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Hormonal contraception

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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.

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Hormonal contraception

  1. 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. 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. 3. 10/13/2015 Dr ShashwatJani.9909944160 3
  4. 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. 5. HORMONAL CONTRACEPTION  ORAL CONTRACEPTION COMBINED, PROGESTERONE ONLY PILLS (MINI PILLS)  NON- ORAL CONTRACEPTION TRANSDERMAL PATCHES INJECTABLE CONTRACEPTION IUDs IMPLANTS VAGINAL RINGS
  6. 6. ORAL CONTRACEPTION
  7. 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. 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. 9. Estrogens:  Ethinyl estradiol  Mestranol Progestins:  Ethynodiol diacetate  Norethindrone acetate  Norethindrone  Norgestrel  Levonorgestrel  Desogestrel  Norgestimate  Drospirenone 2nd Generation 3rd Generation Spironolactone Derived
  10. 10. Types of COC
  11. 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. 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. 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. 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. 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. 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. 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. 18. Missed Pill Regime(WHO)
  19. 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. 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. 21. Follow up …  Examined after 3 months , thenafter 6 months and then yearly.  Askfor anysymptoms… Examination for breast , pelvis, BP& weight& cervical cytology.
  22. 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. 23. Side Effects  Breakthrough Bleeding (≤ 25%)  Amenorrhea  Breast Tenderness, Nausea  ? HTN  ? Weight Gain
  24. 24. Risks  Thromboembolism (≥ 35 yo, Smoker)  MI (Smokers Only):  < 15 cig/day: 3X Risk  > 15 cig/day : 21X Risk  Liver Adenomas (Very Rare)
  25. 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. 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. 27. Contraindications  Pregnancy  Breast Cancer  Unexplained Vaginalbleeding
  28. 28. NON-ORAL CONTRACEPTION
  29. 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. 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. 31. Depo Provera: -every 3 months -Medroxyprogestin Acetate 150 mg. Types
  32. 32. Main Side-Effects:  Amenorrhea  AUB  Weight Gain  Hair Loss
  33. 33. THANK YOU

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