Hormonal contraception refers to birth control methods that act on the endocrine system. Almost all methods are composed of steroid hormones, although in India one selective estrogen receptor modulator is marketed as a contraceptive.

1. Hormonal Contraception
Prepared By:
1. Bibhu Prasad Sahu (GM/16/058)
2. Subhrajyoti Roy (GM/16/139)
3. Protiksha Saha (GM/16/024)
4. Biswarup Boxi (GM/16/087)

2. Introduction
 World’s population expected to reach 9 billion by2050.
 India accounts for 18%of World’s population…!!!
 Annually, 529,000 maternal deaths & 50million
morbidity.
 In India, contraceptive prevalence is 48.3%.
 21%of all pregnancies resulting live births are
unplanned….!!!
 If unmet need for contraception wasmet, we canavoid
52 million unwanted pregnancies
25-50%of maternal deaths

3. 10/13/2015 Dr ShashwatJani.9909944160 3

4. Advantages
 Most effective, long-term reversible
contraception available
 Most methods offer complete privacy
 Require no planning before intercourse
Disadvantages
 Require a visit to a healthcare professional
 May cause common hormonal side effects
 Products containing estrogen may be
associated with rare, but serious health risks
 Not effective against STD

5. HORMONAL CONTRACEPTION
 ORAL CONTRACEPTION
COMBINED, PROGESTERONE
ONLY PILLS (MINI PILLS)
 NON- ORAL CONTRACEPTION
TRANSDERMAL PATCHES
INJECTABLE
CONTRACEPTION IUDs
IMPLANTS
VAGINAL RINGS

6. ORAL
CONTRACEPTION

7. Commonly known asthe “ Pill“
Widely Accepted & Most Effective
Reversible method of FertilityControl.
In 1951, India wasthe 1st countryin
world to introduce COCin National
programme of FamilyPlanning.
1. The Combined Oral Pill

8.  Contain Synthetic Estrogen/Progestin
 Modern E2 Dosage ≤ 50 Mcg
 Despite Diversity, Side Effects and Efficacies
Similar
 Requires Patient Compliance
 May Be Monophasic or Triphasic
COC:Estrogen + Progestrogen

9. Estrogens:
 Ethinyl estradiol
 Mestranol
Progestins:
 Ethynodiol
diacetate
 Norethindrone
acetate
 Norethindrone
 Norgestrel
 Levonorgestrel
 Desogestrel
 Norgestimate
 Drospirenone
2nd
Generation
3rd Generation
Spironolactone Derived

10. Types of COC

11. 1) Monophasic
Contains Estrogen & Progesterone in same
amount in Each pill .
 Divided in 2 subgroups :
- Low dose pills : EE 30 – 35 microgm
- Very low dose pills : EE 15 – 25 microgm.
Mala - N
• dl – NGL 0.15 mg
• EE 0.03 mg
Mala - D
• l – NGL 0.15 mg
• EE 0.03 mg

12. 2 ) Multiphasic
Contains low or variable amounts of E and P in 2 (
biphasic ) or 3 ( triphasic ) phases of cycles.
Biphasic : constant EE – 35 microgm
progestogens : low in first 10 days
higher in next 11 days .
NOT POPULAR – MORE FAILURE RATE
. NOT AVAILABLE IN INDIA … 

13. 3.Triphasic :
Triquilar –
- 0.03 EE+0.5mg l-norgestrel (1 - 6)
- 0.03 EE+0.75mg l-norgestrel (7-11)
- 0.03 EE+0.125mg l-norgestrel (12 - 21)
Total monthly intake – 0.68mg EE+1.92mgprogesterone
• Adv. – high efficacy rates
- few sideeffects
- lessbreak through bleeding
- does not affect s.cholesterol &LIPIDS
• Disadv.– high pregnancy rates iferrors in pill intake .

14. Mechanism of Action
 Suppresses LH / FSH Release
(E2 FSH, P LH)
 Progestin Thickens Cervical Mucus and Alters
Endometrium
 Major Effect Is Anovulation and Impairment of
Sperm Transport and Oöcyte Implantation

15. Advantages:
 Highly effective
 Provides noncontraceptive health benefits
 Private
 Does not require vaginal insertion
 Allows to control cycle
Disadvantages:
 Must be taken daily
 Side effects may lead to discontinuation
 Associated with rare, but serious health risks,
such as blood clots and stroke

