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Hormonal contraceptives
Contents
2/24/2016 2
Classification
A) Oral pills
1) Combined pill
2) Progestogen only pill
3) Post- coital pill
4) Once a month (long acting )pill
5) Male pill
B) Depot (slow release) formulations
1) Injectables
2) Subcutaneous implants
3) Vaginal rings
Combined Pill
• In early 1960s
• At present Most formulations:
– Oestrogen < 30 – 35mcg
– Progestogen 0.5 – 1mg
• Pill is given orally for 21 consecutive days
beginning on 5th day of menstrual cycle followed
by break of 7 days during menstruation
• Withdrawal bleeding: episode of uterine bleeding
from incompletely formed endometrium caused
by withdrawal of exogenous hormones.
• MOHFW:
– MALA- N : 21 tablets of
Levonorgestrel 0.15mg +
Ethinil oestradiol 0.03 mg
– MALA – D: 28 tablets : 21 Hormonal pills +
7 tab of Feso4
• Mechanism of action:
– Prevent release of ovum from the ovary
– Achieved by blocking the pituitary secretions of
gonadotropins that is necessary for ovulation
Pills missed?
WHAT TO DO IF YOU MISS ONE OR MORE PILLS
Every time you miss one or more active pills (days 1-21):
Source: Johns Hopkins University Bloomberg School of Health, Population information program
2. Progestogen – only pill (POP)
– Referred as “Minipill”
– Norethisterone / LNG
– Disadv: poor cycle control & ↑ Pregnancy rate
– Can be prescribed to older women for whom the
combined preparation is contraindicated
– ↓ HDL
– MOA: renders cervical mucus thick & scanty so
inhibits sperm penetration
Post – coital contraception (Emergency
contraception)
Situations
• Voluntary sexual intercourse where no contraceptive is
used.
• When there is a contraceptive method failure or a
method is used incorrectly, such as:
 Condom leakage
 Failure to take OCP for 3 consecutive days
 Delaying contraceptive injection more than 2 weeks
 Miscalculation of the infertile (safe) period
 Failed coitus interruptus
• Involuntary sex such as rape/sexual assault
• Yuzpe regimen: LNG 0.5mg+EE 0.1mg
• E-pill: LNG 0.75mg (2 tab at the interval of 12 hrs).
• I-pill: LNG 1.5mg.
• EE: 1 mg for 5 days.
• LNG 600 μg or D-Norgestrol:
1.5 mg for 5 days within 72 hrs.
• Centchroman: 60 mg within 24 hours.
• Mifepristone (RU 486): 600 mg taken within 72 hrs.
• Cu-T
4. Once – a – month (long acting) pill
– Quinesterol (long acting oestrogen given with
progesterone .
– High failure rate, irregular bleeding
5. Male pill
– Preventing spermatogenesis
– Interfering with sperm storage & maturation
– Preventing sperm transport in vas
– Affecting constituents of the seminal fluid
– Gosssypol (cotton seed oil)
Beneficial effects of OCP’S
• Almost 100% effective in preventing pregnancy
• Protection from at least six diseases e.g. benign
breast disorders, ovarian cysts, iron deficiency
anaemia, PID, ectopic pregnancy, ovarian cancer
Adverse effects of OCP’s
1) Cardiovascular side effects: have 40% more risk of mortality
than non users due to cardiovascular causes
2) Carcinogenesis: increased risk of cervical cancer
3) Metabolic side effects: deranged lipid profile, glucose
intolerance, increased blood pressure
4) Other side effects:
a) liver disorders: hepatocellular carcinoma, adenoma of
gall bladder, cholestatic jaundice
b)decrease in breast milk if used during lactation
c) more chance of ectopic pregnancy in case of mini pill d) ill
effect on foetal development not proved yet
5. Common unwanted effects of OCP
1) Breast tenderness
2) Weight gain in about 25% cases in first 6
months
3) Headache &migrane may aggrevate
4) Breakthrough bleeding or spotting may
happen in early cycles in some cases
Contraindications of OCP’s
Absolute Special problems requiring
special surveillance
Cancer of breast & genitalia
Liver disease
Past or present history of
Thromboembolism
Cardiac abnormalities
Congenital hyperlipidemia
Undiagnosed uterine bleeding
Age over 40 or age over 35 &
smoking
Mild hypertension
Chronic liver disease
Migraine
Nursing mothers in first 6
months
Diabetes
Gall bladder disease
Amenorrhea
Irregular bleeding
Depot formulations
1. Injectable contraceptives:
A. Progestogen only injectables
I. DMPA:
– 150 mg IM every 3 months
– 99% protection: suppression of ovulation
II. NET – EN: (Norethisterone enatate)
– 200mg every 2 mts
– Higher failure rate compared to DMPA
III. DMPA – SC 104 mg
– Depo-subQ provera104 ( DMPA – SC)
– Injected SC
– 104mg every 3 months
– Upper thigh / abdomen
• S.E.:
– Disruption of normal menstrual cycle
• Contra indications:
– Ca breast, all genital cancers
– Undiagnosed uterine bleeding, suspected malignancy
– Hypertension
– H/o stroke, MI,DVT
2. Sub dermal implants
• Norplant:
– 6 silastic (silicon rubber) capsules containing 35mg
each of LNG
• Norplant (R) – 2 :
– Easier to remove
– Rods are inserted beneath the skin of forearm /
upper arm
– Effective contraception for 5yrs
Post conceptional methods
• Menstrual regulation : i.e. aspiration of
uterine content within 6-14 days of missed
periods
• Menstrual induction : by intra uterine
installation of prostaglandin F2
• Abortion :may be first or second trimester.
