Contraception

Август 8, 2022

Содержание

2. Introduction Contraception is a part of Family Planning (Contraception - recurrent abortion and infertility management -
3. Stratification Physiological - Natural Hormonal Mechanical - Barrier Chemical Oral - Vaginal Intrauterine Device Injectable -
4. Hormonal Contraception Synthetic female sex steroids ( estrogens - progestins ) Administration (oral - implant -
5. Hormonal Contraception The Progestins 1- Affinities for estrogen, androgen, and progesterone receptors: Directly bounded ( norethinodrone,
6. Hormonal Contraception * Oral Contraceptive Pills ( the most widely used ) : Combined oral contraceptives
7. Hormonal Contraception Oral Contraceptive Pills : Types: a- Combined oral contraceptives : Monophasic / Multiphasic, (+21
8. Hormonal Contraception Oral Contraceptive Pills Advantages : Effective Other beneficial health effects - Reduce menstrual irregularities.
9. Hormonal Contraception Oral Contraceptive Pills Disadvantages : Require daily use No protection against STIs, HIV Side
10. Hormonal Contraception Oral Contraceptive Pills Adverse effects : ( Combined ) Lipid (+LDL, +Cholesterol, -HDL) Glucose
11. Hormonal Contraception Oral Contraceptive Pills Contraindications: ( Combined ) History: thrombosis/ embolus/ cerebral hemorrhage/ coronary disease.
12. Hormonal Contraception Injectable Hormonal Contraceptives : Types : a- Progestin-only Depot-medroxyprogesterone acetate (DMPA) / 3 months
13. Hormonal Contraception Injectable Hormonal Contraceptives Mechanism of action: a- Suppression of ovulation . b- Endometrium hypotrophy,
14. Hormonal Contraception Injectable Hormonal Contraceptives Disadvantages : - Menstrual changes ( Irregular bleeding/spotting , prolonged/heavy bleeding
15. Hormonal Contraception Subdermal Implants : Types : Capsules placed under the skin that slowly release a
16. Hormonal Contraception Subdermal Implants Advantages : Safe & effective Long-acting No effect on lactation Other beneficial
17. Postcoital Contraception (Emergency C): Implantation occurs on the 6th day after fertilization / Within 72hrs Estrogens
18. STERILIZATION Female sterilization: Surgical tubal occlusion Advantages : Safe & highly effective Permanent method No long-term
19. STERILIZATION Male sterilization: Vasectomy, vas deferens and tubes occlusion Advantages : Safe Permanent method No long-term
20. Non Hormonal Contraception * Lactational amenorrhea method (LAM) ** Periodic abstinence *** Coitus interruptus **** Barrier
21. Non Hormonal Contraception Lactational amenorrhea method (LAM): Must be: Within 6 m. postpartum + Amenorrhea +
22. Non Hormonal Contraception Periodic abstinence & Coitus interruptus : Advantages : Readily available Safe and side
23. Non Hormonal Contraception Barrier methods: Male, female condom / Diaphragm / Cervical cap / Vaginal spermicides
24. Intrauterine Devices IUD Inert & Medicated ( Copper or Hormone releasing ) Mechanism of action: Causing
25. Intrauterine Devices IUD Disadvantages : No protection against STIs, HIV Requires trained provider's help ( twice
26. Intrauterine Devices IUD Contraindications : History or recent STIs or PID Uterine distortion Unexplained vaginal bleeding
27. Typical rate Non 85% 85% COC 0.001% 2-3% POP 0.005% 2-3% IUD 2-3% Sterilization ( F
28. Contraception « 45% women in genital activity» Asia >60% ---- Africa
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Слайд 2

Introduction
Contraception is a part of Family Planning
(Contraception - recurrent abortion and

infertility management - genetic counseling)
Regulation of family size
Wide range of methods is available
No ideal contraception exists
Contraception failure ( the perfect use rate - the typical rate )
Intelligent choice of contraception :
Medical care provider (information , advice) + Couple (needs)

Слайд 3

Stratification
Physiological - Natural
Hormonal
Mechanical - Barrier
Chemical
Oral - Vaginal
Intrauterine Device
Injectable - Implant
Temporary -

Permanent
Emergency contraception

Слайд 4

Hormonal Contraception
Synthetic female sex steroids ( estrogens - progestins )
Administration (oral

