Hormonal contraception

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)

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

10/13/2015 Dr ShashwatJani.9909944160 3

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

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

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

 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

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

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

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 … 

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 .

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

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

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

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.

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

• 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.

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

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.

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

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

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

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

Contraindications
 Pregnancy
 Breast Cancer
 Unexplained Vaginalbleeding

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

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

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

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

Hormonal contraception

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Hormonal contraception