• Contraception

• Measures either temporary or permanent , Methods of contraception

designed to prevent pregnancy due to the Natural Artificial
coital act.
• Contraceptives: those which prevent
fertilization of ovum Temporary Permanent

• Interceptives: those which work prior to or at

the time of implantation of blastocyst. e.g.
postcoital pill, IUCD Hormonal Non hormonal

• Contragestives: those which prevent Barrier Methods

gestation by preventing implantation or by
causing uterine lining to shed after
implantation.eg mifepristone
 HORMONAL
CONTRACEPTIVES
COMPOSITION
Estrogens
• Commonly ethinyl estradiol
• (rarely mestranol & Estradiol
valerate)
Progestins
• Commonly -19 nor testosterone
derivatives,
(levonorgestrel,norethisterone,d
esogestrel)
• Classified as

• Monophasic-pills: with same dose of

estrogen and progestin administered each
day

• Biphasic-pills: with two different doses of

estrogen and progestin used during the
cycle

• Triphasic-pills: with three different doses of

estrogen and progestin are used over the
course of cycle
1.Inhibition of ovulation
 Both hormones act synergistically on
hypothalamus
 cause negative feed back on hypothalamus
 Decrease GnRH
 No peak release of LH and FSH from pituitary
 low Estrogen/Progesterone – inhibit LH
surge
 Anovulation
2.Producing static endometrial hypoplasia
stroma –edematous ; glands –atrophic,
exausted
these changes resist implantation even if
implantation occurs
3. Alteration of character of cervical
mucus( thick, viscous and scanty)
(progesteron)
-impair sperm transport
4. Interfering with motility and secretion of
fallopian tubes
 Initiation & administration (Standard
21 day regimen)
Simple regime of 3 weeks on and one week off

One tablet is taken daily preferably at bed time

for 21 days

Either 7 days break or 7 days placebo

Next pack- started on eighth day irrespective of

bleeding
MISSED PILLS
• Take the pill as soon as you
remember. Then take the rest of the
pills like you normally would. To stay
on schedule, this might mean that
you have to take two pills in one
day. Back-up birth control or
emergency contraception typically
aren’t needed. However, if you
previously missed pills in the same
pack you should consider using a
back-up method of protection like
barrier contraceptives.
ONE PILL MISSED
• Take the pill you most recently missed as
soon as you remember. Then continue
taking the rest of your pills like normal.
For example, if it’s now Wednesday and
you missed Monday’s and Tuesday’s pills,
take Tuesday’s pill right away and take
Wednesday’s pill at the usual time. Use
back-up birth control or avoid sex until
you have taken seven days of hormonal
pills in a row. If you had unprotected sex
in the last five days, consider using
emergency contraception.
• TWO OR MORE PILLS MIXED
Non Contraceptive Benefits
Progestin only pill (POP)/minipill
• Contains only progestin in the form
of levonorgestrel, norethindrone,
desogestrel, lynestrenol or norgestrel

• The older formulations -

(norethindrone)
• inconsistently inhibits ovulation.

• The newest POP - (desogestrel)

• at a dose sufficient to inhibit ovulation
in almost every cycle
Administration and initiation
• POP has to be taken regularly at the same
time each day. Back-up contraceptive must be
used for the first 7 days

• There must be no break between the pack

• If POP is taken >3 hours late or forgotten on

any given day, then the women should take
missed pill immediately and next one as
schedule. A back-up contraceptive should be
used for at least 2 days