949 as a possible cause of infertility and recurrent miscarriage by Jones. Innumerable investigations have been undertaken in an effort to verify its existence or to characterize its pathophysiology, diagnosis, and treatment. The consensus of the literature is that LPD does exist and that its cause is multifactorial like abnormal folliculogenesis, inadequate LH surge,inadequate secretion of progesterone by the corpus luteum, aberrant end-organ response by the endometrium.
Dexamethasone in Prevention of Respiratory Morbidity in Elective Caesarean S...احمد عبدالراضى
Dexamethasone in Prevention of Respiratory Morbidity in
Elective Caesarean Section in Term Fetus
Qena University Hospital Experience
By
Ahmed Abdel-Rady Ali
(M.B, B.Ch.)
Resident physician in obstetrics and gynecology
Qena University Hospital
South Valley University
Course Director, Elizabeth A. Stewart, MD, prepared useful Practice Aids pertaining to uterine fibroids and endometriosis for this CME activity titled "Advances in Medical Options for Uterine Fibroids and Endometriosis: Clinical Highlights From Montreal." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2HY3HDz. CME credit will be available until June 24, 2020.
Surgical treatment for hydrosalpinx prior to in‐vitro fertilization embryo transfer: a network meta‐analysis
A. Tsiami, A. Chaimani, D. Mavridis, M. Siskou, E. Assimakopoulos, A. Sotiriadis
Volume 48, Issue 4, Pages 434–445
Slides prepared by Dr Shireen Meher (UOG Editor for Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15900/full
Dydrogesterone versus progesterone for luteal-phase support: systematic review and meta-analysis of randomized controlled trials
M. W. P. Barbosa, L. R. Silva, P. A. Navarro, R. A. Ferriani, C. O. Nastri and W. P. Martins
Volume 48, Issue 2, Pages 161–170
Slides prepared by Dr Aly Youssef (UOG Editor for Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15814/full
Study design: A Randomized prospective comparable study.
Objective: To compare the effi cacy of GnRH agonist stop antagonist and GnRH antagonist protocols in ICSI outcome for women
who are expected to have poor ovarian response.
Setting: ART unit of Obstetrics and Gynecology Department of Qena University Hospital, South Valley University, Egypt.
Duration: From September 2016 to December 2017.
Abstract— Cervical ripening is an essential factor for initiation of normal labour for vaginal delivery. Prior to onset of spontaneous labour the cervix undergoes a gradual process of ripening. But in certain cases it does not occur spontaneously at term and sometimes induction of labour is required. Then cervical ripening means high bishop score in essential for successful induction of labour. This comparative study was conducted at Bikaner to compare induction of labour by vaginal prostaglandin E1 tablet (tablet Misoprostol 25 µg 4 hourly) and Intra cervical Dinoprostone gel 0.5 mg. For this purpose 100 clients were given vaginal prostaglandin E1 tablet (tablet Misoprostol 25 µg 4 hourly) and 100 clients were given Intra cervical Dinoprostone gel 0.5 mg. It was observed in this study that Dinoprostone gel is more efficacious for cervical ripening and labour induction in cases of nulliparous & primiparous at term with unfavourable cervix with intact membranes, as compared to misoprostol in terms of shorter total duration of labour, shorter mean induction delivery interval, more spontaneous vaginal deliveries, and reduced incidence of LSCS as well as instrumental deliveries.
Update (2021) Oral Contraceptive Pill : Dr. Jyoti Agarwal Dr Sharda Jain Lifecare Centre
Update (2021) Oral Contraceptive Pill : Dr Sharda Jain
7 Billion 2011 & increasing a rate of 150 million per year
INDIA
Today – 1.3 billion 2050 – 1.628 expected
Effects of intrauterine retention and postmortem interval on body weight following intrauterine death: implications for assessment of fetal growth restriction at autopsy
J Man, JC Hutchinson, M Ashworth, AE Heazell, S Levine and NJ Sebire
Volume 47, Issue 11; Date: November, pages 574–578
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.16018/full
Organ weights and ratios for postmortem identification of fetal growth restriction: utility and confounding factors
J Man, JC Hutchinson, M Ashworth, I Jeffrey, AE Heazell, and NJ Sebire
Volume 48, Issue 5; Date: November, pages 585–590
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.16017/full
PANEL DISCUSSION ON PRACTICAL APPROACH TO ENDOMETRIOSISWith FOCUS ON DINOGESTLifecare Centre
PANEL DISCUSSION ON PRACTICAL APPROACH TO ENDOMETRIOSISWith FOCUS ON DINOGEST
UMA RAI
RAJ BOKARIA
JYOTI AGARWAL
JYOTI BHASKER
RENU CHAWLA
DIPTI NABH
VANDANA GUPTA
Since the first formal description of LPD in 1949 as a possible cause of infertility and recurrent miscarriage by Jones. Innumerable investigations have been undertaken in an effort to verify its existence or to characterize its pathophysiology, diagnosis, and treatment. The consensus of the literature is that LPD does exist and that its cause is multifactorial like abnormal folliculogenesis, inadequate LH surge,inadequate secretion of progesterone by the corpus luteum, aberrant end-organ response by the endometrium.
