Hormonal contraceptives include oral contraceptives, injectables, and emergency contraception. Oral contraceptives are highly effective and commonly used female contraceptives that contain estrogen and progestin. Injectables provide contraception through long-acting progestin or progestin-estrogen combinations injected every 1-3 months. Emergency contraception can prevent pregnancy if taken within 72 hours of unprotected sex, and works mainly by preventing or disrupting ovulation and fertilization. Male contraceptives aim to inhibit spermatogenesis but complete suppression without side effects has been difficult to achieve.

1. HORMONAL CONTRACEPTIVES Hormonal preparations used for reversible suppression of fertility FEMALE CONTRACEPTIVES Oral contraceptives Efficacious Low cost Overall safety Complete return of fertility on discontinuation

2. Types ORAL Combined pill- efficacy 98-99.9% Estrogen+Progestin 2 nd generation pills- ↓estrogen+progestins 3 rd generation pills- newer progestins-desogestrel COURSE 1 tablet daily(starting on 5 th day of menstruation)-21 days Next course after gap of 7 days

3. 2 . Phased regimens Reduction in total steroid dose without compromising efficacy -Biphasic -Triphasic Estrogen - constant(or varied b/w 30-40µg) Progestin - low in 1 st phase-progressively higher in 2 nd and 3 rd phase 3. Minipill Low dose Progestin only pill Taken continuously without any gap Efficacy- 96-98%

4. 4. Postcoital (emergency) contraception 3 regimens Levonorgestrel 0.5mg+ethinylestradiol 0.1mg within 72 hrs & repeated after 12 hrs ‘ YUZPE method’ Levonorgestrel 0.75mg twice with 12 hr gap within 72 hrs WHO essential drug list(2001)- recommended replacement of YUZPE method by this regimen c) Mifepristone 600mg- single dose within 72 hrs

5. INJECTABLE -obviate need for daily injestion of pills -given i.m as oily solution -highly effective i) Long acting progestin alone injected once in 2-3 months depending on steroid & its amount Depot medroxyprogesterone acetate(DMPA) 150mg at 3month interval Norethindrone(norethisterone)enanthate(NEE) 200mg at 2 month intervals

6. ii) Long acting progestins+ long acting estrogens once a month MPA+ estradiol cypionate-approved by US-FDA Mechanism of Action 1. Inhibition of Gn release from pituitary by reinforcement of normal feedback inhibition 2. Thick cervical mucus secretion hostile to sperm penetration is evoked by progestin action. 3. Make endometrium hyperproliferative or hypersecretory or atrophic- not suitable for nidation

7. 4. Modify uterine and tubal contractions –disfavour fertilization. 5. Postcoital pill-dislodge a just implanted blastocyst or may interfere with fertilization/implantation Adverse effects Nonserious - nausea, vomiting, headache Later - Weight gain Chloasma mood swings

8. Serious - leg vein and pulmonary thrombosis Rise in BP Genital carcinoma Gallstones Contraindications Coronary & cerebrovascular disease Hypertension Liver disease Interactions Enzyme inducers Suppression of intestinal microflora

9. MALE CONTRACEPTIVE -Inhibit spermatogenesis -complete suppression of spermatogenesis is relatively difficult without affecting other tissues. -spermatogenesis takes 64 days DRUGS Antiandrogens Estrogens & progestins

10. Cytotoxic drugs-cadmium, nitrofurans Gossypol-nonsteroidal compound obtained fron cotton seed supress spermatogenesis in 99% men reduce sperm motility Dose- 20mg/day for 2-3 months followed by 40-60mg/week