Transcript
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Dr.U.P.RathnakarMD.DIH.PGDHM

HORMONALCONTRACEPTION

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We Tw

o

We have one

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CONTRACEPTION:METHODS Natural family planning methods.

Barrier methods.Hormonal methods.Intrauterine devices.Permanent methods for females and for males.

Emergency contraception.

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NATURAL FAMILY PLANNING METHODS

Rhythm Method.Basal Body Temperature method.

Cervical mucus method.Symptothermal method.[temperature, cervical mucus, and calendar ]

Withdrawal method.

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Barrier methods of contraception

Cervical capVaginal diaphgramFemale condom

Prevent sperm from entering uterine cavity

With or without spermicidal jelly

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INTRAUTERINE CONTRACEPTIVE DEVICES (IUCD)

Multi load copper

Cu T

Act as FB-Prevents implantation

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Permanent methods

Vasectomy Tubectomy

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Oral Contraceptives

ENOVID-First OCP

JUN 10 1957The PillMargaret Sanger

[Research grant]

Frank B. ColtonDeveloped Enovid,the first OCP

Carl DjerassiInventor of modern OCP

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ORAL CONTRACEPTIVE [HORMONAL]

WomenCombined pillPhased RegimensBiphasicTriphasicMinipillPost Coital [Emergency]

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HOW DO THEY ACT? [MOA]

Principal MOASuppress gonadotropin secretion, and inhibit ovulationOthers1.Viscous cervical mucus impedes sperm transport

2.Peristalsis in the fallopian tube-interferes with ovum and sperm transport.

3.Endometrium unreceptive-implantation

4.Dislodge –implanted ovum

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1. Combined pill 2. Phased RegimensEstrogen/ProgesteroneE.estradiol [50/30/20 μg]And Norgestrel/ Dsogestrel/

Levonorgestrel[0.5/.15/.25mg]

3. Mini PillProgestin onlyLong term risks of

estrogen↓Daily-No interruptionEfficacy lowerIrregular bleeding

1. Biphasic: Fixed amount of

estrogen- Amount of progestin increases in the second half of the cycle

1. Triphasic:

Estrogen may be fixed or variable, -Amount of progestin increases in 3 equal phases

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4. POSTCOITAL [Emergency-

Morning after-Yuzpe] CONTRACEPTION

1. Levonogestrel0.5mg+Ethynylestrdiol0.1mg] =2 Ovral

Within 72 h of unprotected sex Repeated after 12 h2. Levonogestrel-0.75mg-Twice in 12h

gap-within72h3. Mifepristone 600mg within 72h Emergency contaraception not

used routinely

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INJECTABLE-HORMONE CONTRACEPTION

Long acting progesterone:DMPA [Depot MedroxyProgesterone Acetate• 150mg/3months-deep i.m during I 5days

NEE [NorEthindrone Enanthate]• 200mg/60days-Deep i.m.

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INJECTABLE-HORMONES…….

AdvantagesNo daily ingestionI.M.Highly effective

DisadvantagesCarcinogenic potential in animals

Menstrual irregularitiesDelayed fertility after discontinuation-3-6 mo.

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IMPLANTS - NORPLANT•Original: 6 capsules[6x36.g/Pro]• New: Norplant II - two small (2.5 mm x 43 mm) silicone rods each containing 75 mg of levonorgestrel in a polymer matrix,. • Effective for 5 years.• Inserted s.c upper armProgestin coated IUCD

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ADVERSE EFFECTS: ORAL CONTRACEPTIVES

Mild SevereNausea, vomitingHead ache, migriane pptIrregular cycle/ Break

through bleeding/ Amenorrhoea

Breast discomfort

ModerateWt. gain, AcnePigmentation-as in

pregnancyCH-intoleranceMood swings

Peripheral/Pulmonary thrombosis-[MI-STROKE]

Coronary-Cerebral thrombosis

BP↑Estrogen/

Progesterone-Oppose each other-No effect on plasma lipids

Benign hepatomaGall stones

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WHY THROMBOSIS?Venous-EstrogenArterial-Estrogen + ProgestinLow dose pills-Probably safe1.Increase in clotting factors2.Decrease-Antithrombin3.Decreased plasminogen activator

4.Increased platelet aggregation

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HEALTH BENEFITS↓Endometrial & Ovarian Carcinoma

Regular cycles, Less bleeding Premenstrual tension & Dysmenorrhoea ↓

Endometriosis and PID ↓

Fibrocystic disease of breast, ovarian cyst ↓

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DRUG INTERACTIONSEnzyme inducers Contraceptive failure-[Phenytoin, Pheno, Carbamazapin, Rifampicin]

: T.C. → Suppression of Intestinal flora → E.H.circulation interrupted → Less absorption of hormones → Blood level fall → Contraceptive failure

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CONTRA INDICATIONS

Absolute RelativeTE , Coronary, Crebrovascular diseases

Mod to severe HTN

HyperlipidemiaMalignacy of genitals, breast [Even suspected]

PorphyriaPlanned surgery

DMObesitySmokingVag BleedingFibroidMentally illAbove 35Mild HTNMigraineBall bladder

disease

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CentchromanNonsteroidalDeveloped in india

Anti implantation agent

Long actingOnce a week dosage

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MALE VS FEMALE---CONTRACEPTION

FemalesOne ovum/monthShort latent period to

take effect

‘GOSSYPOL’

Males

Millions of sperms/ejaculation

Spermatogenesis 64 days-long latent period

Gonadotropin suppression inhibits testosterone synthesis

No libido suppression

Men do not get pregnant

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AbstinenceOnly 100%Safe Method

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