hormonal contraceptive -bds
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Dr.U.P.RathnakarMD.DIH.PGDHM
HORMONALCONTRACEPTION
We Tw
o
We have one
CONTRACEPTION:METHODS Natural family planning methods.
Barrier methods.Hormonal methods.Intrauterine devices.Permanent methods for females and for males.
Emergency contraception.
NATURAL FAMILY PLANNING METHODS
Rhythm Method.Basal Body Temperature method.
Cervical mucus method.Symptothermal method.[temperature, cervical mucus, and calendar ]
Withdrawal method.
Barrier methods of contraception
Cervical capVaginal diaphgramFemale condom
Prevent sperm from entering uterine cavity
With or without spermicidal jelly
INTRAUTERINE CONTRACEPTIVE DEVICES (IUCD)
Multi load copper
Cu T
Act as FB-Prevents implantation
Permanent methods
Vasectomy Tubectomy
Oral Contraceptives
ENOVID-First OCP
JUN 10 1957The PillMargaret Sanger
[Research grant]
Frank B. ColtonDeveloped Enovid,the first OCP
Carl DjerassiInventor of modern OCP
ORAL CONTRACEPTIVE [HORMONAL]
WomenCombined pillPhased RegimensBiphasicTriphasicMinipillPost Coital [Emergency]
HOW DO THEY ACT? [MOA]
Principal MOASuppress gonadotropin secretion, and inhibit ovulationOthers1.Viscous cervical mucus impedes sperm transport
2.Peristalsis in the fallopian tube-interferes with ovum and sperm transport.
3.Endometrium unreceptive-implantation
4.Dislodge –implanted ovum
1. Combined pill 2. Phased RegimensEstrogen/ProgesteroneE.estradiol [50/30/20 μg]And Norgestrel/ Dsogestrel/
Levonorgestrel[0.5/.15/.25mg]
3. Mini PillProgestin onlyLong term risks of
estrogen↓Daily-No interruptionEfficacy lowerIrregular bleeding
1. Biphasic: Fixed amount of
estrogen- Amount of progestin increases in the second half of the cycle
1. Triphasic:
Estrogen may be fixed or variable, -Amount of progestin increases in 3 equal phases
4. POSTCOITAL [Emergency-
Morning after-Yuzpe] CONTRACEPTION
1. Levonogestrel0.5mg+Ethynylestrdiol0.1mg] =2 Ovral
Within 72 h of unprotected sex Repeated after 12 h2. Levonogestrel-0.75mg-Twice in 12h
gap-within72h3. Mifepristone 600mg within 72h Emergency contaraception not
used routinely
INJECTABLE-HORMONE CONTRACEPTION
Long acting progesterone:DMPA [Depot MedroxyProgesterone Acetate• 150mg/3months-deep i.m during I 5days
NEE [NorEthindrone Enanthate]• 200mg/60days-Deep i.m.
INJECTABLE-HORMONES…….
AdvantagesNo daily ingestionI.M.Highly effective
DisadvantagesCarcinogenic potential in animals
Menstrual irregularitiesDelayed fertility after discontinuation-3-6 mo.
IMPLANTS - NORPLANT•Original: 6 capsules[6x36.g/Pro]• New: Norplant II - two small (2.5 mm x 43 mm) silicone rods each containing 75 mg of levonorgestrel in a polymer matrix,. • Effective for 5 years.• Inserted s.c upper armProgestin coated IUCD
ADVERSE EFFECTS: ORAL CONTRACEPTIVES
Mild SevereNausea, vomitingHead ache, migriane pptIrregular cycle/ Break
through bleeding/ Amenorrhoea
Breast discomfort
ModerateWt. gain, AcnePigmentation-as in
pregnancyCH-intoleranceMood swings
Peripheral/Pulmonary thrombosis-[MI-STROKE]
Coronary-Cerebral thrombosis
BP↑Estrogen/
Progesterone-Oppose each other-No effect on plasma lipids
Benign hepatomaGall stones
WHY THROMBOSIS?Venous-EstrogenArterial-Estrogen + ProgestinLow dose pills-Probably safe1.Increase in clotting factors2.Decrease-Antithrombin3.Decreased plasminogen activator
4.Increased platelet aggregation
HEALTH BENEFITS↓Endometrial & Ovarian Carcinoma
Regular cycles, Less bleeding Premenstrual tension & Dysmenorrhoea ↓
Endometriosis and PID ↓
Fibrocystic disease of breast, ovarian cyst ↓
DRUG INTERACTIONSEnzyme inducers Contraceptive failure-[Phenytoin, Pheno, Carbamazapin, Rifampicin]
: T.C. → Suppression of Intestinal flora → E.H.circulation interrupted → Less absorption of hormones → Blood level fall → Contraceptive failure
CONTRA INDICATIONS
Absolute RelativeTE , Coronary, Crebrovascular diseases
Mod to severe HTN
HyperlipidemiaMalignacy of genitals, breast [Even suspected]
PorphyriaPlanned surgery
DMObesitySmokingVag BleedingFibroidMentally illAbove 35Mild HTNMigraineBall bladder
disease
CentchromanNonsteroidalDeveloped in india
Anti implantation agent
Long actingOnce a week dosage
MALE VS FEMALE---CONTRACEPTION
FemalesOne ovum/monthShort latent period to
take effect
‘GOSSYPOL’
Males
Millions of sperms/ejaculation
Spermatogenesis 64 days-long latent period
Gonadotropin suppression inhibits testosterone synthesis
No libido suppression
Men do not get pregnant
AbstinenceOnly 100%Safe Method
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