- implant - injectable - IUDs - vaginal)
Estrogens :
Ethinyl Estradiol (EE)
Mestranol (ME) - bioactivation in liver to EE
Progestins:
- Estrane / 19-norprogestins ( = testosterone + C 19 ), oral :
norethynodrel, norethinodrone acetate, lynestrenol, norgestrel
norgestimate, desogestrel, gestodene (newer)
- Pregnane / 17-acetoxy progestin ( = progesterone ), injectable :
medroxy-progesterone acetate ( Provera )

Слайд 5

Hormonal Contraception
The Progestins
1- Affinities for estrogen, androgen, and progesterone receptors:
Directly bounded

( norethinodrone, levonorgestrel )
Require bioactivation ( newer : norgestimate, desogestrel, gestodene )
Progesterone receptors (medroxy-progesterone acetate,17-acetoxy progestin)
2- Ovulation inhibition:
newer are more selective
little dose ( = little or no androgenic effect + inhibit ovulation )
3- Substitute for progesterone, and antagonize estrogen:
androgenic potency on lipid and glucose metabolism
+LDL , -HDL / effect glucose tolerance

Слайд 6

Hormonal Contraception
* Oral Contraceptive Pills ( the most widely used )

:
Combined oral contraceptives (COCs)
Progestin-only formulations (POPs)
** Injectable Hormonal Contraceptives:
Progestin-only injectables
Combined injectables
*** Subdermal implants:
Norplant
Implanon
**** Postcoital Contraception (emergency contraception):
Estrogens - Combined
Copper IUDs
Danazol - Mifepristone

Слайд 7

Hormonal Contraception
Oral Contraceptive Pills :
Types:
a- Combined oral contraceptives :
Monophasic /

Multiphasic, (+21 days, -7days ).
b- Progestin-only formulations : ( Every day without interruption ).
Mechanism of action:
a- Suppression of ovulation :
Suppress FSH and LH
b- Endometrium hypotrophy :
Not suitable to implantation
c- Thickening of cervical mucus :
Difficult for sperm

Слайд 8

Hormonal Contraception
Oral Contraceptive Pills
Advantages :
Effective
Other beneficial health effects
- Reduce menstrual irregularities.
-

Reduce hpermenorrhea / anemia / dysmenorrhea / premenstrual syndrome / PID / Functional ovarian cyst.
- Reduce ovarian and endometrial cancer.
- Reduce ectopic pregnancy.
- Reduce benign breast disease.

Слайд 9

Hormonal Contraception
Oral Contraceptive Pills
Disadvantages :
Require daily use
No protection against STIs, HIV
Side

effects are common :
Combined Nausea, Dizziness, breast tenderness, headaches, mood changes, weight gain, breakthrough bleeding.
Progestins Irregular bleeding, amenorrhea, and similar but less common.
May pose health risks ( Combined )

Слайд 10

Hormonal Contraception
Oral Contraceptive Pills
Adverse effects : ( Combined )
Lipid (+LDL, +Cholesterol,

-HDL)
Glucose metabolism (effect glucose tolerance)
Hypertension (A-Rennin / H2O + Na) + weight gain
Thrombosis ( ? Coagulation factors ? Platelet ?)
Hepatic (biliary stone)

Слайд 11

Hormonal Contraception
Oral Contraceptive Pills
Contraindications: ( Combined )
History: thrombosis/ embolus/ cerebral hemorrhage/

coronary disease.
Estrogen-dependent malignancy
History: gestational cholestasis/ impaired liver function/ hepatic adenoma.
Hypertension / Diabetes / Heavy smoking + >35years /
Hyperlipidemia
Migraine / Sickle cell disease / Epilepsy
Planned major surgery / Active gallbladder disease / Undiagnosed genital bleeding

Слайд 12

Hormonal Contraception
Injectable Hormonal Contraceptives :
Types :
a- Progestin-only
Depot-medroxyprogesterone acetate (DMPA) / 3

months Norethisterone enamthate / 2 months
b- Combined / 1 month
Mesygyna (50mg DMPA+5mg estradiol valerate)
Cyclofem (25mg DMPA+5mg estradiol cypionate)

Слайд 13

Hormonal Contraception
Injectable Hormonal Contraceptives
Mechanism of action:
a- Suppression of ovulation .
b- Endometrium

hypotrophy, not suitable to implantation
c- Thickening of cervical mucus, making it difficult for sperm
Advantages :
Safe & effective
Long-acting (but combined 1 month)
No effect on lactation
Other beneficial health effects

Слайд 14

Hormonal Contraception
Injectable Hormonal Contraceptives
Disadvantages :
- Menstrual changes ( Irregular bleeding/spotting ,

prolonged/heavy bleeding , amenorrhea ) ( less in combined )
- No protection against STIs, HIV
- Side effects ( headache ,dizziness ,breast tenderness , mood changes , Weight gain) (more in combined)
- Effects cannot be stopped immediately
- Return to fertility is usually delayed ( 9 months )
Long term adverse effects :
DMPA : possible effect on bone density ( <21y)
Combined : based on safety information for COCs.

