You are on page 1of 65

Contraception

Technology Update
{
KONTRASEPSI TERKINI

Dr. dr. Eka Rusdianto SpOG ( K )


1
Life is short
Number of germ cells in human ovaries:

3
Pola Perencanaan Keluarga

Fase Fase Fase

Menunda Menjarangkan Tidak Hamil


Kehamilan Kehamilan lagi

2-4

20 35

4
Contraceptive Methods Rationale Choice

Phase Phase Phase


DIFFERING SPACING COMPLETING

2-4

- Pill - IUD - IUD - Steril


- IUD - Inject. - Inject. - IUD
- Conventional - Pill - Pill - Pill
20 35 - Implant
- Inject. - Implant - Implant
- Implant - Conventional - Conventional - Inject.
- Steril - Conventional
5
World wide use of methods
Fem. Sterilisation
29%
Male Sterilisation
9%

Injectables
IUD
4% 21%

Condoms
9%

Trad. Methods Pill


14% 14%
6 WHO, 1990
Contraceptive Users

METHODS USERS %

INJECTABLES 9,743,550 35.2


PILLs 7,796,474 28.1
IUDs 5,218,196 18.8
IMPLANTABLES 3,156,705 11.4
STERILIZATION 1,515,406 5.5
OTHERS 278,473 1.0
TOTAL 27,708,804 100.0

7
Source: BKKBN, 2007
Current Contraceptive Users
METHODS USERS %

Users 20,714835 61.9


Modern 19,376,235 57.9
Injectables 10,675,335 31.9
Pills 4,551,240 13.6
IUDs 1,305,135 3.9
Implantables 1,104,345 3.3
Sterilization 1,070,880 3.2
Others 669,300 2.0
Traditional 1,338,600 4.0
Non-users 12,750,165 38.1
TOTAL 33,465,000 100.0
8
Source: SDKI, 2012
New CONTRACEPTIVE CHOICES

1. PILLS
2. PATCHES
3. INJECTABLES
4. HORMONE-RELEASING IUDs
5. VAGINAL RINGS
6. IMPLANTABLES

9
{
ORAL CONTRACEPTIVE PILLS

10
Why do we need a new pill?

1. Improve patient compliance

2. Reduce unwanted side effects

3. Provide additional benefits

11
Pharmacokinetic Profile of Different
Contraception

12
PIL KB

13
14
15
16
 Pack berisi 91 Pil
 84 Pil aktif (Pink)
 7 Inaktif Pil (Putih)
 Dosis kombinasi rendah:
 EE 30 μg
 LNG 150 μg

Seasonale ®
17
Reason why the lady stops their pills,
not even to start using it………

18
 Estrogen:
 Ethinyl estradiol (EE)
 Mestranol

 Progestogen/Gestogen/Progestin:
 17 alpha-hydroxyprogesterone

derivatives
 19 nortestosterone derivatives

 17 alpha-spironolactone derivatives

Composition of OCP
19
Progestin
Classification of Progestins

Progesterone 19-nortestosterone 17α-spirolactone

Pregnanes Gonanes

Norgestrel
Medroxy- Drospirenone
progesterone Levonorgestrel
acetate Norgestimate
Cyproterone Desogestrel
acetate Gestodene
Chlormadinone
acetate

20
0.03 mg ethynilestradiol
0.15 mg levonorgestrel

0.03 mg ethynilestradiol + 0.05 mg levonorgestrel for 6


days 0.04 mg
ethynilestradiol + 0.075 mg levonorgestrel for 5 days
21 0.03 mg
ethynilestradiol + 0.125 mg levonorgestrel for 10 days
Mempercantik diri dengan ber-KB

0.03 mg ethynilestradiol
0.075 mg gestodene

0.03 mg ethynilestradiol
3.00 mg drospirenone

22
23
Epidemiologi Gejala dan
Keluhan Premenstruasi

Semua Wanita dengan 50–80%


mengalami gejala 13– 3–8%
siklus menstruasi PMDD 3–14
premenstruasi 1–4 26%
PMS 3,5,6

1. de la Gandara Martin and de Diego Herrero 1996; 2. Ramcharan et al. 1992; 3. Wittchen et al. 2002;
4. Woods et al. 1982; 5. Angst et al. 2001; 6. Halbreich et al. 2003; 7. Campbell et al. 1997; 8. Chawla et al. 2002; 9.
Cohen et al. 2002; 10. Deuster et al. 1999; 11. Gehlert and Hartlage 1997; 12. Johnson et al. 1988;
13. Rivera-Tovar and Frank, 1990; 14. Sveindóttir and Bäckström 2000
24
PMS: A common disorder affecting
millions of women worldwide

25
26
Modern contraception trends

Efficacy, Reliability, Safety


New
Formula
1960 2010

efit s , ifes t yle


n L
ea lth Be norrhea,
dd e d H e, Ame
A
v e nienc
Con

Reduction / elimination of EE 20 microgram

New progestines with additional benefits

Changes in intake regimen


24/4 regimen
27
New
Formula

mengandung
ethinyl estradiol (EE) 20 g
drospirenone (drsp) 3 mg

Diminum setiap hari selama 24 hari


kemudian dilanjutkandengan interval
bebas hormon selama 4 hari (regimen
24/4)

