Transcript
1. Hormonal contraception
2. Intrauterine devices
3. Barrier contraception
4. Natural family planning
methods
Estrogen- ethyl estradiol 50μg(20-35)Progesterone-generation progestogen
first Norethynodrel, norethisterone
acetate and lynestrenol
second Norgestrel, levonorgestrel
third Desogestrel, gestodene,
norgestimate
newer drospirenone
First generation;-50 μg ethinyl estradiol or more
moderate antrogenic activity :ovral
Second generation: 20-30μ ethinyl estradiol :ovral –L, malaN , malaD
Third generation:
• less antrogenic
• Increase sexhormone binding globulins
and decrease free testosterone
• Less effect on lipid profile-stroke and mi
• Less effect on body weight
• Beneficial in acne , hirsuitism
Venous thromboembolism
:novelon , femilon
Newer progestogens:
• Like natural progestrone
antimineralocorticoid
activity
no androgenic action
-hisuitism, acne
-fluid retention on coc
: yasmin, crisanta, tarana
Monophasic multiphasic
-same dose of bi/tri
Progesterone and total dose reduced
Estrogen mimicing normal-
Contraindications- absolute
• Ischemic heart disease
• Valvular heart disease
• Porphyria
• Epilepsy or migraine with
aura
• Active liver disease
• Hypercholestrolemia
• Arterial and venous
thrombosis
• Women above 35 and obese
or smoke
Relative
• Obesity , HTN , obesity, family
history
• Patients on anti tuberculosis
• Breast feeding
• Venous thromboembolism
• Arterial thrombosis
• HTN
• Glucose metabolism
• Lipid metabolism
• Breast and cervical cancer
• Liver- adenoma, gallstone
,cholestatic jauntice
• Break through bleeding
• Regular menses
• Reduced blood loss-iron
deficiency anemia
• Reduces dysmenorrhea
• Reduces premenstrual
syndrome
• Decreases functional ovarian cyst
• Reduces chances of fibroid
• Reduces acute pid
• Treatment of perimenopausal
changes
• Treatment of pcos by reducing
acne, hirsuitism, and regularizing
bleeding
• treatment of dub
• Beneficial in endometriosis
Newer combination pills
1. pills containing drospirenone
2. pills containing cyproterone acetate
3. Pills with extended cycle length
4. Ultra low dose pills
• Daily
• Same time
• Back up- if more than 3 hours
• 6 weeks after delivery in breast
feeding
• Others from 1st day
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