Слайд 15

Hormonal Contraception
Subdermal Implants :
Types :
Capsules placed under the skin that slowly

release a progestin
a- Norplant:
Levonorgestrel / 6 match-sized / 5 years
b- Implanon:
Etonogestrel / single rod / 3 years
Mechanism of action:
a- Thickening of cervical mucus, making it difficult for sperm
b- Suppression of ovulation in 1/2 of a women's cycles

Слайд 16

Hormonal Contraception
Subdermal Implants
Advantages :
Safe & effective
Long-acting
No effect on lactation
Other beneficial

health effects
Can be reversed anytime + Rapidly restoring fertility
Disadvantages :
- Menstrual changes ( Irregular bleeding/spotting , prolonged/heavy bleeding , amenorrhea )
- No protection against STIs, HIV
- Requires provider's help + minor surgical procedure (twice)

Слайд 17

Postcoital Contraception (Emergency C):
Implantation occurs on the 6th day after

fertilization / Within 72hrs
Estrogens :
Tubal mobility and endometrium alteration - Interference with corpus luteum function.
Combined :
The most used regimen ( EE 200mcg+norgestrel 2mg ) (Overal 2+2tab/12h )
Copper IUDs :
More effective than sex steroids.
Mifepristone : Anti progesterone (RU486).
Danazol : Weak androgen - pregnancy rate 2%.

Слайд 18

STERILIZATION
Female sterilization:
Surgical tubal occlusion
Advantages :
Safe & highly effective
Permanent method
No long-term adverse

effects
Disadvantages :
Small risk of surgical complications
High initial cost
No protection against STIs, HIV
Cannot be reversed
Post-sterilization syndrome

Слайд 19

STERILIZATION
Male sterilization:
Vasectomy, vas deferens and tubes occlusion
Advantages :
Safe
Permanent method
No long-term

adverse effects
Minor surgery
A waiting period

Слайд 20

Non Hormonal Contraception
* Lactational amenorrhea method (LAM)
Periodic abstinence
* Coitus

interruptus
**** Barrier methods
Male, female condom / Diaphragm / Cervical cap
Vaginal spermicides

Слайд 21

Non Hormonal Contraception
Lactational amenorrhea method (LAM):
Must be:
Within 6 m. postpartum +

Amenorrhea + Fully breastfeeding
Mechanism of action:
Suckling nipples >> Hypothalamus , Prolactin + >> GnRH - >> FSH - LH - >> Follicular development 0 >> No ovulation.
Advantages :
Effective (for all breastfeeding women) (no preparations )
Begins immediately postpartum (be used while women decide)
Disadvantages :
Requires conditions
No protection against STIs, HIV

Слайд 22

Non Hormonal Contraception
Periodic abstinence & Coitus interruptus :
Advantages :
Readily available
Safe and

side effects free
Disadvantages :
Requires skills and motivation (partner's cooperation)
No protection against STIs, HIV
High failure rate

Слайд 23

Non Hormonal Contraception
Barrier methods:
Male, female condom / Diaphragm / Cervical cap

/ Vaginal spermicides
Mechanism of action:
Work by physically or chemically blocking.
Advantages :
Effective if used consistently and correctly
Safe and no systemic side effects
Immediate initiate, discontinue and return to fertility
Some protects against STIs, HIV
Disadvantages :
Requires motivation + partner's cooperation consistently
High failure rate

Слайд 24

Intrauterine Devices IUD
Inert & Medicated ( Copper or Hormone releasing )

Mechanism of action:
Causing endometrium reaction (making it hostile to sperm and possibly to egg).
Timing of insertion :
During menstruation - Anytime if no pregnancy
Postpartum >6w - post abortion (if no infection or hemorrhage)
Advantages :
Highly effective
Long acting but easily reversible with return to fertility
No effect on lactation

Слайд 25

Intrauterine Devices IUD
Disadvantages :
No protection against STIs, HIV
Requires trained provider's help

