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    Barrier Methods Hormonal Methods Oral Contraceptives Vaginal Rings Implants, Injectables Withdrawal and Abstinence

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    Em Walker
    This document summarizes various contraceptive methods including barrier methods, hormonal methods, behavioral methods, and emergency contraceptives. It describes common contraceptives such as oral contraceptives, vaginal rings, implants, injections, IUDs, condoms, diaphragms and spermicides. It provides details on mechanisms of action, effectiveness, side effects, benefits and risks of different hormonal methods and emergency contraception options.

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    Barrier Methods Hormonal Methods Oral Contraceptives Vaginal Rings Implants, Injectables Withdrawal and Abstinence

    Uploaded by

    Em Walker
    121 views37 pages
    This document summarizes various contraceptive methods including barrier methods, hormonal methods, behavioral methods, and emergency contraceptives. It describes common contraceptives such as oral contraceptives, vaginal rings, implants, injections, IUDs, condoms, diaphragms and spermicides. It provides details on mechanisms of action, effectiveness, side effects, benefits and risks of different hormonal methods and emergency contraception options.

    Original Title

    Contraception Handout

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    This document summarizes various contraceptive methods including barrier methods, hormonal methods, behavioral methods, and emergency contraceptives. It describes common contraceptives such as oral contraceptives, vaginal rings, implants, injections, IUDs, condoms, diaphragms and spermicides. It provides details on mechanisms of action, effectiveness, side effects, benefits and risks of different hormonal methods and emergency contraception options.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    121 views37 pages

    Barrier Methods Hormonal Methods Oral Contraceptives Vaginal Rings Implants, Injectables Withdrawal and Abstinence

    Uploaded by

    Em Walker
    This document summarizes various contraceptive methods including barrier methods, hormonal methods, behavioral methods, and emergency contraceptives. It describes common contraceptives such as oral contraceptives, vaginal rings, implants, injections, IUDs, condoms, diaphragms and spermicides. It provides details on mechanisms of action, effectiveness, side effects, benefits and risks of different hormonal methods and emergency contraception options.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 37

    Contraceptive Methods

    Barrier methods Hormonal methods

    Oral Contraceptives Vaginal rings Implants, Injectables


    Behavioral methods

    Withdrawal and Abstinence

    The Basics
    The female ovaries usually release one egg every month When the egg is released (ovulation) it makes its way to the uterus through one of the fallopian tubes. At the same time, the lining of the uterus becomes thicker and prepares for pregnancy.

    The Basics
    The female ovaries usually release one egg every month When the egg is released (ovulation) it makes its way to the uterus through one of the fallopian tubes. At the same time, the lining of the uterus becomes thicker and prepares for pregnancy.

    BARRIER METHODS

    Condom Cervical cap Leas shield Diaphragm

    Contraceptives
    Avoids unplanned pregnancies Among the most-used (prescribed) in the world Available from 1960s

    Contraceptives
    among the most effective drugs available
    A wide variety : different components, doses, and side effects used in relatively young, healthy persons (in contrast to disease treating agents) side effects therefore are an important consideration

    Contraceptives
    have substantial health benefits . Should not directly conclude the adverse effects of hormonal contraceptives to HRT and vice versa Have low incidence of untoward effects for most women

    Contraceptives
    Estrogens + Progestins
    Oral Contraceptive (~1% preg. Rate) Also useful to treat endometriosis

    Progestins only

    Action
    Inhibit the hypothalamic pituitary axis, to inhibition of ovulation
    Also affect
    Cervical mucus Uterine endometrium Uterine tubes - Motility - Secretion

    (-)

    HYPOTHALAMUS
    GnRH

    (-)

    PITUITARY
    ACTH LH FSH, PRL LH FSH

    Ad. Cortex

    BREAST

    GONADS

    STEROIDS

    Contraceptives
    Estrogens + Progestins
    Estradiol Ethinyl estradiol Mestranol Norethindrone Norgestrel Desogestrel Norgestimate

    Contraceptives Regimen
    Monophasic
    Constant Dose of Est & Pro

    Bi/Triphasic
    Dosage of one/both changed

    Pharmacological Effects
    The Ovary Inhibition of follicle development The Uterus Hypertrophy polyp formation (with prolonged use) Thickening of cervical mucus The Breast.

    Enlargement in most cases


    The central nervous system.

    Excitability?

    Pharmacological Effects
    The endocrine function.
    inhibition of pituitary gonadotropin secretion alteration of adrenal structure and function

    The blood. Lipid metabolism.


    serious thromboembolic effects - reason unknown increase serum triglycerides, free and esterified cholesterol and HDL

    Pharmacological Effects
    Cardiovascular system.
    small increase in cardiac output higher bp and heart rate.

    Carbohydrate metabolism Skin.


    progressive decrease in carbohydrate tolerance increase in skin pigmentation androgenic steroids may result in acne

    Adverse Effects
    Nausea mastalgia (pain in the breast) breakthrough bleeding edema
    REMEDY:
    lesser concentration of estrogens or substitution with drugs containing progestins with more androgenic effects.

