contraceptive presentation

1. BY
MAGDY ABDELRAHMAN MOHAMED
2015
ORAL HORMONAL
CONTRACEPTIVE

2. CONTRACEPTIVE PILLS
 1- Combined oral contraceptive pills.
(COCs)
 2- Progestogen only pills. (POPs)

3. COCs
 Composition :
1. Estrogen :
 Ethinyl estradiol (20 times more active)
100µg
50 µg
35 µg
30 µg
20 µg
 Mestranol (3-ethyl ester of ethinyl estradiol)
low dose pills

4. 2. Progestogen:
• 19-Nortestosterone derivatives:
 Norethinderone “norethisterone”.
 Levonorgestrel (microcept) 150 µg
 Gestodene (gynera) 75 µg
 Desogestrel ( marvelon)150 µg
 Norgestimate ( cilest )250 µg
• 17-α spironolactone derivatives:
 Drospirenone (yasmin) 3mg

5. Action
Suppress ovulation through negative
feedback to hypothalamic-pituitary axis.
Thickening of cervical mucus to prevent
sperm entry.
May also slow tubal motility, disrupt
transport of ova. (not proven)

6. Efficacy
 COC is highly effective 99.9% in preventing
pregnancy.
 However the user failure rate is 3-8%.

7. Types of COCs
1. Monophasic pills.
 E.g. Microcept, Gynera, Cilest, Marvelon and Yasmin.
2. Biphasic pills.
 Estrogen fixed dose throughout the cycle with doubled
dose of progestin in the 2nd. Half of the cycle.
3. Triphasic pills.
 1st. 6days : 30 µg EE + 50 µg LNG
 2nd. 5days: 40 µg EE + 75 µg LNG
 3rd. 10days: 30 µg EE + 125 µg LNG

8. Types of COCs
 1st. Generation: EE > 50 µg
 2nd.Generation: EE<50 µg + any
progestin except( Gestodine, Desogestrel,
Norgestimate or Drospirenone)
 3rd. Generation: EE<50 µg + Gestodine,
Desogestrel or Norgestimate.
 4th. Generation: EE<50 µg +
Drospirenone.

10. How and when to use it???
 Start on the 1st 5 days of the cycle
regularly every day.
 21 days 0n, 7 days off.

11. Missed pills
 One pill.
 No problem.
 Take the missed pill immediately.
 2 pills or more.
 Take the pills
 Backup methods should be used.
 Emergency contraception if sexual intercourse
was occurred in preceding 7 days.

12. Advantages of COCs
1. Highly effective if used correctly.
2. Rapid return of fertility after stoppage.
3. Suitable for nulligravida and newly
married couples.
4. Completely controlled by the woman and
can be stopped at any time unlike other
methods (IUD & Implants).
5. No need to do any thing at the time of
intercourse.

13. Non contraceptive benefits of COCs
 Regulation of the cycle with ↓
amount & duration.
 So it helps in prevention & ttt of iron
def. anemia.
 ↓risk of epithelial ovarian tumors.
 ↓Inc. of functional ovarian cysts.
 ↓ risk of ectopic pregnancy.

14. Non contraceptive benefits of COCs
 ↓risk of developing PID.
 ↓risk of endometrial cancer.
 ↓spasmodic dysmenorrhea and PMS.
 ↓risk of benign breast lesions.
 May protect from colorectal cancer.
 May ↓ Inc. of fibroid.
 Improvement of rhumatoid arthritis.

15. Non contraceptive uses of COCs
 Ttt of Dysfunctional uterine bleeding.
 Ttt of Endometriosis.
 Ttt of PMS.
 Ttt of spasmodic dysmenorrhea.
 Postponing of menstruation for social or
religious causes.
 Ttt of hirsutism: “ Yasmin” contains
antiandrogenic progestin Drosprirenone.

16. Disadvantages & Side effects
1- The need for daily use.
2- GIT:
 Nausea and vomiting.
 Increased incidence of gall bladder stones).
 Women with active hepatitis will have a deterioration in
liver functions.
 ↑inc. of hepatocellular adenoma ( rare).
3-central nervous system:
 Headache and migraine.
 Mood changes: depression, irritabilty.

