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CONTRACEPTION

CONTRACEPTION. DR MAUREEN UMEMMUO CONSULTANT OBSTETRICIAN AND GYNAECOLOGIST NATIONAL HOSPITAL ABUJA. INTRODUCTION. There are about 1.2 billion women of reproductive age world wide About 114 - 120 million acts of sexual intercourse daily worldwide

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CONTRACEPTION

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  1. CONTRACEPTION DR MAUREEN UMEMMUO CONSULTANT OBSTETRICIAN AND GYNAECOLOGIST NATIONAL HOSPITAL ABUJA

  2. INTRODUCTION • There are about 1.2 billion women of reproductive age world wide • About 114 - 120 million acts of sexual intercourse daily worldwide • Likely to result in 910,000 conceptions / day • A significant number of these conceptions / pregnancies are unwanted • Contraception a key strategy for the prevention of unwanted pregnancy • Like all aspects of medicine, contraception is also witnessing advances, changes, improvements, etc

  3. INTRODUCTION CONTD • A single human ejaculate has the potential to equal population of USA and Canada 4ml x 90 million = 360 million (355 million) • A healthy man in his lifetime produces enough sperm to replace the whole human race 7.2 billion as of 2014

  4. CONTRACEPTIVES METHODS • Hormonal methods • Intrauterine device • Barrier methods • Natural method • Sterilization

  5. HORMONAL METHODS • ADVANTAGES • Most effective, long term reversible contraception available • Most methods offer complete privacy • Requires no planning before intercourse

  6. HORMONAL METHODS CONTD • DISADVANTAGES • May cause hormonal side effects • Products containing estrogen may be associated with rare, but serious health risks • Not effective against STD

  7. HORMONAL METHOD CONTD • DAILY USE • Oral contraceptive pill • combination pill • progesterone only pill

  8. HORMONAL CONTRACEPTIVE METHODS CONTD • NON DAILY USE • injectable contraceptive • Contraceptive patch • Vaginal rings • Hormonal-releasing intrauterine system • Emergency contraceptives

  9. THE COMBINATION PILL • Contain synthetic Estrogen/progesterone • Modern estrogen dosage ≤ 50 Mcg • Despite diversity, side effects and efficacies similar • Requires patients compliance

  10. COMBINATION PILL • ESTROGEN • Ethinyl estradiol • Mestranol

  11. COMBINATION PILL • PROGESTINS (2nd generation)  Ethynodiol diacetate  Norethindrone acetate  Norethindrone  Norgestrel  Levonorgestrel

  12. COMBINATION PILL • PROGESTINS CONTD (3rd generation) • Desogestrel • Norgestimate • Drospirenone - Spironolactone Derived

  13. Combination pills contd • Advantages: • Highly effective • Provides non-contraceptive health benefits • Private • Does not require vaginal insertion • Allows to control cycle

  14. Disadvantages of ocps • Must be taken daily • Side effects may lead to discontinuation • Associated with rare, but serious health risks, such as blood clots and stroke

  15. NON-CONTRACEPTIVE BENEFITS OF OCPs • Improvement in : • Dysmenorrhea • Acne • Hirsutism • Anemia • Cycle Regulation

  16. NON-CONTRACEPTIVE BENEFITS OF OCPs • Reduction in Risks of : • Colorectal Cancer (18-40%) • Endometrial Cancer • PID (10 – 70%) • Osteoporosis • Osteopenia

  17. MECHANISM OF ACTION OF OCPs • Suppresses LH / FSH Release • Progestin Thickens Cervical Mucus and Alters Endometrium • Major Effect Is Anovulation and Impairment of Sperm Transport and Oöcyte Implantation

  18. SIDE EFFECTS OF OCPs Breakthrough Bleeding (≤ 25%)  Amenorrhea  Breast Tenderness, Nausea  ? HTN  ? Weight Gain

  19. OCPs • Risks •  Thromboembolism (≥ 35 yrs, Smoker) •  MI (Smokers Only): • < 15 cig/day: 3X Risk • > 15 cig/day : 21X Risk •  Liver Adenomas (Very Rare)

  20. CONTRACEPTIVES PATCH • Trans-dermal contraceptive system • Square, flexible, extended-release matrix patch system • Contains norelgestromin (NGMN) and ethinyl estradiol (EE) for use in a weekly dosing schedule • Product launched: April 2002

  21. The ContraCeptive Patch (Evra Patch) • Advantages:  Efficacy comparable to OCPs  Weekly application encourages compliance  Does not require vaginal insertion