Dexamethasone in Prevention of Respiratory Morbidity in Elective Caesarean S...احمد عبدالراضى
Dexamethasone in Prevention of Respiratory Morbidity in
Elective Caesarean Section in Term Fetus
Qena University Hospital Experience
By
Ahmed Abdel-Rady Ali
(M.B, B.Ch.)
Resident physician in obstetrics and gynecology
Qena University Hospital
South Valley University
Course Director, Elizabeth A. Stewart, MD, prepared useful Practice Aids pertaining to uterine fibroids and endometriosis for this CME activity titled "Advances in Medical Options for Uterine Fibroids and Endometriosis: Clinical Highlights From Montreal." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2HY3HDz. CME credit will be available until June 24, 2020.
Surgical treatment for hydrosalpinx prior to in‐vitro fertilization embryo transfer: a network meta‐analysis
A. Tsiami, A. Chaimani, D. Mavridis, M. Siskou, E. Assimakopoulos, A. Sotiriadis
Volume 48, Issue 4, Pages 434–445
Slides prepared by Dr Shireen Meher (UOG Editor for Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15900/full
Dydrogesterone versus progesterone for luteal-phase support: systematic review and meta-analysis of randomized controlled trials
M. W. P. Barbosa, L. R. Silva, P. A. Navarro, R. A. Ferriani, C. O. Nastri and W. P. Martins
Volume 48, Issue 2, Pages 161–170
Slides prepared by Dr Aly Youssef (UOG Editor for Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15814/full
Study design: A Randomized prospective comparable study.
Objective: To compare the effi cacy of GnRH agonist stop antagonist and GnRH antagonist protocols in ICSI outcome for women
who are expected to have poor ovarian response.
Setting: ART unit of Obstetrics and Gynecology Department of Qena University Hospital, South Valley University, Egypt.
Duration: From September 2016 to December 2017.
Contraception where have we been and where are we going is a presentation made by Dr.Laxmi Shrikhande who is a Fertility Specialist, Laparoscopic Surgeon & no scar Hysterectomy Specialist and a leading Gynaecologist from Nagpur
Early pregnancy loss by dr alka mukherjee dr apurva mukherjee nagpur ms indiaalka mukherjee
Early pregnancy loss, or loss of an intrauterine pregnancy within the first trimester, is encountered commonly in clinical practice. Obstetricians and gynecologists should understand the use of various diagnostic tools to differentiate between viable and nonviable pregnancies and offer the full range of therapeutic options to patients, including expectant, medical, and surgical management.
Early pregnancy loss is defined as a nonviable, intrauterine pregnancy with either an empty gestational sac or a gestational sac containing an embryo or fetus without fetal heart activity within the first 12 6/7 weeks of gestation 1. In the first trimester, the terms miscarriage, spontaneous abortion, and early pregnancy loss are used interchangeably, and there is no consensus on terminology in the literature.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Evaluation of new approaches
1. NARENDRA MALHOTRA
M.D., F.I.C.O.G., F.I.C.M.C.H
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Prof. Dubrovick International university,croatia
Indian FOGSI representative to FIGO
President FOGSI (2008)
Dean of I.C.M.U. (2008)
Director Ian Donald School of Ultrasound
National Tech. Advisor for FOGSI-G.O.I.—Mc Arthur Foundation EOC Course
Hon Prof Ob Gyn at DMIMS,Sawangi,Advisor ART unit at MAMC & SMS Jaipur
Editor od SAFOG journal
Chairman publication committee of AOFOG
Practicing Obstetrician Gynecologist at Agra. Special Interest in High Risk Obs., Ultrasound, Laparoscopy
and Infertility, ART & Genetics
Member and Fellow of many Indian and international organisations
FOGSI Imaging Science Chairman (1996-2000)
Awarded best paper and best poster at FOGSI : 5 times, Ethicon fellowship, AOFOG young gyn. award,
Corion award, Man of the year award, Best Citizens of India award
Over 30 published and 100 presented papers
Over 50 guest lectures given in India & Abroad.Presented 10 orations.
Organised many workshops, training programmes, travel seminars and conferences
Editor 8 books, many chapters, on editorial board of many journals
Editor of series of STEP by STEP books
Revising editor for Jeatcoate’s Textbook of Gynaecology (2007) and DONALD OBS MANNUAL(2012)
Very active Sports man, Rotarian and Social worker
MALHOTRA HOSPITALS
84, M.G. Road, Agra-282 010
Phone : (O) 0562-2260275/2260276/2260277, (R) 0562-2260279, (M) 98370-33335; Fax : 0562-2265194
E-mail : mnmhagra10@dataone.in / mnmhagra3@gmail.com
Website : www.malhotrahospitals.com
Apollo Pankaj Hospitals, Agra
Consultant for IVF at jalandhar,ludhiana,ambala,bhiwani,gwalior,allahabad,gorakhpur,udaipur,bariely,jaipur,delhi
Neapal & Bangladesh
7. population control has been practised from ancient times
when arabs used to insert pebbles in the uterus of female
camels and various concoctions were used for douching just
after and before intercourse
AS THE KNOWLEDGE OF
REPRODUCTIVE PHYSIOLOGY
GREW,NEWER METHODS TO CONTROL
FERTILITY EVOLVED
8. Antiquity: Ancient Egyptian women
use a combination of
cotton, dates, honey and acacia as a
suppository, and it turns out
fermented acacia really does have a
spermicidal effect. The Bible and the
Koran both refer to coitus
interruptus (the withdrawal method).
