HORMONAL

CONTRACEPTION

Dr.U.P.Rathnakar
MD.DIH.PGDHM
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 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

Female condom Vaginal diaphgram Cervical cap

With or without
spermicidal jelly
revent sperm from entering uterine cavit
 INTRAUTERINE
CONTRACEPTIVE DEVICES
(IUCD)

Multi load copper

Cu T
Act as FB-Prevents implantation
Permanent methods

Vasectomy Tubectomy
 Oral Contraceptives

Frank B. Carl Djerassi

Colton Inventor of
Developed modern
ENOVID Enovid, OCP
-First OCP the first OCP
JUN 10 1957
Margaret Sanger The Pill
[Research grant]
 ORAL CONTRACEPTIVE
[HORMONAL]

Women
Combined pill
Phased Regimens
Biphasic
Triphasic
Minipill
Post Coital [Emergency]
 HOW DO THEY ACT?
[MOA]
Principal MOA
Suppress gonadotropin secretion,
and inhibit ovulation
Others
Viscous cervical mucus impedes sperm
transport
Peristalsis in the fallopian tube-
interferes with ovum and sperm
transport.
Endometrium unreceptive-implantation
Dislodge –implanted ovum
1. Combined 2. Phased
pill Regimens
Estrogen/Progesterone 1. Biphasic:
E.estradiol [50/30/20
μg] Fixed amount of estrogen-
And Amount of progestin
Norgestrel/ Dsogestrel/ increases in the second
Levonorgestrel[0.5/.15/. half of the cycle
25mg]
3. Triphasic:

3. Mini Pill Estrogen may be fixed

Progestin only or variable,
Long term risks of -Amount of
estrogen↓ progestin increases
Daily-No interruption
Efficacy lower in 3 equal phases
Irregular bleeding
4. POSTCOITAL [Emergency-
Morning after-Yuzpe]
CONTRACEPTION
1. Levonogestrel0.5mg+Ethynylestrdiol0.1mg]
=2 Ovral
 Within 72 h of unprotected sex
 Repeated after 12 h
2. Levonogestrel-0.75mg-Twice in 12h gap-
within72h
3. 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…….
Advantages
No daily ingestion
I.M.
Highly effective

Disadvantages
Carcinogenic potential in
animals
Menstrual irregularities
Delayed 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 arm
Progestin coated IUCD
ADVERSE EFFECTS: ORAL
CONTRACEPTIVES
Mild Severe
 Nausea, vomiting Peripheral/Pulmonary
 Head ache, migriane ppt thrombosis-[MI-
 Irregular cycle/ Break STROKE]
through bleeding/ Coronary-Cerebral
Amenorrhoea thrombosis
 Breast discomfort
BP↑
Moderate Estrogen/Progesterone
 Wt. gain, Acne -Oppose each other-
 Pigmentation-as in No effect on plasma
pregnancy lipids
 CH-intolerance Benign hepatoma
 Mood swings Gall stones
 WHY THROMBOSIS?
Venous-Estrogen
Arterial-Estrogen + Progestin
Low dose pills-Probably safe
Increase in clotting factors
Decrease-Antithrombin
Decreased plasminogen activator
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 INTERACTIONS
Enzyme 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 Relative
TE , Coronary, DM
Crebrovascular Obesity
diseases
Smoking
Mod to severe
HTN Vag Bleeding
Hyperlipidemia Fibroid
Malignacy of Mentally ill
genitals, breast Above 35
[Even suspected] Mild HTN
Porphyria
Migraine
Planned surgery
Ball bladder
Centchroman
Nonsteroidal
Developed in india
Anti implantation
agent
Long acting
Once a week
dosage
 MALE VS FEMALE---
CONTRACEPTION
Males
Females
One ovum/month Millions of
Short latent period to sperms/ejaculation
take effect Spermatogenesis
64 days-long latent
period
Gonadotropin
suppression
inhibits
testosterone
synthesis
‘GOSSYP No libido
suppression
Men do not get
Abstinence
Only 100%
Safe Method