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Hormonal contraception
Includes
Oral
Parenteral
Implanted contraception
Oral contraceptives
1. The combined pills (estrogen with progestin)
2. Progestin only pills
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Contraceptives cont
The combined pill
Most commonly used
Combines both estrogen & progestin
Estrogen: ethinyl estradiol, mestranol
Progestin: norethindrone, levonorgestrel or
desogestrel
The combined pill is taken for 21 consecutive days
followed by placebo pills for 7 days
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Mechanism of action:
Estrogen inhibits the release of FSH from the
anterior pituitary by a negative feedback effect
suppresses development of ovarian follicles.
Progestins inhibit secretion of LH prevents
ovulation.
Progestins also make the cervical mucus less
suitable for the passage of sperm (makes it more
viscous)
progestins and estrogen make the uterus
unfavourable for implantation.
Adverse Effect
Weight gain due to fluid retention and
anabolic effect of both estrogen and
progesterone
Mild nausea, flushing, dizziness and
depression
Skin changes like acne and increased
pigmentation
Amenorrhea of variable duration
Drug Interaction
OCPs are metabolized by CYP450 so
coadministration of enzyme inducers like
Rifampicin, Carbamazepine, Phenytoin and
Phenobarbitone may decrease contraceptive
effectiveness.
Broad spectrum antibiotics like amoxycilline,
Ampicilline alter intestinal flora, inhibit intero
hepatic cycling of estrogen leading to failure of
effectiveness.
Progestine only coantraceptives
Progestine only pills
Usually contain norethisterone and
levonorgestrel
Mechanism of action:
Makes cervical mucus inconvenient for sperm
migration.
It also hinders implantation through its effect on the
endometrium and on the motility and secretion of
the fallopian tube.
It is preferred in lactating women and in whom
estrogen is contraindicated.
Emergency contraception ( Post coital
contraception)
Is a method of contraception used within 72
hours of unprotected sexual intercourse.
It should not be used in place of the normal
family planning methods.
Its use is recomended when:
A woman has made sex against her will (raped).
A condom has broken
An IUD come out of its place
The most commonly used emergency
contraceptive is a pill containing levonorgestril
0.75 mg 1 tab. as soon as possible and the
same dose after 12 hrs.
Long acting contraceptives