    Adverse Effects
    Weight gain (common)
    Dieting; drug containing more progestin.

    Increased skin pigmentation, Acne


    May be exacerbated by androgen-like progestins.

    Hirsutism (Esp. 19-nortestosterone derivatives) Vaginal infections - common, difficult to treat

    Do not use oral contraceptives in patients with: Thrombophlebitis

    Thromboembolic phenomenon
    Cerebrovascular disorders Known or suspected tumor of the breast or other estrogen-dependent neoplasm

    Use oral contraceptives with caution in patients with: liver disease asthma eczema migraine diabetes hypertension optic neuritis convulsive disorders congestive failure

    Contraception with Progestins alone


    If estrogen administration is undesirable small doses of progestin oral or by implantation effectiveness is comparable to IUDs or to the combination of pills containing 20-30 mg of ethinyl estradiol.

    Contraception with Progestins alone

    Levonorgestrel Family (Gonanes)


    Norethindrone Family (Estranes)


    Norethindrone Norethindrone

    SpironolactoneDerived
    Drospirenone

    Levonorgestrel Norgestrel Desogestrel Norgestimate Gestodene*

    acetate Ethynodiol diacetate Lynestrenol*

    Remember Yaz?

    DEPO-PROVERA: The 3-MONTH SHOT

    Synthetic Progesterone analog (no estrogen) Application


    First shot - during or a few days after the start of the menstrual period. After 24 hours, the shot is effective for the next 13 weeks.

    DEPO-PROVERA: The 3-MONTH SHOT Contraindications


    Unexplained bleeding Known or suspected bleeding Planning to become pregnant Concerned being over weight With Liver Disease With Gallbladder disease With history of depression

    Risks

    Allergic reactions Increased risk of osteoporosis If becomes pregnant during use: Increased risk of premature birth

    DEPO-PROVERA: The 3-MONTH SHOT Possible Side Effects


    Headaches Nervousness Mood changes Bloating Hot flashes Decreased interest in sex Breast tenderness Acne Hair loss Back ache

    Other Health Benefits of Contraceptives


    ovarian and endometrial cancer
    within 6 months of use lasts up to 15 years after discontinuation

    regularity of menstrual cycle menstrual blood loss premenstrual tension dysmenorrhea incidence of pelvic inflammatory disease (PID) ectopic pregnancies may improve endometriosis

    Plan BTM: Progestin Only Emergency Contraception


    Levonorgesterol 0.75 mg

    First Dose: within 72 hrs of unprotected intercourse Second Dose : Within 12 hrs of first dose

    Emergency Contraceptives The morning after pill

    Prevents the sperm-egg union


    Blocks fertilized egg from implanting 90 95% effective

    Side Effects - vomitting, bleeding - Heart attack, blood clots

    Other Post-Coital Contraceptives

    Conjugated estrogens: 10 mg/ 3 a day/ 5 days


    Ethinyl Estradiol: 2.5 mg/ 2 a day/5 days Norgestrol (0.5 mg) + Ethinyl Estradiol (0.05 mg)

    (Ovral, Preven) 4 tablets - 2 immediately - 2 after 12 hrs

    Mifepristone (RU486)
    A 19-Norsteroid binds progesterone receptor inhibits the progesterone activity

    Major use : termination of early pregnancies


    (less than 49 d after last cycle)

    Mifepristone (RU486) - Dosage


    400-600 mg/d for 4 days or

    800 mg/d for 2 days


    successfully terminates pregnancy in 85% of the women. Combination : single oral dose of 600 mg mifepristone

    a vaginal pessary of 1 mg of prostaglandin E1


    successfully terminates pregnancy in 95% of the women 7 wks after conception

    Mifepristone (RU486) Adv. Effects

    Vomiting Diarrhea Vaginal bleeding

    Intra Uterine Devices - Hormonal

    Mirena Releases progestin Effective for 5 yrs

    Vaginal Rings - Contraceptive

    Nuvaring Estrogen + Progest. Use 3 wks; Removal - menstruation

    IMPLANTS

    Progestin-only method 1 6 match-sized rods are implanted under the skin Release progestin slowly over time.
    Stops ovulation Thickens cervical mucus to block sperm entry Thins uterine lining

    IMPLANTS
    consists of one or six match-sized rods inserted underneath the skin. the rods release a steady dose of one hormone only - progestin.

    prevents the ovaries from releasing eggs (stops ovulation). Thickens cervical mucus, blocking sperm entry
    Thins uterine lining, further reducing the chances of pregnancy.

    CONTRACEPTION IN MEN
    No suitable oral contraceptive for man has yet been developed.

    Gossypol

    Destroys the seminiferous epithelium

    Does not affect the endocrine apparatus of the testis

    CONTRACEPTION IN MEN RISUG Reversible Inhibition of Sperm Under Guidance Partially blocks vas deferentia Disrupts sperm that pass through

    Currently in Phase III clinical trials in India

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