This document summarizes hormonal methods of contraception. It describes family planning and the criteria for an ideal contraceptive. Hormonal contraceptives are classified as oral pills, depot formulations, injections, subdermal implants, and vaginal rings. Combined oral contraceptive pills contain estrogen and progesterone while progesterone-only pills contain only progesterone. Depot formulations provide long-lasting, reversible contraception through injections or implants. The various hormonal methods, their mechanisms of action, effectiveness, advantages, and potential side effects are discussed.

2. HORMONAL METHOD OF
CONTRACEPTION
By: Kavya
1st year MSc Nursing

3. Objectives
• describe the meaning of family planning
• list criteria for an ideal contraceptive
• enumerate classification of hormonal methods
• explain combined pills
• describes progesterone only pills
• enumerate the post coital pill
• describe once a month pill

4. • explain male pill
• state advantage of oral pills
• enlist contraindications
• list few adverse effects
• explain depot formulations
• describe combined injections
• explain subdermal implant
• describe vaginal rings

5. Introduction: Meaning
• Family planning refers to the planning of when to
have children, and the use of birth control. It
allows individuals and couples to anticipate and
have their desired number of children, and to
achieve healthy spacing and timing of their
births.

6. Purpose
 Reduces the need for abortion
 Family planning reinforces people’s rights to
determine the number and spacing of their children.
 Prevents deaths of mothers and children
 Raising a child with significant amount of time,
social, financial, environment

7. Types of contraceptives
I Spacing methods
1.Barrier method
2. Intra-uterine devices
3. Hormonal method of
contraceptive
4. Post-conceptional
methods
5. Miscellaneous
II. Terminal methods
1. Male sterilization
2. Female sterilization

8. Mechanism of action
• The Concept of Contraception based on
prevention sperm to fertilize ovum or to prevent
implantation of fertilized ovum.

9. Criteria for an ideal contraceptive
• Safe: it means that the contraceptives is free
from any kind of side effects or complications
• Reliable: it means that the contraceptives is cent
percent effective
• Easy to administer and convenient
• Cost effective
• Culturally feasible and acceptable

10. Hormonal contraception
• Hormonal contraceptives refers to birth control
methods that act on the endocrine system.
• Action varies from one type to another
• Uses synthetic progesterone and estrogen

11. Classification of hormonal methods
1.Oral pills
a)Combined pills
b)Progesterone only pills
c)Post coital pill
d)Once a month pill
e)Male pill

12. 2. Depot
A)Progesterone only injectable
oDepo metroxyprogesterone acetate (DMPA)
oNorethisterone enantate (NET EN)
oDMPA- SC
• B) Combined injectable

13. 1. Oral pills : a) Combined pills
• Content: Contains estrogen and progesterone
• Mode of action: Inhibits ovulation of ovum by
blocking the gonadotropin from pituitary gland.
• The progestogen alters the cervical mucosa
which prevents entry of sperms into genital canal
makes the uterine inner lining unsuitable for
implantation of fertilized egg.

15. • Duration: 21 or 28 days
• Taken for 21 consecutive days beginning from 5th
day of menstruation.
• Effects: “withdrawal bleeding”
• Points to remember:
• fixed time
• If the user forgets

16. Example
• Mala-N and Mala - D
• It is supplied by the government of India
• Content: Contains levonorgesterol .15 mg and
ethinil estrodiol .003 mg
• Mala- D: 21 OCP and 7 iron tablets (60 mg ferrous
fumarate tablet) available at the cost of Rs. 3
• Mala-N: 21 OCP, supplied free of cost through
PHC, Urban health centers.

17. Progesterone only pills (Minipill/ micro pill )
• Content: Contains only progesterone
• Mode of action:
 The progestogen alters the cervical mucosa which
prevents entry of sperms into genital canal makes the
uterine inner lining unsuitable for implantation of
fertilized egg.
• Duration: throughout the menstrual cycle

19. • Commonly used progesterone are Norethirsterone and
levonorgesterol
• Disadvantage: Increased pregnancy rate and poor
cycle control
• Advantage: can be used in older women with
cardiovascular risks

20. Post coital pill
• Post coital method is advocated as an emergency
method eg. Contraceptives failure, rape, unprotected sex
• Duration: To be taken within 72 hours of unprotected
intercourse
• Content: Contains hormone progesterone
• Action: It prevents ovary from releasing egg or
prevents fertilization or implantation

21. Example:
• Levonorgesterol 0.75 is approved in India
• One tablet within 24 hours and the 2nd tablet after 12
hours of 1st dose
• Advantage: Failure rate less than 1 %
• Side effects: nausea, mild stomach upset, spotting,
headache and tiredness

22. Once a month pill
• Its a long acting pill
• Combination of long acting estrogen (quinestrol)
with short acting progesterone
• High pregnancy rate
• Irregular menstrual cycle

23. Male pill
• An ideal male contraceptive pill should decrease
sperm count but does not affect testosterone levels.
• Eg. Gossypol- derivation of cotton seed oil
• Produces oligospermia or azoospermia
• 10% of men because permanently azoospermia after
taking it for 6 months
• Not on practice

24. Advantage of oral pills
• Prevents pregnancy
• Eases menstrual cramps
• Regular period
• Decreases incidence of ovarian and uterine cancer
• Decease acne
• Provides protection against at least 6 disease: benign
breast disorder, ovarian cysts, iron deficiency
anaemia, pelvic inflammatory disease, ectopic
pregnancy, ovarian cancer