9. BIRTH CONTROL & PLANNED PARENTHOOD
1914-1921 Activist
Margaret Sanger coins
the term “birth control,”
opens first birth control
clinic in
Brownsville, Brooklyn, an
d starts the American
Birth Control League, the
precursor to Planned
is on. Pincus tests progesterone in
Parenthood. Pincus meet at a 1952 The raceworks. He meets gynecologist John
1951 Sanger and
rats and finds it
Rock, who has already begun testing chemical
dinner party in New York;
contraception in women. Frank Colton, chief chemist at
she persuades him to work on a birth the pharmaceutical company Searle, also independently
control pill.
develops synthetic progesterone
10. Introduction
• Despite of the wide spread
availability of a cafeteria of
contraceptive choices the
world still sees
• a 49% rate of unintended pregnancies
• a 22.5% rate of unintended births
• a 26.5% rate of elective abortions in the U.S.
• In the developing world this
figure may be much higher
60
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12. UN/WORLD BANK
According to projections of the United
Nations (UN) and the World Bank, 80–
90 % of population growth until 2025
will occur in developing countries; 50 %
of population growth is based on increasing
life expectancy attributed to
e. g. better medical care, 17 % of couples
are wishing for more than two children
and 33 % of the population growth stems
from unwanted pregnancies.
www.unfpa.org
WHO www.who.int/reproductivehealth/en
UN : The world at six billion www.u.n.org
13. IS THERE STILL HOPE TO CONTROL
POPULATION ???
• WELL YES AND NO ?
• NO BECAUSE THE BATTLE IS LOST….
• YES BECOS WE CAN STILL HOPE TO STABILSE THE
POPULATION GROWTH BY USE OF NEWER
CONTRACEPTIVE METHODS(SPECIALLY
EDUCATING AND EMPOWERING WOMEN TO
USE NEWER METHODS)
14. Female contraception has given a new
meaning to control of reproduction to a
woman.
Various female contraceptive methods have
flooded the market today and the choice for
the user and also for the provider sometimes
has become difficult.
This presentation aims to evaluate
the various newer approaches to
female contraception in Global
settings.
15. Today a basket of contraceptive choices available to
women and various studies have shown that today even
in the educated and developed world the first year failure
rates are much higher in typical users than perfect users
16. What do women want from an
ideal contraceptive method?
• Highly effective
• Prolonged duration of action
• Rapidly reversible
• Privacy of use
• Protection against STD
• Easily accessible
17. WHY NEWER CONTRACEPTION ?
“Newer”, innovations are needed,and the
obvious answer is because ‘the pill’ will not
work if not taken (for many reasons) and
hormones are not suitable to all women and
what may be good for some, may not be
suitable to everyone
19. The newer research being done in the
world by only two major
pharmaceuticals who can afford
research
Generics are mainly produced by One .
To find one new substance more than 5000 drugs need to be tested over 10–
15 years, costing 400–800 million US Dollars.
The other three have stopped the research in the field of contraception
20. The newer methods make a
formidable list of additions to the
current choices
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Newer Pills
Newer Barrier methods
Implants
Patches
Rings
Injectables
Microbicides
I.U.C.D.’s(Intrauterine Uterine
Devises)
Transcervical Sterilization
Male hormonal contraception
Gene based approaches
Immune contraception
Anti Progesterone
Surgeryless Contraception
New Fertility awareness based
methods
21. EVALUATION OF NEWER METHODS
HOW??
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Efficacy
Side Effects
Easy use
Compliance
Duration of action
Manufacturing Process
Costs
Newer mode of actions
Additional non-contraceptive benefits
Applicable to masses and acceptance
22. WHO
fertility control in the future will
focus on
1. Improvement of existing methods:
efficacy, side effects, duration of action,
manufacturing process, costs
2. New approaches: more selective
mode of action
3. New targets for contraception
23. INNOVATIONS FOR MODERN
CONTRACEPTIVE METHOD
Modern contraceptive methods have
surprisingly only a short history and has been
dominated by the innovations in the “pill” and
to some extent “other hormonal methods”.
These innovations have mainly targeted
• Tinkering with the pill contents
• Tinkering with the pill dosage
• Tinkering with the routes of administration of
hormonal contraception
24.
25. News about 3rd gen OCPs with
• Contain progestins desogestrel or gestodene
do have increased risk of VTE
– LOE=2a
• Odds of developing a VTE
with 3rd gen OCP was
70% higher than with 2nd gen OCPs
26. Increased Risk of OCP Failure in
Obese Women
• Study showed women with BMI> 27 had 60%
increased pregnancy risk compared to
women with BMI of 21 or less
• Biologic reasons may include:
– higher BMR
– induction of hepatic enzymes
– increased sequestration of hormones in adipose
Holt,VL et al. OB/GYN Jan 2005;105:46-52
27. OCP recommendation for Women
>70 kg
• Consider using OCPs with at least
50 mcg ethinyl estradiol to avoid
contraceptive failure.