This procedure is governed in India by MTP
Act of 1971
Summary
2/24/2016 19
‘THANKS FOR THE
ATTENTION’
REVISE IT Today
2/24/2016 20

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Mgm hormonal contraceptives

  • 3. Classification A) Oral pills 1) Combined pill 2) Progestogen only pill 3) Post- coital pill 4) Once a month (long acting )pill 5) Male pill B) Depot (slow release) formulations 1) Injectables 2) Subcutaneous implants 3) Vaginal rings
  • 4. Combined Pill • In early 1960s • At present Most formulations: – Oestrogen < 30 – 35mcg – Progestogen 0.5 – 1mg • Pill is given orally for 21 consecutive days beginning on 5th day of menstrual cycle followed by break of 7 days during menstruation • Withdrawal bleeding: episode of uterine bleeding from incompletely formed endometrium caused by withdrawal of exogenous hormones.
  • 5. • MOHFW: – MALA- N : 21 tablets of Levonorgestrel 0.15mg + Ethinil oestradiol 0.03 mg – MALA – D: 28 tablets : 21 Hormonal pills + 7 tab of Feso4 • Mechanism of action: – Prevent release of ovum from the ovary – Achieved by blocking the pituitary secretions of gonadotropins that is necessary for ovulation
  • 6. Pills missed? WHAT TO DO IF YOU MISS ONE OR MORE PILLS Every time you miss one or more active pills (days 1-21): Source: Johns Hopkins University Bloomberg School of Health, Population information program
  • 7. 2. Progestogen – only pill (POP) – Referred as “Minipill” – Norethisterone / LNG – Disadv: poor cycle control & ↑ Pregnancy rate – Can be prescribed to older women for whom the combined preparation is contraindicated – ↓ HDL – MOA: renders cervical mucus thick & scanty so inhibits sperm penetration
  • 8. Post – coital contraception (Emergency contraception) Situations • Voluntary sexual intercourse where no contraceptive is used. • When there is a contraceptive method failure or a method is used incorrectly, such as:  Condom leakage  Failure to take OCP for 3 consecutive days  Delaying contraceptive injection more than 2 weeks  Miscalculation of the infertile (safe) period  Failed coitus interruptus • Involuntary sex such as rape/sexual assault
  • 9. • Yuzpe regimen: LNG 0.5mg+EE 0.1mg • E-pill: LNG 0.75mg (2 tab at the interval of 12 hrs). • I-pill: LNG 1.5mg. • EE: 1 mg for 5 days. • LNG 600 μg or D-Norgestrol: 1.5 mg for 5 days within 72 hrs. • Centchroman: 60 mg within 24 hours. • Mifepristone (RU 486): 600 mg taken within 72 hrs. • Cu-T
  • 10. 4. Once – a – month (long acting) pill – Quinesterol (long acting oestrogen given with progesterone . – High failure rate, irregular bleeding 5. Male pill – Preventing spermatogenesis – Interfering with sperm storage & maturation – Preventing sperm transport in vas – Affecting constituents of the seminal fluid – Gosssypol (cotton seed oil)
  • 11. Beneficial effects of OCP’S • Almost 100% effective in preventing pregnancy • Protection from at least six diseases e.g. benign breast disorders, ovarian cysts, iron deficiency anaemia, PID, ectopic pregnancy, ovarian cancer
  • 12. Adverse effects of OCP’s 1) Cardiovascular side effects: have 40% more risk of mortality than non users due to cardiovascular causes 2) Carcinogenesis: increased risk of cervical cancer 3) Metabolic side effects: deranged lipid profile, glucose intolerance, increased blood pressure 4) Other side effects: a) liver disorders: hepatocellular carcinoma, adenoma of gall bladder, cholestatic jaundice b)decrease in breast milk if used during lactation c) more chance of ectopic pregnancy in case of mini pill d) ill effect on foetal development not proved yet
  • 13. 5. Common unwanted effects of OCP 1) Breast tenderness 2) Weight gain in about 25% cases in first 6 months 3) Headache &migrane may aggrevate 4) Breakthrough bleeding or spotting may happen in early cycles in some cases
  • 14. Contraindications of OCP’s Absolute Special problems requiring special surveillance Cancer of breast & genitalia Liver disease Past or present history of Thromboembolism Cardiac abnormalities Congenital hyperlipidemia Undiagnosed uterine bleeding Age over 40 or age over 35 & smoking Mild hypertension Chronic liver disease Migraine Nursing mothers in first 6 months Diabetes Gall bladder disease Amenorrhea Irregular bleeding
  • 15. Depot formulations 1. Injectable contraceptives: A. Progestogen only injectables I. DMPA: – 150 mg IM every 3 months – 99% protection: suppression of ovulation II. NET – EN: (Norethisterone enatate) – 200mg every 2 mts – Higher failure rate compared to DMPA
  • 16. III. DMPA – SC 104 mg – Depo-subQ provera104 ( DMPA – SC) – Injected SC – 104mg every 3 months – Upper thigh / abdomen • S.E.: – Disruption of normal menstrual cycle • Contra indications: – Ca breast, all genital cancers – Undiagnosed uterine bleeding, suspected malignancy – Hypertension – H/o stroke, MI,DVT
  • 17. 2. Sub dermal implants • Norplant: – 6 silastic (silicon rubber) capsules containing 35mg each of LNG • Norplant (R) – 2 : – Easier to remove – Rods are inserted beneath the skin of forearm / upper arm – Effective contraception for 5yrs
  • 18. Post conceptional methods • Menstrual regulation : i.e. aspiration of uterine content within 6-14 days of missed periods • Menstrual induction : by intra uterine installation of prostaglandin F2 • Abortion :may be first or second trimester. This procedure is governed in India by MTP Act of 1971
  • 20. ‘THANKS FOR THE ATTENTION’ REVISE IT Today 2/24/2016 20