Sehingga memberikan interval bebas


hormon yang lebih pendek
28
Keunikan regimen 24/4
 28 hari DRSP exist

29
{ PATCHES

30
31
The Contraceptive Patch Ortho Evra ®

32
Composition of EVRA
Backing Film
– Flexible Polyester Film

Middle Layer
– Norelgestromin & Ethinyl
Estradiol
– Polyisobutylene/polybutene
adhesive
– Lauryl lactate
– PVP
– Non-woven polyester fabric

Release Liner
– Clear polyester S-cut film
33 protecting the adhesive
layer
Activities...
34
{ INJECTABLES

35
Status Kontrasepsi Suntikan, 2004
Affandi, 2004

Jenis Kurun Yang Tersedia Status


Suntikan bulanan 1. DMPA 25 mg + EC 5 mg Pemasaran
2. Net-En 50 mg – EV 5 mg Pemasaran
3. Net-En 20 mg Fase II
4. DMPA 150 mg + EE 10 mg Pemasaran
5. Lain-lain

Suntikan 2-3 bulanan 1. Net-En 200 mg Pemasaran


2. DMPA 150 mg Pemasaran
3. Net Mikrokapsul 100 mg Fase I - II

Suntikan 6 bulanan 1. DMPA 450 mg Pemasaran


2. Net mikrokapsul 200 mg Fase I – II

36
Injectable Contraception
Suntikan KB 1 bulanan

Suntikan KB 3 bulanan – 3 ml Suntikan KB 3 bulanan – 1 ml


{
HORMONE-RELEASING IUDs

38
 The 1st IUS (Intra Uterine System) is
Progestasert® , 38 mg of progesterone,
with a release rate of 65 µg of
progesterone per day.
 Approved by FDA in 1976, it was

manufactured by ALZA Corporation,


USA.
 Marketing of Progestasert® ended in

the summer of 2001, and it is no longer


available

The Intrauterine System


39
40
 New technic
 Normal (pervaginam) or CS

(perabdominam)
 Post placental insertion (within 10

minute)

Post placental IUD


41
{
VAGINAL RINGS
42
The Contraceptive Vaginal Ring:
NuvaRing ®

Flexible, soft,
transparent ring with
outer diameter of 54
mm and cross section
of 4 mm

43
44
{
IMPLANTABLES
45
46
Status & Development of
Implantable Contraceptives 2009

TRADE NAME PROGESTIN IMPLANTS DURATION STATUS

Norplant LNG 6 rods 5 years Market


Implanon ENG 1 rod 3 years Market
Jadelle LNG 2 rods 5 years Market
Uniplant NMA 1 caps 1 year Phase III
Nestrone ST1435 1 rod 2 years Phase III
Elcometrine ST1435 1 caps 6 months Market
Indoplant LNG 2 caps 3 years Market
Monoplant LNG 1 caps 3 years Phase II
47
48
MONOPLANT®
49
POSTCOITAL CONTRACEPTION
MORNING AFTER PILLS

{
EMERGENCY
CONTRACEPTION
50
 Emergency contraception (EC)
is any method of contraception
which is used after intercourse
and before the potential time
of implantation

What is emergency
contraception?
51
From fertilization to
implantation about 6 days

52
Lumire, Jakarta, 7/9/2013
...not a New Idea...

 “Traditional” methods for post coital contraception


have been used for decades
 High doses of vitamin C, aspirin or chloroquine

 Douches of coca cola, baking soda, urine

53
Family Planning Perspectives.1996;22:52-66
 As these methods work prior to
implantation, they are not
abortifacients.
 Emergency contraception is a
backup method for occasional
use, and should not be used as a
regular method of birth control.

IMPORTANT NOTES
54
1. A woman was raped
2. No contraception used
3. Condom slipped, leaked, broke
4. Diaphragm or cervical cap inserted
incorrectly, removed too soon, torn
5. Two consecutive birth control pills
were missed

ECPs can be used when:


55
6. An IUD was partially or totally
expelled
7. A three-month contraceptive
injection was missed by more than
two weeks
8. A one-month contraceptive
injection was missed by more than
three days

ECPs can be used when:


56
There are 2 methods of emergency
contraception:
1. Hormonal methods, which involve the
use of emergency contraceptive pills
(ECPs)
2. The post-coital insertion of a copper
intrauterine device (IUD)

Methods of EC
57
Two hormonal preparations are:
1. One contains only the progestin
levonorgestrel, while the other is a
2. Combined preparation containing
both ethinyl estradiol and
levonorgestrel

Hormonal Method
58
Progestin only

 Plan B
 Valenor-2
 Levonelle-2
 Postinor-2
 Contraplan II

59
 The regimen consists of 2
doses of 750 µg
levonorgestrel taken orally 12
hours apart

Levonorgestrel-only
method
60
61
 Copper Intrauterine Device
 An IUD (or advice on how to obtain one)
should be offered to all women attending for
EC even if presenting within 72 hours of
UPSI

IUD
62
 ECPs are not a good long-term

method of contraception

 Should be used as a bridge to a

regular form of birth control

 ECPs do not protect against STDs

Limitations of ECPs
63
64
Thank You

65
Lumire, Jakarta, 7/9/2013