• LOE=2b
28. Reality of Non-compliance with OCPs
• Top 3 reasons for missing pills were:
– Being away from home
– Forgetting to take the pill
– Not having a new pack in time for a new menstrual cycle
• Monthly diary cards completed by 141 women over age 18
• 2/3 of pill users missed at least one pill in 3 mos study
• Almost 50% of users missed 2 or more pills in study
Journal of Midwifery& Women’s Health 2005;50:380-5
29. New Oral Contraceptives (OCs) Offer
Continuous Use and
New Progestin Formulations
• Description: Continuous-use products and pills
containing new progestins.
• How they Work: Continuous pill use reduces
menstrual cycles to four per year. New progestins
may reduce side effects.
• Effectiveness: 6-8 pregnancies per 100 women in the
first year. Continuous-use OCs may be more effective.
30.
31. Drospirenone
•
•
•
•
Preliminary data suggest efficacy for ACNE /PMDD
Improved QOL indicators(non contraceptive benefits)
Reduced premenstrual sxs from 23% to 11%
Study used only 4 days of placebo instead of 7 days for 64
women in placebo-controlled crossover
• May be as efficacious as SSRI
Contraception 2005;72:414-21
32. Importance of 24 days regimen in OCs?
With lower doses of EE & progestins used in recent OC pills ,
EE & progestions are cleared from the circulation 2-3 days after the
active pill is discontinued
Due to several hormone-free days FSH & LH level start rising
It causes unscheduled uterine bleeding (intermittent bleeding &
spotting) & ovulation too
33. So the call for the time is to
reduce the pill free days
from 7 to 4 i.e 24 +4 regimen
34. Benefits of the 24+4 regimen
increased ovulation inhibition during the HFI
• The increases in levels of LH and FSH, observed with the 7day HFI, were reduced by shortening the HFI to 3 or 4 days
10
8
mIU/mL
Post hoc comparisons of cycles
7-day HFI
3- or 4-day HFI
6
**p<0.01
**
4
**
**
**
**
2
**p<0.01
**p<0.01
0
OC 1
2
3
4 5
LH
6
7 OC
OC 1
2
LH = Luteinizing hormone; FSH = Follicle-stimulating hormone:
HFI = Hormone-free interval; OC = Oral contraceptive
Willis SA, et al. Contraception 2006;74:10–3
3
4 5
FSH
6
7 OC
35. Benefits of the 24+4 regimen
increased ovulation inhibition during the HFI
• Levels of estradiol and inhibin-B, representing ovarian response
to gonadotropin increases, that were observed with the 7-day
HFI was reduced by shortening the HFI
Means for 2 cycles in 12 subjects
80
7-day HFI
3- or 4-day HFI
Post hoc comparisons of cycles
60
pg/mL
*p<0.05 **p<0.01
40
**
**
**
*
20
**
0
**
OC 1
2
3
4
5
6
7
OC
OC 1
2
Estradiol
HFI = Hormone-free interval; OC = Oral contraceptive
Willis SA, et al. Contraception 2006;74:10–3
3
4
5
Inhibin-B
6
7
OC
36. Benefits of the 24+4 regimen
reduced hormonal fluctuations
• The shorter HFI with the 24/4-day regimen results in
less pronounced estradiol fluctuations compared with a
21/7-day regimen
• This may reduce hormone-withdrawal symptoms by
creating more stable hormone levels
Estradiol levels (pg/mL)
40
30
21+7 with drsp ®
24+4 with drsp ®
20
10
0
3
5
8
11
14
Cycle days
Klipping C et al. Contraception 2008;78:16–25
17
20
23
26
37. Benefits of the 24+4 regimen
continuous drospirenone activity
• 24+4 with drsp ® regimen provides 3 extra
days of antimineralocorticoid and
antiandrogenic activity per 28-day cycle
relative to conventional 21+7 day OCs
Drospirenone level
3 extra days of drospirenone
28-day presence™
Cycle 1
1 2 3 4 5 6 7
8
9 10 11 12 13
14
Blode H, et al. Eur J Contracept Reprod Health Care 2000;5:256–64
15 16 17 18 19 20
Cycle 2
21
22 23
24
25 26 27
28
Days
38. More Ovulation Inhibition
24+4 with drsp® has less follicular development even with ‘missed pills’ compared to
21+7 with drsp®M
Percentage of women with follicular development: Hoogland Scores 4-6
% of study population
80
24+4 with drsp®
21+7 with drsp®
60
40
20
0
2nd Cycle
"Missed Pill Cycle"
Hoogland Scores range from 1 to 6,
1 meaning no follicular activity, 6 meaning ovulation
Klipping et al, Contraception 2008
39. How effective is 24+4 with drsp®?
• 24+4 with drsp® has proven its excellent contraceptive efficacy in clinical trials
• Pearl Index*
• 0.80 (upper one-sided 97.5% CI of 1.30) for typical use
• 0.41 (upper one-sided 97.5% CI of 0.85) for perfect use
This corresponds to more than 99% contraceptive protection
*The total number of unplanned pregnancies which occurred per 100 woman-years of use;
CI = confidence interval; Anttila L, et al. Int J Gynecol Obstet. 2009;107(suppl 2):s622
40. Significant reduction in acne lesions with
24+4 with drsp® : pooled data
Cycle 1
Cycle 3
Cycle 6
Percentage reduction in total lesion
count from baseline
0
-10
-20
-30
-40
-50
-60
*p<0.0001 vs. placebo
Koltun W, et al. Int J Gynecol Obstet 2009;107(suppl 2):s620
24+4 with drsp®
Placebo
24+4 with drsp®
was associated
with a greater
reduction from
baseline in total
lesion counts
versus placebo
41. Significant improvement in individual
items with 24+4 with drsp
Item number
0.0
1
2
3
4
5
6
7
8
9
10
11
1.