( twice )
Can cause side effects :
Cramping & Increased, prolonged menstrual ( inter. ) bleeding
Can have complications :
PID ( sequels )
Perforation ( serious )
Expulsion
Ectopic pregnancy ( more than other methods )
Intrauterine pregnancy ( septic abortion - PROM - premature )

Слайд 26

Intrauterine Devices IUD
Contraindications :
History or recent STIs or PID
Uterine distortion
Unexplained vaginal

bleeding
Others :Allergic to Cu /// Previous EP /// Nulliparity
Hormone releasing intrauterine system (IUS)
Progestins released directly into the uterus
Thickening of cervical mucus + Partial ovulation suppression + Tubal motility
Reduces quantity and duration of menstruation + pain
Expensive

Слайд 27

Typical
rate
Non 85% 85%
COC 0.001% 2-3%
POP 0.005% 2-3%
IUD

2-3%
Sterilization ( F ) 0.004
Sterilization ( M ) 0.001
Periodic abstinence 9% 20%
Male condom 2% 12%
Diaphragm 6% 18%
Vaginal spermicides 9% 28%

Typical
rate

Perfect
rate

Method

Слайд 28

Contraception
« 45% women in genital activity»
Asia >60% ---- Africa

< 20%

Contraception

Содержание

IntroductionContraception is a part of Family Planning(Contraception - recurrent abortion and

StratificationPhysiological - NaturalHormonalMechanical - BarrierChemicalOral - VaginalIntrauterine DeviceInjectable - ImplantTemporary -

Hormonal ContraceptionSynthetic female sex steroids ( estrogens - progestins )Administration (oral

Hormonal ContraceptionThe Progestins1- Affinities for estrogen, androgen, and progesterone receptors:Directly bounded

Hormonal Contraception* Oral Contraceptive Pills ( the most widely used )

Hormonal ContraceptionOral Contraceptive Pills :Types:a- Combined oral contraceptives : Monophasic /

Hormonal ContraceptionOral Contraceptive PillsAdvantages :EffectiveOther beneficial health effects- Reduce menstrual irregularities.-

Hormonal ContraceptionOral Contraceptive PillsDisadvantages :Require daily useNo protection against STIs, HIVSide

Hormonal ContraceptionOral Contraceptive PillsAdverse effects : ( Combined )Lipid (+LDL, +Cholesterol,

Hormonal ContraceptionOral Contraceptive PillsContraindications: ( Combined )History: thrombosis/ embolus/ cerebral hemorrhage/

Hormonal ContraceptionInjectable Hormonal Contraceptives :Types :a- Progestin-onlyDepot-medroxyprogesterone acetate (DMPA) / 3

Hormonal ContraceptionInjectable Hormonal ContraceptivesMechanism of action:a- Suppression of ovulation .b- Endometrium

Hormonal ContraceptionInjectable Hormonal ContraceptivesDisadvantages :- Menstrual changes ( Irregular bleeding/spotting ,

Hormonal ContraceptionSubdermal Implants :Types :Capsules placed under the skin that slowly

Hormonal ContraceptionSubdermal ImplantsAdvantages :Safe & effectiveLong-acting No effect on lactationOther beneficial

Postcoital Contraception (Emergency C):Implantation occurs on the 6th day after

STERILIZATIONFemale sterilization:Surgical tubal occlusionAdvantages :Safe & highly effectivePermanent methodNo long-term adverse

STERILIZATIONMale sterilization:Vasectomy, vas deferens and tubes occlusion Advantages :SafePermanent methodNo long-term

Non Hormonal Contraception* Lactational amenorrhea method (LAM)** Periodic abstinence *** Coitus

Non Hormonal ContraceptionLactational amenorrhea method (LAM):Must be:Within 6 m. postpartum +

Non Hormonal ContraceptionPeriodic abstinence & Coitus interruptus :Advantages :Readily availableSafe and

Non Hormonal ContraceptionBarrier methods:Male, female condom / Diaphragm / Cervical cap

Intrauterine Devices IUDInert & Medicated ( Copper or Hormone releasing )

Intrauterine Devices IUDDisadvantages :No protection against STIs, HIVRequires trained provider's help

Intrauterine Devices IUDContraindications :History or recent STIs or PIDUterine distortionUnexplained vaginal

Typical rateNon 85% 85% COC 0.001% 2-3% POP 0.005% 2-3% IUD

Contraception« 45% women in genital activity» Asia >60% ---- Africa

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