Hormonal contraception Intrauterine devices Barrier contraception Natural family planning methods

1. HORMONAL
CONTRACEPTION

2. • Permanent
• temporary

3. 1. Hormonal contraception
2. Intrauterine devices
3. Barrier contraception
4. Natural family planning
methods

7. Pop are ideal for conditions
were estrogen is
contraindicated
…… irregular bleeding

9. Estrogen- ethyl estradiol 50μg(20-
35)
Progesterone-generation progestogen
first Norethynodrel, norethisterone
acetate and lynestrenol
second Norgestrel, levonorgestrel
third Desogestrel, gestodene,
norgestimate
newer drospirenone

10. First generation;-50 μg ethinyl estradiol or
more
moderate antrogenic activity
:ovral
Second generation: 20-30μ ethinyl estradiol
:ovral –L, malaN , malaD

11. 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

12. Newer progestogens:
• Like natural progestrone
antimineralocorticoid
activity
no androgenic action
-hisuitism, acne
-fluid retention on coc
: yasmin, crisanta, tarana

13. Monophasic multiphasic
-same dose of bi/tri
Progesterone and total dose reduced
Estrogen mimicing normal-

14. Primary action is inhibition of
ovulation

15. fsh
Progestogen-
LH

18. Failiure rate below 0.3%
-…. High as .0.5%

19. 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

20. • Venous thromboembolism
• Arterial thrombosis
• HTN
• Glucose metabolism
• Lipid metabolism
• Breast and cervical cancer
• Liver- adenoma, gallstone
,cholestatic jauntice
• Break through bleeding

21. Other,,,,
Nausea ,vomiting,brast
tenderness ,chlosma….
Acne ,depression,loss of
libido,

23. • Regular menses
• Reduced blood loss-iron
deficiency anemia
• Reduces dysmenorrhea
• Reduces premenstrual
syndrome

24. • 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

25. • Increases bone mass
• Reduces fibrocystic breast disease
• Reduces acne
• Reduces RA

26. • Reduces endometrial
cancer
• Reduces overian cancer
• Reduces colorectal cancer

28. Missed pills
1missed---1
2missed---2-2

29. Newer combination pills
1. pills containing drospirenone
2. pills containing cyproterone acetate
3. Pills with extended cycle length
4. Ultra low dose pills

31. -desogestrel
--cerazette
---breast feeding women

32. 60%

33. • Daily
• Same time
• Back up- if more than 3 hours
• 6 weeks after delivery in breast
feeding
• Others from 1st day

34. • Breast feeding
• SLE
• Cardiovascular diseases…. etc

35. • Irregular bleeding
• Amenorrhea
• Acne
• Breast tenderness