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CONTRACEPTION ,[object Object],Dr. Mona A. Almushait,[object Object],Dean, Girl’s Centre,[object Object],Associate Professor, Medical College,[object Object],Consultant, Obstetrics & Gynaecology,[object Object],King Khalid University,[object Object],Abha, Saudi Arabia,[object Object]
Methods of Contraception,[object Object]
I.Combined Hormonal Products ,[object Object],and ,[object Object],Progestin–Only Injection and Pills,[object Object]
Combined Estrogen and Progesterone Contraceptives ,[object Object],4Different delivery systems are used to supply estrogen and progestin to provide contraception:,[object Object],[object Object]
Monthly injections
Transdermal patches
Vaginal rings ,[object Object]
Mode of action: ,[object Object], 	Combination of hormonal methods utilizes 2 main mechanisms of contraceptive action:,[object Object],[object Object]
Thickening of the cervical mucus (to prevent sperm entering the upper genital tract)
Other mechanisms:-> slowing of tubal transport ,[object Object],-> atrophy of the endometrium ,[object Object], ,[object Object]
Complications of Estrogen–Containing Contraceptives:,[object Object],[object Object]
Post pill amenorrhea
Cerebrovascular accidents
Increased in Cholelithiasis       (cholestatic jaundice)
HTN
Benign hepatic tumors (Hepatoma)
Headache in the week off ,[object Object]
Venous thrombus (Thromboembolism)
Pulmonary embolism
Coronary vascular disease, IHD -> cardiomyopathy, vascular heart disease
Past cerebrovascular accident
Pulmonary HTN
Current pregnancy
Breast cancer within the last 5 years (Oestrogen–dependent Cancer),[object Object]
Hepatic tumor or abnormal liver function, Dubin–Johnson or Rotor syndrome, known gallstones
Unexplained abnormal uterine bleeding
Age >35 and cigarette smoking
Uncontrolled hypertension
History of melanoma
Hyperlipidaemia, focal and crescendo migraine
Trophoblastic disease,[object Object]
Complicated prolonged Diabetes -> F.H. of DM
Estrogen–dependent neoplasm
Depression, Hyperprolactinemia
Severe varicose veins
Hypertriglyceridemia
increasing age, smoking, obesity, migraine,[object Object]
The Progestin–only methods provide the greatest pregnancy protection of all reversible methods of contraception.,[object Object]
Few women inhibit ovulation
Twining the endometriumHow to use?,[object Object],[object Object]
Taken at the same time each day
Irregular bleeding in the first few months
Most women continue to menstruate although some may have lighter periods and a few become amenorrhoeic. ,[object Object]
Older women
Smokers, immediately post–partum, breastfeeding, risk of DVT, hypertension, migraine, or diabetes, PMS
Pills most frequently used by breastfeeding women Side effects:,[object Object],[object Object]
↑ risk of ectopic pregnancy
Acne, headache, breast tenderness, nausea, irregular bleeding
Weight change
↑ breast cancer diagnosis,[object Object]
Amenorrhea, improve dysmenorrheafor mentally retarded woman -> good hygiene,[object Object],[object Object]
Failure rates of 3% to 9%
Return to fertility ranges from immediate with pills and implants to slow with DMPA (Depo-Provera).,[object Object]
[object Object]
Serum level of DMPA is higher than with implants and IUDs
DMPA
Suppresses gonadotropins to inhibit ovulation
Change cervix mucus  (thickening)
Twining endometrium
Good for women using anticonvulsants which increased hepatic clearance of sex steroids
The majority of women develop Amenorrhea
Ovarian suppression
Hypoestrogenism (Postmenopausal level)-> dry vagina, low bone mineral density,[object Object],[object Object],[object Object]

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Contraception