Hormonal contraception

HORMONAL CONTRACEPTION

• Permanent

• temporary

1. Hormonal contraception

2. Intrauterine devices

3. Barrier contraception

4. Natural family planning

methods

Pop are ideal for conditions

were estrogen is

contraindicated

…… irregular bleeding

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-

Primary action is inhibition of

ovulation

fsh

Progestogen-

LH

Failiure rate below 0.3%

-…. High as .0.5%

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

Other,,,,

Nausea ,vomiting,brast

tenderness ,chlosma….

Acne ,depression,loss of

libido,

• 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

• Increases bone mass

• Reduces fibrocystic breast disease

• Reduces acne

• Reduces RA

• Reduces endometrial

cancer

• Reduces overian cancer

• Reduces colorectal cancer

Missed pills

1missed---1

2missed---2-2

Newer combination pills

1. pills containing drospirenone

2. pills containing cyproterone acetate

3. Pills with extended cycle length

4. Ultra low dose pills

-desogestrel

--cerazette

---breast feeding women

60%

• Daily

• Same time

• Back up- if more than 3 hours

• 6 weeks after delivery in breast

feeding

• Others from 1st day

• Breast feeding

• SLE

• Cardiovascular diseases…. etc

• Irregular bleeding

• Amenorrhea

• Acne

• Breast tenderness