This document discusses hormonal contraceptives, including combined oral contraceptives containing estrogen and progesterone, progestogen-only pills, and emergency hormonal contraception. It describes how each method works, directions for use, effectiveness, and potential side effects. Hormonal contraceptives are widely used birth control methods that are convenient and reversible. When taken properly, combined oral contraceptives are over 99% effective in preventing pregnancy. The document also summarizes research on the cancer risks associated with hormonal contraceptive use.

1. Hormonal
Contraceptives
Alternative name:
Birth-control pills

2.  World wide used
 Convenient method
 Inexpensive
 Reversible
 Easy and simple to use with minimum side effects
 Readily available
 Can be administered by non-healthcare personnel.
 Pills are safe and effective when taken properly
 Pills are over 99% effective

3. Types of hormonal methods of contraception
There are several different types hormonal methods of birth
control. The differences among them involve
 the type of hormone,
 the amount of hormone, and
 the way the hormone enters a woman's body.
 The hormones can be estrogen and/or progesterone. These
hormones may be taken orally (taken by mouth), implanted into
body tissue, injected under the skin, absorbed from a patch on
the skin, or placed in the vagina. The mode of delivery
determines whether the hormonal exposure is continuous or
intermittent.

4. Oral Contraception
 Combined oral
contraception
(COC)
 Progestogen
only pill (POP)
 Emergency
Hormonal
Contraception
(EHC)

5. Combined Oral Contraception
 Contains oestrogen and
progestogen
 Take one tablet daily
for 21 days (28 for ED)
followed by a 7 day pill
free period
• Most effective
preparation for
general use
• With optimal use,
> 99% effective

6. Combined Oral Contraception
 Monophasic
 fixed amount of an oestrogen and a progestogen
in each active tablet
 Biphasic/Triphasic
 varying amounts of the two hormones according
to the stage of the cycle
 ED (every day)
 includes 7 days of placebo tablets

7. Combined Oral Contraception
How does it work?

8. Oral Contraception
 Combined oral
contraception
(COC)
 Progestogen
only pill (POP)
 Emergency
Hormonal
Contraception
(EHC)

9. Progestogen only pill
 Contains one active ingredient -
progesterone
 Taken continuously – no break
 Offers an alternative when oestrogens
are contraindicated
 Efficacy dependent on the
meticulousness of the user

10. Oral Contraception
 Combined oral
contraception
(COC)
 Progestogen
only pill (POP)
 Emergency
Hormonal
Contraception
(EHC)

11. Emergency Hormonal Contraception (EHC)
 Levonelle 1500 (one step)
 Contains high dose progesterone
(levonorgesterel)
 One 1500mcg tablet taken as soon as
possible after unprotected intercourse
(up to 72 hours after)
 Preferably within 12 hours, no later
than 72 hours

12. Emergency Hormonal Contraception
 Taking the dose as soon as possible increases
efficacy
 Available from:
 A & E
 GP
 Walk in Centres
 Family Planning Clinics
 Sexual Health Clinics
 Community Pharmacies

13. When is EHC indicated?
 Unprotected sexual intercourse
 Reduced efficacy of other forms of
contraception:
 Torn, leaking condom
 Missed pills
 Late implant or injection
 Detached contraceptive patch

14. How does EHC work?
 Dependent on point in the menstrual
cycle
 Either prevents or delays ovulation,
prevents fertilisation or prevents
implantation of the fertilised egg into
the uterus.
 Clinical opinion is that EHC is not an
abortifacient (a substance that induces
abortion)

15. Side effects
 Nausea, vomiting
 stomach cramps or bloating
 diarrhea
 constipation
 gingivitis (swelling of the gum tissue)
 increased or decreased appetite
 weight gain or weight loss
 brown or black skin patches
 acne
 hair growth in unusual places
 bleeding or spotting
between menstrual periods
 changes in menstrual flow
 painful or missed periods
 breast tenderness,
enlargement, or discharge
 swelling, redness, irritation,
burning, or itching of the
vagina
 white vaginal discharge

16. Severe S/E
 severe headache
 severe vomiting
 speech problems
 dizziness or faintness
 weakness or numbness of an arm or
leg
 crushing chest pain or chest heaviness
 coughing up blood
 SOB
 leg pain
 partial or complete loss of vision
 double vision
 bulging eyes
 severe stomach pain
 yellowing of the skin or eyes
 loss of appetite
 extreme tiredness, weakness, or lack
of energy
 fever
 dark-colored urine
 light-colored stool
 swelling of the hands, feet, ankles,
or lower legs
 depression, especially if you also
have trouble sleeping, tiredness, loss
of energy, or other mood changes
 unusual bleeding
 rash
 menstrual bleeding that is unusually
heavy or that lasts for longer than 7
days in a row

17. Hormonal Contraceptives and Cancer Risk
（Research done by National Cancer
Institute ）
Lifetime Risk of Reproductive Cancers in All Women
Type of Cancer Risk of
Contracting
Risk of Dying Added Risk with
Hormonal
Contraceptives
Breast 1 in 8 (12%) 1 in 34 (3%) Increased
Cervical 1 in 142 (0.7%) 1 in 434 (0.2%) Increased
Ovarian 1 in 71 (1.4%) 1 in 91 (1.1%) Decreased
Uterine/
Endometrial
1 in 41 (2.5%) 1 in 190 (0.5%) Decreased

18. References
 http://www.contracept.org/hormonal.php
 http://www.medicinenet.com/hormonal_methods_
of_birth_control/page2.htm