Change from baseline
-1.5
*
-2.0
-3.5
*
*
* *
24+4 with drsp®
Placebo
*p<0.05 vs. placebo; decrease = improvement
Pearlstein TB, et al. Contraception. 2005;72:414–21;
Bayer Schering Pharma AG, data on file (protocol number 305141)
Difficulty concentrating
7.
Tired, fatigued
8.
*
Diminished interest
6.
*
-2.5
a) Angry, irritable; b) Conflicts
5.
*
a) Mood swings; b) Feel sensitive
4.
* * *
Anxious, tense
3.
-1.0
a) Depressed; b) Hopeless;
c) Worthless, guilty
2.
-0.5
3.0
11 items of Daily Record of Severity of
Problems:
a) Increased appetite;
b) Food cravings
9.
a) Slept more;
b) Trouble sleeping
10. Overwhelmed, lack of control
11. a) Breast tenderness; b) Breast
swelling; c) Bloated sensation;
d) Headache; e) Muscle pain
43. VTE associated with COC use:
a class effect
CLASS EFFECT:
the risk of VTE is increased during COC use
– The risk of VTE during COC use is lower than during pregnancy and childbirth
44. Continuous-Use Regimen Offers New
Choice for Pill Users
• Reduces side effects associated with hormone
withdrawal (migraines, heavy or painful
monthly bleeding).
• Breakthrough bleeding is more likely, but
diminishes after 8 or 9 months of use.
• Seasonale® is packaged specifically for
continuous use and is US FDA approved.
– Users take pill every day for 84 days (12 weeks)
and then take a hormone-free pill for 7 days.
45. Annual (365 days) Regimen – Lybrel
• Approved by FDA on 5/22/2007.
• A low dose pill (20mcg ethinyl estradiol /
90mcg levonorgestrel) taken daily for 364 days
without a placebophase or pill free interval.
• 13 dispenses of 28 active yellow pills.
46. Progestogen only pills,
progesterone only injectables,
contraceptive patches and implants
which are more popular in the developing countries
and why?
47. PICs: Other Benefits
•
•
•
•
Do not affect breast feeding
Few side effects
No supplies needed by the client
Can be provided by trained non-medical
staff
• Contain no estrogen
• Do not interfere with intercourse
48. Effective, daily regimen of COCs is
burdensome for many women
Women’s rating of ‘very desirable/absolutely essential’ for
contraceptive attributes
75%
Non-daily regim en
Effective with low
dose of horm one
72%
66%
Is taken m onthly
0%
50%
Percent of wom en
Thompson M. Sexuality, Reproduction and Menopause 2006;4:74–79
100%
49. Women Prefer Monthly Contraceptive
Compared With A Daily Pill Regimen
Prefer m onthly
option with a lower
dose of horm ones
85%
Prefer convenience
of a m onthly option
to a daily pill
84%
Consider switching
to m inim ize
estrogen exposure
80%
77%
78%
79%
80%
81%
82%
83%
Percent of wom en
Synovate Healthcare. Hormonal Contraceptive Claim Test survey data – ExUS, 2009
84%
85%
86%
50. change of routes of hormonal
contraceptives
NEWER DELIVERY ROUTES
51. Comparison of New
Contraceptive Methods
Monthly
injectable
Implant
Intrauterine
system
Ring
Patch
Yes
Yes
Yes
Yes
Yes
1 month
Insertion &
removal
Insertion &
removal
Rx
Rx
Easily
reversible
Yes
Yes
Yes
Yes
Yes
Dosing
frequency
1 month
3-5 yrs
5 yrs
Every 4
weeks
Weekly
Usercontrolled
No
No
No
Yes
Yes
Discreet
Yes
Sometimes
Yes
Yes
Sometimes
Efficacious
Office Visits
www.contraceptiononline.
52. INJECTABLE CONTRACEPTIVES
Progestin – Only Injectables
- Norethindrone enanthate (NET-EN)
- Depot-medroxyprogestrone acetate
- 150mg of DMPA via deep intramuscular
(DMPA).
injecton in gluteal region / deltoid muscle.
- Depo-SubQ Provera 104- 104mg of DMPA via
subcutaneous injection into anterior thigh or
abdomen.
- Duration of protection : 3 months (13 weeks).
- Pearl index of 0.3-0.8 with typical use.
53. New Subcutaneous DMPA Formulation
Recently Approved
• DMPA-SC provides
slower, more
sustained absorption
of the progestin than
conventional DMPA.
• Available only in a
pre-filled Uniject
syringe.
54. New Combined Injectables Offer
Alternative to Progestin-only
Injectables
• Description: Monthly injections containing a
progestin and an estrogen.