25. • Effectiveness
• Taken according to prescribed regimen, oral
contraceptive of the combined type are almost
100% effective. In developed countries the
annual pregnancy rate is less than 1%

26. Contraindications
Absolute Relative
Cancer of breast and
genital
History of thrombo-
embolism
Cardiac abnormality
Abnormal uterine bleeding
Congenital hyperlipidemia
Age above 40 years
Smoking
Mild hypertension
Epilepsy
Migraine
Lactating mother

27. Adverse effects
• Cardiovascular disease
• Risk of breast cancer
• Risk of cervical cancer
• Risk of thromboembolism
• Risk of liver adenoma
• Lipid metabolism disorder
• Nausea
• Depression
• Post-pill amenorrhea
• Weight gain
• Headache
• Migraine
• Breast tenderness

28. Duration of use
• The pill should be used primarily for spacing
pregnancies in young women, those over 35 years
should go for other method of contraception because
of increased risk of cardiovascular disease.

29. • The administration of a sustained-action drug
formulation that allows slow release and gradual
absorption, so that the active agent can act for much
longer periods than is possible with standard
injections. Depot injections are usually given deep
into a muscle.
B. Depot formulation

30. Uses:
• Highly effective
• Long acting
• Reversible
• Estrogen free
• Protection for several months
• Ex: Injectable, subdermal implants, vaginal rings

31. Injectable contraceptives
• Types:
A) Progesterone only injectable
B) Combined injectable contraceptives

32. Progesterone only injectable
• 1. Depo metroxyprogesterone acetate (DMPA)
• 2. Norethisterone enantate (NET EN)
• 3. DMPA- SC

33. Depo metroxyprogesterone acetate (DMPA)
• Safe, effective and acceptable contraceptive that needs
minimum motivation
• Good use among multipara women>35 years who
have completed family
• Administration: IM injection of 150 mg every 3
months
• Duration: Given at 1st 5 days of menstrual cycle,
timing is to rule out pregnancy

35. • Effectiveness: 99% protection from pregnancy
• Mode of action: Stops ovulation and thickens
cervical mucus
• Side effects: weight increase, irregular menstrual
bleed, prolonged infertility
• Points to remember
• Given deep IM in the gluteus maximus
• Injection site should never be massaged

36. DMPA- SC
• Administration: Subcutaneous injection of 104 mg
at 3 months intervals

37. Norethisterone enantate
• Less extensively used than DMPA
• Administration: IM injection of 200 mg every 2
months
• Duration: Given deep at 1st 5 days of menstrual
cycle
• Mode of action: Inhibition of ovulation and
thickening of cervical mucus

38. • Effectiveness: Higher pregnancy rate than DMPA
(0.4%)
• Points to remember
• Given deep IM in gluteus maximus
• Injection site should never be massaged

39. Contraindications for injectable contraceptives
• Cancer of breast, genitals
• Undiagnosed abnormal uterine bleeding
• Deep vein thrombosis
• History of stroke, heart attack
• High BP>160/100 mm of hg

40. B. Combined injectable
• Content: Contains progesterone and estrogen
• Duration: Given at monthly intervals
• Mode of action: Action mainly ovulation suppression
• Ex: Cyclo provera

41. 2. Subdermal implants
• Administration:
• Implants are placed in the body filled with hormone
that prevents pregnancy
• Physically inserted in simple 15 minute outpatient
procedures
• Plastic capsules the size of paper matchsticks inserted
under the skin in the arm
• Effectiveness: 99.95% effectiveness rate

42. • NORPLANT 1
• Six capsules
• Five years effectiveness
• NORPLANT 2
• Two capsules
• Three years

43. 3. Vaginal rings
• Vaginal rings containing levonorgesterol have
been found to be effective
• Hormone is slowly absorbed through vaginal
mucosa
• Rings is worn 3weeks of the cycle and
removed

44. Conclusion:
• Every contraceptive methods have its own pros
and cons. Hence it should be utilized by individual
in a very cautious manner. Role of Nurse is to
provide information regarding wide range of
family planning method but not force any
individual.

45. Summary
• family planning
• criteria for an ideal contraceptive
• classification of hormonal methods
• combined pills
• progesterone only pills
• the post coital pill

46. • male pill
• advantage of oral pills
• adverse effects
• depot formulations
• Progesterone only and combined injectable
• subdermal implant
• vaginal rings

47. Evaluation Questions
1. list the classification of oral pills
2. describe the progesterone only pills
3. give example for Combined oral pill
4. list few advantage of oral pills

48. ASSIGNMENT
• 1. explains the nurses role in educating public about
contraception
• SL NO: CRITERIA FOR EVALUATION MARKS
ALLOTED
• 1 introduction 2
• 2 Critical thinking 5
• 3 Completeness 2
• 5 Submission on time 1
• total 10

49. References
1. Park, K. (2015). Park's textbook of preventive and social
medicine (23rd ed.). Jabalpur: M/S Banarsidas Bhanot.
2. Kumari, N. (2011). A Text Book of community health
nursing. Jalandhar: S.vikas and company (medical ) India
3. Stöppler, M. M. (n.d.). Hormonal Methods of Birth Control:
Learn About Pros and Cons. Retrieved April 05, 2017, from
http://www.medicinenet.com/hormonal_methods_of_birth_con
trol/article.htm