  22. DISADVANTAGES  Application site reactions may occur  May not be as effective in obese women  May produce side effects similar to OCPs, with higher rate of transient breast pain  Noncontraceptive health benefits theoretically similar to combination OCPs, but not as well documented  May be visible on the skin

  23. THE PROGESTINS ONLY CONTRACEPTIVES PILL • Progestins:  Norethindrone  Norgestrel

  24. ADVANTAGES • Useful for women with contraindications to estrogen • Use with postpartum women who are breastfeeding • Does not require vaginal insertion

  25. DISADVANTAGES • Higher pregnancy rate than combination OCPs • More sensitive to missed pills than combination OCPs • Associated with abnormal bleeding and other side effects

  26. INJECTABLE HORMONAL CONTRACEPTION • Advantages:  Highly effective  Convenient three month administration schedule encourages adherence  Private  Useful when estrogen should be avoided  Decreases risk of endometrial cancer

  27. INJECTABLE HORMONAL CONTRACEPTION • Disadvantages:  Irregular bleeding and amenorrhea frequently occur  Weight gain, abdominal pain, and depression are common side effects  Prolonged use may decrease bone mass

  28. TYPES • DEPO PROVERA: • every 3 months • Medroxyprogestin Acetate 150 mg. • Norethisterone Enanthate (Net-En) 200 mg • In oil • 2 monthly

  29. New Combined Monthly Injectable Contraceptives • MPA combined with estradiol cypionate (E2C) Cyclofem, Lunelle (25mg MPA and 5 mg E2C) • Net-En combined with estradiol valerate (E2V) Mesigyna, Norigynon 50mg Net-En; 5mg E2V

  30. Newly approved Depo-provera • Depo-subQ Provera (DMPA-SC) • Contains 104 mg Depo-medroxy progesterone acetate • In micro-crystalline suspension form • Now Subcutaneous cf Intramuscular DMPA • Also every 12 weeks • Should not be used continuously for ˃2 years • (Sayanapress)

  31. Main Side-Effects: • Amenorrhea • AUB • Weight Gain • Hair Loss

  32. Contraceptive Implants • Initially Six Rods, Norplant (now discarded) • Two rod Jadelle (levonorgestrel) – 5 years • One rod Implanon (etonogestrel) – 3 years • Bio-degradable (Capronor) that does not require removal (2 years) – Developed by Research Triangle Institute

  33. Nexplanon (ImplanonNXT) • Nexplanon is essentially identical to Implanon except Nexplanon has 15 mg of Barium sulphate added to the core, so it is detectable by x-ray. • Has a pre-loaded applicator for easier insertion • It is off-white, non-biodegradable and 4 cm long, diameter of 2 mm

  34. Contraceptive Vaginal Rings • Combined Estrogen and Progestogen • Progestin Only

  35. Vaginal Contraceptive Ring(Combined)

  36. Progesterone Vaginal Ring • Progesterone diffuses at a continuous flow of 10mg per day through the silicone • Prolongs lactation amenorrhoea • Used for Postpartum contraception • After 6 weeks of delivery and for 3 months

  37. How the Ring is Used • A vaginal ring is inserted at postnatal visit (6 weeks) • Once inserted, the Ring is worn for 3 months • At end of 3 months, it is removed and another replaced • For now, use is stopped when menstruation returns, or for a maximum of 1 year • Meant for breastfeeding women only

  38. EMERGENCY CONTRACEPTIVES • Indications: • -standard of care for women not protected by efffective contraception. • -No contraception was used • -Condom broke, slipped, leaked etc…. • -Missed more 2 or more days of ocp’s

  39. EMERGENCY CONTRACEPTIVES • Highly effective 75% -Effective up to 120 hours after unprotected sex • Will not disrupt or harm developing pregnancy

  40. FDA Approved Emergency Contraceptive Kits • PREVEN KIT • Contains 4 pills • EE 50 ug. • Levonorgestril 0.25 mg. • -2 pills 12 hourly for 2 doses

  41. FDA Approved Emergency Contraceptive Kits • Plan B Kit • contains 2 pills • Levonorgestril 0.75 mg • 1 pill 12 hourly for 2 doses

  42. The Combination Pill (EMERGENCY) • The Yuzpe Regimen: •  Two Doses of: •  EE 0.1 mg with dl-norgestrel 1.0 mg •  Administered 12hours apart •  First dose taken within 120 hours of unprotected intercourse

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