• How they work: Injected estrogen and
progestin prevent ovulation, thicken cervical
mucus, and suppress endometrial growth.
• Effectiveness: 0.1 to 0.4 pregnancies per 100
women per year.
55. Combined Injectables Offer Advantages
Over Progestin-Only Injectables
• Irregular bleeding patterns less common and
decrease with length of use.
• Women can become pregnant as soon as six
weeks after last injection.
• Community health workers or women
themselves can administer using Uniject, a
single-use, prefilled, nonreusable syringe.
56. Contraceptive Injection: Lunelle
Intramuscular injection q 28-30 days
25 mg medroxyprogesterone acetate/
5 mg estradiol cypionate
Rapid return to fertility
Better efficacy than OCPs
Adverse events are similar to OCPs
Greater than 90% of users would
recommend to a friend
Kaunitz AM, et al. Contraception. 1999;60:179-187.
58. New Implants Have Fewer Rods than
Norplant®
• Description: One or two progestin-releasing
rods inserted just under the skin.
• How they work: Progestin released under the
skin thickens the cervical mucus, prevents
ovulation in many cycles, and suppresses
endometrial growth.
• Effectiveness: 0.3 to 1.1 pregnancies per 100
women in the first year of use as typically
used.
59. New Implants Offer Several
Improvements Over Norplant
• Levonorgestrel implants:
–
–
–
–
Deliver same daily dose as Norplant
Effective for up to 5 years
Two rods instead of six capsules
Easier to insert and remove than Norplant. Insertions take
less than five minutes.
• Etonogestrel implants:
– Single rod provides at least 3 years of protection against
pregnancy. Users have few if any ovulatory cycles.
• Nestorone implants:
– Single rod designed specifically for breastfeeding
women.
61. New Frameless Design May Reduce Some
Side Effects
• Several copper cylinders
strung together are
anchored into the
uterus.
• May cause less pain and
bleeding
• Requires different
insertion technique
• Less likely to be expelled
when inserted correctly.
62. New Progestin-Releasing Lng -IUS Offers Many
Advantages Over Cu-IUDs
• Approved in 2000 for 5 years
of use. Available in over 100
countries.
• More effective than many CuIUDs.
• Over time causes less bleeding
than Cu-IUDs.
• Can use to treat heavy,
prolonged bleeding or painful
menstrual cramps.
63. Levonorgestrel Intrauterine System:
LNG-IUS
• Releases 20 g of
levonorgestrel per 24 hrs
• Duration: 5 years
• Packaged with sterile inserter
• High efficacy-Pearl Index of 0.1
• Cheaper Indian version now
available for 1/3 the costs
Lahteenmaki P, et al. Steroids. 2000;65:693-697.
www.contraceptiononline.org
65. New Contraceptive Rings
• Developed by the
Population Council
• Sponsored by
USAID, NICHD, WHO
• One year vaginal ring
• Releases progesterone
receptor (PR) modulator
• Dual-protection ring
• Anti-retroviral agents
• Contraceptive steroids
Delivers Nesterone/EE
150/15 µg/day
13 cycles with 3 weeks
on reinsert after 1 week
66. Vaginal Ring:
Vaginal ring releases 15
g of ethinyl estradiol and
120 g of etonogestrel
daily
Worn for 3 out of 4 weeks
Self insertion and
removal
Pregnancy rate 0.65 per
100 woman–years
Roumen FJ, et al. Hum Reprod. 2001;16:469-475.
www.contraceptiononline.org
67. Vaginal Ring Cycle Control and Tolerability
• Good cycle control
– Irregular bleeding was rare
(2.6% - 6.4% of evaluable cycles)
– Withdrawal bleeding occurred
(97.9% - 99.4% of evaluable cycles)
• Well tolerated and well accepted by users and their
partners (only 5% of partners objected to use)
Roumen FJ, et al. Hum Reprod. 2001;16:469-475.
www.contraceptiononline.org
68. Vaginal Ring Compared to OC:
Irregular Bleeding
40
*
NuvaRing
Combined
oral
contraceptive
30
20
10
0
1
2
3
4
*P<0.001 for COC vs NuvaRing
5
6
Cycle Number
Bjarnadottir RI, et al. Am J Obstet Gynecol. 2002;186:389-395.
www.contraceptiononline.org
69. Most women who try the vaginal ring
report being very satisfied
Patient satisfaction with the vaginal ring versus a pill
Percentage of women
100%
91%
76%
80%
60%
61%
34%
Very
satisfied
Very
satisfied
40%
20%
30%
42%
Satisfied
Satisfied
NuvaRi ng® user s
Pi l l user s
0%
70. Reasons for satisfaction with vaginal ring
The 3 most frequently mentioned responses were:
• Monthly administration (54%)
• Low hormonal dose (31%)
• 100
Ease92 use (27%) 95
of
96
(Very) Satisfied
Proportion of users (%)
Neutral
75
(Very) Dissatisfied
50
25
7
2
4
1
3
1
0
Cycle 3
Cycle 6
Cycle 13
Roumen et al. Eur J Contracept Reprod Health Care 2006;11:14-22
71. Would women recommend
Vaginal Ring to others?