16. Non-Contraceptive Benefits of OCPs
Improvement
Dysmenorrh
ea Acne
Hirsutism
Anemia
Cycle
Regulation
Reduction Risks Colorectal
Cancer (18-40%)
Endometrial Cancer
PID (10 – 70%)
Osteoporosis
Osteopenia
Cleveland Journal of Medicine
2004

17. Administration
New User :
-1st day of Cycle.
- Daily 1 tab. Preferably at night for consecutive 21 days.
-Continued for 21 daysand then 7 daysbreak (with
iron tablets ).
-Next packof Pill should be started on 8th day,
IRRESPECTIVE OF BLEEDING ( sameday of the week , pill
finished ).
- Simple Regimenof “ 3 WEEKSON& 1 WEEKOFF“
- No break between packs.
 Canstart pill up to 5 daysof bleeding with extra
precaution with condom fornext 7 days.

18. Missed Pill Regime(WHO)

19. Extended Useof COC…
(Seasonale)
Available since 2003
150µg of LNG +30µg of EE
OnlyActive Pills taken continuously for 84days,
then break for 7days.
Fewer periods (4 in ayear)
Pearl index- 0.78
Breakthrough bleeding/ spotting – Firstfew
cycles

20. • Lactating Women – Progestogen only pills /
Combined pills after 6months
• Non Lactating Women – Combined oral pills
after 3 to 6 weeks or aftermenstruation
• 1st / 2nd Trimester abortion – during first7
days.
• Amenorrhea : At any time afterexcluding
pregnancy +barrier method for 7days.

21. Follow up …
 Examined after 3 months , thenafter
6 months and then yearly.
 Askfor anysymptoms…
Examination for breast , pelvis, BP& weight&
cervical cytology.

22. How long can be continued …???
In properly selected patient without
any risk factor , benefits are more ,
and socanbe continued up to ageof
50 with careful monitoring. Offers
dual advantage of Contraceptionand
HRT.
For spacing of birth : 3 – 5years.

23. Side Effects
 Breakthrough Bleeding (≤ 25%)
 Amenorrhea
 Breast Tenderness, Nausea
 ? HTN
 ? Weight Gain

24. Risks
 Thromboembolism (≥ 35 yo, Smoker)
 MI (Smokers Only):
 < 15 cig/day: 3X Risk
 > 15 cig/day : 21X Risk
 Liver Adenomas (Very Rare)

25. Mini pills
PREPARATIONS
Norethindrone – 0.350 mg ( micronor/cerazette)
Levonorgestrel – 0.075 mg (Neogest)
Norgestrel - 0.030 mg (Norgeston)
Ethynodiol diacetate – 0.5 mg(Femulen)
INDICATIONS :
Age>40 Yrs.
Lactating Women.
MECHANISM :
Cervical Mucus Thickning :- Effect starts in 2-4 hrs. & last
for 20–24hrs.
Inhibits Ovulation
Involute Endometrium

26. 2. MINI PILLS
Schedule
• 1st day of M.C.and abackup method for 7 days
• 6 wks after delivery – no backupmethod
• Missed Tablet – Backupmethod for 48Hrs.
• Failure Rate - 3- 10 %
Lactating Women – 0.5 %
Advantages
Canbe used above 16 yrs of age,Smokers&
obesity
Best in DM, CVSDiseases& SLE
Disadvantages
Irregular Bleeding,Acne, Mastalgia,Amenorrhoea

27. Contraindications
 Pregnancy
 Breast Cancer
 Unexplained Vaginalbleeding

28. NON-ORAL
CONTRACEPTION

29. 1.The Contraceptive Patch
(Evra Patch)
Advantages:
 Efficacy comparable to OCPs
 Weekly application encourages compliance
 Does not require vaginal insertion
Disadvantages:
 Application site reactions may occur
 May not be as effective in women weighing
more than 198 pounds
 May produce side effects similar to OCPs,
with higher rate of transient breast pain
 Noncontraceptive health benefits
theoretically similar to combination OCPs,
but not as well documented
 May be visible on the skin
OCP = Oral Contraceptive Pill

30. 2. Injectable Hormonal Contraception
Advantages:
 Highly effective
 Convenient three month administration schedule
encourages
adheren
ce
 Private
 Useful when estrogen should be avoided
 Decreases risk of endometrial cancer
Disadvantages:
 Irregular bleeding and amenorrhea frequently occur
 Weight gain, abdominal pain, and depression are
common side effects
 Prolonged use may decrease bone mass

31. Depo Provera:
-every 3 months
-Medroxyprogestin Acetate 150 mg.
Types

32. Main Side-Effects:
 Amenorrhea
 AUB
 Weight Gain
 Hair Loss

34. THANK YOU