17. 4-Breast
 Not suitable with breast feeding.
 Mild breast tenderness may occur.
5-Genital tract.
 Cervix:
 Cervical erosion is a common finding.
 Vagina:
 Increased normal vaginal disharge.
 Vaginal candidiasis.

18. 6-CVS:
 Increased risk of venous thromboembolism.
 Increased risk of MI & stroke in elderly patients
with hypertension and smokers.
7-Metabolic :
 Increased body wt.
 In diabetic patients: leads to hyperglycemia and
increased risk of vascular complications.
 Dyslipidemia:↑cholesterol, ↑triglycrides, ↑LDL&
↓HDL.

19. Absolute contraindications
 < 6 months postpartum if breastfeeding
 Smoker over the age of 35 (≥ 15 cigarettes per day)
 Hypertension (systolic ≥ 160mm Hg or diastolic ≥
100mm Hg)
 Current or past history of venous thromboembolism
(VTE)
 Ischemic heart disease
 History of cerebrovascular accident

20. Absolute contraindications
 Complicated valvular heart disease
 Migraine headache with focal neurological symptoms
 Breast cancer (current)
 Diabetes with retinopathy/nephropathy/neuropathy
 Severe cirrhosis
 Liver tumour (adenoma or hepatoma)

21. Relative contraindications
 Smoker over the age of 35 (< 15 cigarettes per
day)
 Hypertension (systolic 140–159mm Hg,
diastolic 90–99mm Hg)
 Currently symptomatic gallbladder disease
 Mild cirrhosis
 History of combined OC-related cholestasis
 Users of medications that may interfere with
combined OC metabolism

22. MYTHS AND MISCONCEPTIONS
1. The combined OC causes cancer.
 Fact:
 The combined OC reduces the risks of ovarian and
endometrial cancer.
 The risk of ovarian cancer is reduced by at least half
in women who use combined OCs.

23. MYTHS AND MISCONCEPTIONS
2. Women on the combined OC
should have periodic pill breaks.
Fact:
This is unnecessary.
Pill breaks place a woman at risk
for unintended pregnancy and
cycle irregularity.

24. MYTHS AND MISCONCEPTIONS
3. The combined OC affects future
fertility.
Fact:
Fertility is restored within
1 to 3 months after stopping
the combined pills.

25. MYTHS AND MISCONCEPTIONS
4. The combined OC causes
birth defects if a woman
becomes pregnant while taking it.
 Fact:
 There is no evidence that the
combined OC causes birth defects.

26. MYTHS AND MISCONCEPTIONS
5. The combined OC must be
stopped in all women
over 35 years old.
Fact:
Healthy, non-smoking women may
continue to use the combined OC
until menopause.

27. MYTHS AND MISCONCEPTIONS
6.The combined OC causes acne.
Fact:
Acne improves in women using the
combined OC due to a decrease in
circulating free androgen.
All combined OCs will result in an
improvement of acne

28. PROGESTOGEN ONLY PILLS ( POPS)
 Types:
 Levonorgestrel 30µg ( microlut)
 Lynestrenol 500µg (exluton)

30. Efficacy
Must be taken at same time every day to be
effective.
Perfect use failure rate  0.5%
Typical use failure rate  5-10%

31. Mechanism of action
1-Main mechanism is alteration of Cx mucous.
 ↓↓ volume of mucous
 ↑↑ viscosity
2- Ovulation is suppressed in 60% of the
women.
3-Endometrial changes  ↓↓ implantation.

32. How to use????
 Start on the 1st 5 days of the cycle or after 6
weeks postpartum.
 Daily tablet at the same time every day
without discontinuation.
 Woman consider her self fertile for the first
week of use.

33. Missed pill
 To be taken as soon as possible.
 Next pill to be taken at the regular time.
 If delayed > 3hrs  use back up contraception for
48 hrs.
 If 2 or more pills missed in a row  2 pills/day for
2 days back up contraception for 48 hrs.
 Emergency contraception must be used if
intercourse occurred after a missed pill.

34. Advantages
 Suitable when breast feeding.
 Suitable when EE is contraindicated.
 Immediate return of fertility.
 Less likely to cause metabolic
disturbances.

35. Disadvantages
 Must be taken daily at the same time
 Less effective than COCs
 More likely to cause menstrual irregularities
 Headache, nausea, breast tenderness, mood
changes, depression and ↓libido.
 Less effective in preventing ectopic
pregnancy.