Proportion of users (%)
100
97
75
75
50
25
0
Women who completed the Women who discontinued
study
the study
Dieben T, et al. Obstet Gynecol 2002;100:585-593
Agree
73. Contraceptive Patch:
• Patch contains 6 mg
norelgestromin and 0.75 mg
ethinyl estradiol
• Delivers continuous systemic
doses of hormones
– 150 µg norelgestromin (NGMN)
– 20 µg ethinyl estradiol (EE)
Per day
• Direct comparisons to oral
contraceptive delivery doses
cannot be made
www.contraceptiononline.
74. Transdermal Contraceptive Patch
• 3-patch system
– Apply 1 patch each week for 3 weeks
– Apply each patch the same day of the week
• 1 week is patch-free
Patch #1 Patch #2
Patch #3 Patch-free
28-day cycle
28-day cycle
Week 1
Week 2
Week 3
Start next cycle
Week 4
Week 5
Abrams et al. J Clin Pharmacol. 41:1232, 2001
Smallwood et al. Obstet Gynecol. 98:799, 2001
75. Transdermal Contraceptive Patch
Efficacy & Cycle Control
Estrogen-progesterone patch with 7 day patches for 3
weeks, followed by a patch free week
Randomised study in 812 Vs OCs in 605
• Pearl Index marginally lower than OCs
• Higher breakthrough bleeding in first 2 cycles
• More site reactions, mastalgia & dysmenorrhoea
• Perfect compliance in 88.2% with patch & 77.7% with
OCs
Creasy, JAMA, 285:2347, 2001
77. News about Patch
• FDA updated labelling since product exposes
women to higher levels of estrogen than
most OCPs
– 60% more estrogen than 35 microgram estrogen
pill
• May increase risk of thrombotic disease
• FDA monitoring safety data closely
• Lawyers already jumping on the band wagon
78. Patch Compared to OC: Adverse Events
Patch (n=812)
OC (n=605)
Overall
Treatment
limiting
Overall
Treatmen
t limiting
Breast
discomfort
19%
1.0%
6%
0.2%
Headache
22%
1.5%
22%
0.3%
Application site
reaction
20%
2.6%
NA
NA
Nausea
20%
1.8%
18%
0.8%
Abdominal pain
8%
0.2%
8%
0.3%
Dysmenorrhea
13%
1.5%
10%
0.2%
Audet MC, et al. JAMA. 2001;285:2347-2354.
79. Spray-On Contraceptives: A New
Technique For Hormone Delivery
• Daily progestin-only sprayon is absorbed into the
skin, then diffuses into
bloodstream.
• Phase I clinical trials
underway in Australia.
80. Contraceptive Gel
Clinical trial of Nestorone gel is applied to the
skin daily for 3 months, suppressed ovulation
in 83% of participants.
81. The need…
Every year, an estimated :
• 20 million unsafe abortions occur
• 80,000 deaths result from
complications of unsafe abortions
• 287,000 maternal deaths occur from
complications of pregnancy and
birth
TIMELY AND PROPER USE OF EMERGENCY CONTRACEPTION
TO PREVENT UNWANTED PREGNANCY CAN SAVE MANY LIVES
AND REDUCE MENTAL TORTURE
82. Emergency Contraception…
is it enough?
• There are safe methods to
prevent pregnancy after
unprotected sex
• How long ago did you have
unprotected sex?
• Could you have been
exposed to STIs/HIV?
83. Emergency Contraception
• Reduce risk of pregnancy
– Use even up to 5 days after unprotected
intercourse
– More effective the sooner taken
• Consider giving pt advance supply at annual PE/pap
– Pregnancy Risk reduced by 75-89%, if taken
within 72 hrs
84. Types of Emergency Contraception
Progestin-only Oral Contraceptive Pills :
(Emergency Contraceptive Pill)
containing levonorgestrel
Combined Oral Contraceptive Pills : containing
ethinyl estradiol and levonorgestrel
(Use only pills brands containing these Hormones)
Insertion of IUCD
Anti-progestins
(Mifepristone(RU486- 1st gen.Progestrone Receptor Modulator)
85. WHO multicentric randomized trial,
Lancet 2002,360:1803-10
TWO TABLETS (0.75 mg Levonorgestrel each)
TAKEN AS A SINGLE DOSE WITHIN 120
HOURS (5 days) OF EXPOSURE
IS EQUALLY EFFECTIVE
86. IUCD
Inserted within 5 days of unprotected exposure
• mechanical interference with implantation
• Copper is blastocidal
• Can be continued as regular method
• Lowest failure rate--less than 1 %
89. GnRh antagonist
Yuzpe Regimen <72 h
Propose treatment
Bleeding
Menstruation
Follicular
phase
Preovulatory
period
Mid-luteal
phase
Late luteal
phase
90. GnRh Antagonist as EC
Emergency contraception should prevent
pregnancy in 100%
GnRH antagonist as one single injunction seems to
do the work properly
Highly effective - Avoid pregnancy
Free of side effects…….
Easy administered
Affordable
91. Condom Effectiveness vs
Heterosexual HIV Transmission
• Study showed 80% reduction in HIV incidence
with consistent use for all vaginal intercourse
– LOE=1a
93. New Female Condoms Are Designed For Better
Fit and Lower Cost
• The PATH Woman’s
Condom:
• FC2 Female Condom:
– Synthetic latex model.
