1. Hormonal contraceptives work by intercepting the birth process through mechanisms like inhibiting ovulation, thickening cervical mucus, or preventing implantation of a fertilized egg. 2. Common types include combined oral contraceptives containing estrogen and progestin, progestin-only pills, injectables, implants, and intrauterine devices. 3. Combined oral contraceptives primarily work by inhibiting the release of hormones needed for ovulation. Progestin-only methods thin the uterine lining to prevent implantation. Side effects are usually mild but can include changes to bleeding patterns or mood.

1. HORMONAL
CONTRACEPTION
DR.P.SARAVANAN
PROF&HOD
DEPT OF PHARMACOLOGY
GMC, NAMAKKAL

2. FEMALE
CONTRACEPTIVES

3. CONTRACEPTIONS
Interception in the birth process at
any stage ranging from ovulation to
ovum implantation

4. HUMAN MENSTRUAL CYCLE
HORMONES, TEMPERATURE & OVULATION

5. OV
AR
Y
U
T
E
R
U
S
Proliferative phase Secretary phase
Pri Fol Sec Fol Graf Fol
Folicular phase Luteal phase
Cor Luteum Cor Albicans

6. TYPES OF HORMONAL CONTRACEPTIVES
ORAL
Combined
preparations
(estrogen
&progestin)
Monophasic
Biphasic
Triphasic
Single
preparations
(progestin only
pill)
Minipill
Emergency

7. TYPES OF HORMONAL CONTRACEPTIVES
PARENTERAL
DMPA
EV + 17OH PC
EC + DMPA
Implants
IU – Devices

8. TYPES OF HORMONAL CONTRACEPTIVES
ORAL
Combined
preparations
(estrogen
&progestin)
Monophasic
Biphasic
Triphasic
Single
preparations
(progestin only
pill)
Minipill
Emergency

9. MECHANISM OF ACTION- COMBINED PILLS
Both estrogen & progestin
Act synergistically on HP axis
Inhibit release of FSH & LH(-ve feedback)
Inhibits Ovulation
Estrogen- Inhibits LH surge
Estrogen & Progesteron- impair the nidation of ovum
Progesteron- Increases viscosity of cervical mucus

10. ESTROGEN
Cause tubal & uterine contractions
Interfere with fertilisation
PROGESTERONE
 Make endometrium- less suitable for the implantation
 Thick, viscid cervical mucous secretion
Prevents sperm penetration
MECHANISM OF ACTION- MINIPILLS

11. ♣.ORAL CONTRACEPTIVES
1.COMBINED PILLS:
 Widely used & is the most effective reverrsible
method
 99-99.5% success rate
ESTROGENS PROGESTIN
Ethinyl estradiol (30µg)
+ Norgestrel (300µg)
Ethinyl estradiol (30µg)
+ Levonorgestrel (150µg)
Ethinyl estradiol (50µg)
+ Norgestrel (500µg)
Mestranol (50µg)
+ Norethindrone (1mg)
Ethinyl estradiol (30µg)
+ Desogestrel (150µg)

12. SCHEDULE FOR COMBINED PILL- MONOPHASIC
MENSTRUAL CYCLE
1st day 21st 28th
1tab orally daily for 21 consecutive days Pill free period – 7days
1st Pill – 5th day

13. MENSTRUAL CYCLE
1st day 21st 28th
1tab orally daily for 21 consecutive days Pill free period – 7days
1tab orally daily for 21 consecutive days Pill free period – 7days
1st Pill – 5th day
Day 1-21: Ethinyl estradiol (30µg)
Day 1-10: Norethindrone 0.5mg Day 11-21: Norethindrone 1mg
SCHEDULE FOR COMBINED PILL- BIPHASIC

14. MENSTRUAL CYCLE
1st day 21st 28th
1tab orally daily for 21 consecutive days Pill free period – 7days
Day 1-6: ES 30µg Day 1-6: ES 30µg
Day 7-11: ES 40µg
Day 1-6: NG0.05mg Day 7-11: NG0.075mg Day 11-21:NG0.125mg
1tab orally daily for 21 consecutive days
1st Pill – 5th day
SCHEDULE FOR COMBINED PILL- TRIPHASIC

15. MINIPILLS (PROGESTIN-ONLY PILLS)
 Given where estrogen is CI
 Success rate: 98.3%
 Mechanism
 Side effects
 Ex:
 Norethindrone
 Norgestrel