– available in developing
countries in 2005.
• VA Feminine condom:
– First latex model.
– marketed in Western
Europe, Brazil, India, and
South Africa in 2005.
– Designed for nearuniversal fit.
– High user satisfaction
in clinical trials.
95. Summary of Barrier Methods
Contraceptive Technology,18th Revised edition, by Robert Hatcher, MD.
96. New Cervical Caps Designed to Reduce
Fitting Time
• FemCap™
– Silicone rubber device
fits over cervix and
blocks sperm.
– Comes in three sizes; a
provider must check
the fit.
• Ovès™
– Disposable cervical cap made of
silicone.
– Comes in three sizes; a provider
must check the fit.
– Effectiveness has not yet been
established.
97. Contraceptive Sponges
No Fitting or Prescription Required
• The Today Sponge®
– Discontinued in 1994
but recently rereleased in Canada.
– Effectiveness: 13 to
16 pregnancies per
100 users in the first
year as typically
used.
• Protectaid®
– New polyurethane
foam sponge, packed
with spermicide gel F5®.
– Manufacturer plans to
apply for US FDA
approval.
– Effectiveness: 23
pregnancies per 100
users in one year as
typically used.
98. Microbicides
Can Reduce Transmission of HIV and other STIs
• Description: Vaginally applied
substances designed to reduce
transmission of HIV and other STIs.
Some function as spermicides to
provide contraceptive protection.
• How they work: Boost body’s defense
against infection, damage or hinder
disease pathogens, or prevent virus
replication.
• Effectiveness: First microbicides
expected to be 50-60% effective.
99. Why Are Microbicides So Promising?
• Could save many lives by protecting against HIV
infection.
– If 20% of people in high-risk groups used a 60% effective
microbicide, 2.5 million lives would be saved in the first
three years of use.
– Could lead to considerable savings in public health
expenditures.
• Women could control microbicide use.
– Women could protect themselves against STIs when they
cannot use condoms, perhaps without needing the
cooperation of their partners.
100. Microbicide Studies Explore User
Preferences
• Acceptability studies conducted around the
world found that women and men have great
interest in using microbicides.
– Women would prefer a microbicide to be an
odorless, colorless cream placed in the vagina
with applicator.
– Most women, but few men, would prefer a
formulation offering dual protection against both
pregnancy and STIs.
101. New Fertility Awareness-Based Methods
Provide Simplified Ways to Track Fertile Days
• Description: Tracking a woman’s fertility and
avoiding unprotected sex on fertile days
using colored beads or secretion diary.
• How they work: Avoiding unprotected
intercourse during days identified as
probably fertile.
• Effectiveness: Standard Days Method™—12
pregnancies per 100 women per year.
TwoDay Method™—14 pregnancies per 100
women per year.
102. Standard Days Method Tracks Fertility
with CycleBeads™
• Color-coded beads
indicate fertile days.
• Works best for women
who:
– Have cycles between 26
and 32 days long and,
– Most likely ovulate
between days 8 and 19 of
the fertile period.
103. New Sterilization Techniques Offer
Alternative to Surgery
• Description: Procedures that prevent
pregnancy permanently by reaching and
blocking the fallopian tubes though the vagina
and uterus.
• How they work: Blocks egg from descending
from a fallopian tube.
• Effectiveness: 0.2 to 2 pregnancies per 100
women in the first year of use.
104. Transcervical Female Sterilization
New Sterilization Methods are Safer
• Essure®: A spring-like device scars and plugs
the fallopian tubes.
• Quinacrine: A chemical compound scars and
blocks fallopian tubes.
• The Adiana Procedure: A plastic implant is
inserted into a lesion in the fallopian tubes.
Tissue grows into the plug and blocks the
fallopian tubes.
105. Gene-Based Approaches
Promise Dramatic Change in Contraception
• Target the genes or proteins involved in
sperm and egg development.
• In women: target molecules to prevent
ovulation.
• In men: prevent sperm from penetrating an
egg’s outer layer.
• Unlikely to cause side effects.
• At least 10 years away from reaching the
market.
106. The 21st century has brought many many new
innovations in women health care including a
new era of contraceptive choices. This, has
and is, sometimes confusing to the user,
provider and the prescriber.
107. Users’ opinion of best contraceptive
method (baseline)
66
70
% of women
60
50
40
30
16
20
7
5
10
6
0
COC
IUD
Barrier
Other
No preference
108. “Technology made large populations
possible
and large populations make technology
indispensable”
109. Contraception Resources
• Contraceptive Technology,18th Revised edition, by Robert Hatcher, MD
and website at:
http://www.managingcontraception.com/cmanager/publish/
• Managing Contraception Pocket Guide by Robert Hatcher, MD
• Planned Parenthood section on birth control options:
http://www.plannedparenthood.org/pp2/portal/medicalinfo/birthcon
trol/
• Best Method For Me:
http://www.bestmethodforme.com/survey/index.php
• Ortho Personalized Birth Control Selector:
http://www.orthowomenshealth.com/birthcontrol/selector/index.html
• EC Info: NOT-2-LATE.com at: http://ec.princeton.edu/info/contrac.html