16. POSTCOITAL PILLS (PROGESTIN-ONLY PILLS)
 High dose of estrogen and/or progestin
 Regimens:
a. 2tab of Levonorgestrel(0.75mg)
 1st tab – within 48hrs of the coitus
 2nd: after 12hrs
b. Ethinyl estradiol + Levonorgestrel
 2tab: within 72hrs
 2tab: after 12hrs
c. Mifepristone600mg
 Single dose within 72hrs

17. CENTCHROMAN (ORMELOXIFENE)
 Non steroidal estrogen antagonist or SERM
 SAHELI
 MOA:
 Desynchronises the event of ovum transport with
endometrial phase
 Doses:
 1st 3 months: Twice/week
 Then 1/week subsequently
 CI:
 Jaundice, Hepatic dysfunction, PCOD, TB, Cervical
hyperplasia & RD

18. TYPES OF HORMONAL CONTRACEPTIVES
PARENTERAL
DMPA
EV + 17OH PC
EC + DMPA
Implants
IU – Devices

19. INJECTABLE CONTRACEPTIVES
a. Depot medroxyprogesterone
acetate(DMPA)
 150mg/3rd month, IM, after parturition
 Indication:
 High compliance, Estrogen is CI & Heavy menstural
bleeding
b. Combined estrogen-progestin injectable
contraceptives:
 Estradiol valerate5mg + 17-OH progesterone
caproate 250mg
 IM every month
 Estradiol cypionate 5mg + DMPA25mg
 IM once in 2 months

20. IMPLANTS
NORPLANT
6 flexible rods
216mg of
levonorgestrel
Effect 5years
IMPLANON
Single rod
68mg
3years

21. IUD
a. Intrauterine inserts
 T shaped device
 Releases Levonorgestrel 6mg everyday for 5yrs
b. Transvaginal ring

22. COMBINATION PILLS - SIDE EFFECTS
 Mild: ( No need to withdraw)
Estrogen: migraine, oedema, bleeding
Progesteron: acne, hirsutism, dec libido, Inc temperature
 Moderate: ( May need to withdraw)
Estrogen: Vertigo, Leg & Uterine cramps, DM
Progesteron: Bleeding, amenorrhoea, Vaginitis
 Serious: ( Must need to withdraw)
Estrogen: Thromboembolism, Jaundice, Hepatic adenoma
Progesteron: MI, cerebrothrombosis

23. COMBINATION PILLS - CONTRAINDICATION
 Mild: ( No need to withdraw)
Estrogen: migraine, oedema, bleeding
Progesteron: acne, hirsutism, dec libido, Inc temperature
 Moderate: ( May need to withdraw)
Estrogen: Vertigo, Leg & Uterine cramps, DM
Progesteron: Bleeding, amenorrhoea, Vaginitis
 Serious: ( Must need to withdraw)
Estrogen: Thromboembolism, Jaundice, Hepatic adenoma
Progesteron: MI, cerebrothrombosis

24. NON CONTRACEPTIVE EFFECTS:
Avoids unwanted pregnancy
Relieves dysmenorrhoea
Prevents anemia
Protects against Ovarian & Endometrial CA

25. MALE
CONTRACEPTIVES

26.  Inhibit spermatogenesis
No satisfaction is obtained because of following reasons
Complete inhibition of spermatogenesis is difficult
without affecting other tissues.
Takes longer latent period to produce infertility.
Testosterone suppression leads to loss of libido
MALE CONTRACEPTIVES

27. DRUGS AND APPROACHES
 Antiandrogens – has direct action on testis.
 Estogens and progestins - cause feminization.
 Androgens – poor efficacy ;with progestin efficacious
 Superactive GnRH analogues –inhibits testosterone
 Cytotoxic drugs- cadmium,nitrofurans and indoles

28. Administration
I.M administration of 100 mg of testostrone
weekly with 500 mg of levenegesterol.

29. Adverse reactions
 Gynacomastia
 Acne
 Loss of libido
 Impotence

30. GOSSYPOL
 Non steroidal compound obtained from cotton seed.
 Effective orally
 Inhibits spermatogenesis and sperm motility.
 Serum LH and testosterone levels will not change.
 No hormonal or antihormonal activity.

31.  Causes hypokalemia- renal loss of k ions
 Muscular weakness
 Edema
 Diarrhea
 Breathlessness
 neuritis
GOSSYPOL -Adverse effects

32. TYPES OF HORMONAL CONTRACEPTIVES
ORAL
Combined
preparations
(estrogen
&progestin)
Monophasic
Biphasic
Triphasic
Single
preparations
(progestin only
pill)
Minipill
Emergency

33. TYPES OF HORMONAL CONTRACEPTIVES
PARENTERAL
DMPA
EV + 17OH PC
EC + DMPA
Implants
IU – Devices

34. THANK U