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Contraception

Contraception. For sexually active fertile women who do not use contraception, pregnancy rates approach 90 percent at 1 year. Contraception usually poses less risk than does pregnancy. HORMONAL CONTRACEPTIVES. Oral, injectable, transdermal patch, and transvaginal-ring forms.

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Contraception

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  1. Contraception

  2. For sexually active fertile women who do not use contraception, pregnancy rates approach 90 percent at 1 year. • Contraception usually poses less risk than does pregnancy

  3. HORMONAL CONTRACEPTIVES • Oral, injectable, transdermal patch, and transvaginal-ring forms. • A combination of estrogen and progestin-"the pill"-are or progestin only.

  4. Oral Progestins • mini-pills are progestin-only contraceptives • They do not reliably inhibit ovulation. • Alteration of cervical mucus and effects on the endometrium. • Because mucus changes are not sustained longer than 24 hours, mini-pills should be taken at the same time every day to be maximally effective.

  5. Is not ideal :much higher incidence of irregular bleeding and a somewhat higher pregnancy rate than COCs. • If a progestin-only pill is taken even 4 hours late, a back-up form of contraception must be used for the next 48 hours.

  6. Interacting Drug Documentation • Anti tuberculous • Rifampin • Antifungals • Griseofulvin • Anticonvulsants and Sedatives • Phenytoin, mephenytoin, phenobarbital, • primidone, carbamazepine, ethosuximide • Antibiotics • Tetracycline, doxycycline • Penicillins • Ciprofloxacin • Ofloxacin • Antiretrovirals

  7. Benefits: • They may be ideal for some women who are at increased risk of cardiovascular complications. Moreover, the mini-pill is often an excellent choice for lactating women. • In combination with breast feeding, it is virtually 100% effective for up to 6 months and does not impair milk production.

  8. Disadvantages • These contraceptives must be taken at about the same or nearly the same time each day. If a progestin-only pill is taken even 4 hours late, a back-up form of contraception must be used for the next 48 hours. • Decreased effectiveness by the medications • A relative increase in the proportion of ectopic pregnancies • Functional ovarian cysts • Irregular uterine bleeding as amenorrhea, metrorrhagia, or menorrhagia

  9. Contraindications • Progestin-only pills are contraindicated in women with: • unexplained uterine bleeding • known breast cancer • benign or malignant liver tumors • Pregnancy • acute liver disease

  10. Injectable Progestin Contraceptives Depot medroxy progesterone acetate (Depo-Provera), 150 mg every 3 months(IM, Sub Q), Norethisterone enanthate (Norigest), 200 mg every 2 months,(IM)

  11. The mechanisms of action • Include ovulation inhibition • increased cervical mucus viscosity • creation of an endometrium unfavorable for ovum implantation.

  12. Benefits • Contraception for 3 m.o • Minimal to no lactation impairment • Iron-deficiency anemia is less likely in long-term users • The risk of ovarian and endometrial cancers is decreased • Not been shown to increase the risk for thromboembolism, stroke, or cardiovascular disease

  13. Disadvantages • Irregular menstrual bleeding • prolonged an ovulation after discontinuation, which results in delayed fertility resumption. • A small increased risk of breast ca in recent or current users • Weight gain • Breast tenderness • Depression • loss of bone mineral density

  14. Contraindication • Prior thromboembolism • Pregnancy • Undiagnosed vaginal bleeding • Breast cancer • Cerebrovascular disease • Significant liver disease

  15. Types of Intrauterine Devices • chemically inert often polyethylene • Chemically active have continuous elution of copper or a progestin • Releasing levonorgestrel , T 380A IUD

  16. IUDs are "use and forget" effective reversible contraceptive methods that do not have to be replaced for 10 years with • IUDs are contraceptive, not abortifacient • The risk of pelvic infections is markedly reduced • Decreases the absolute number of ectopic pregnancies

  17. Mechanism • Local endometrial inflammatory response is induced, especially by copper-containing devices. • Cellular and humoral components of this inflammation are expressed in endometrial tissue and in fluid filling the uterine cavity and fallopian tubes. These lead to decreased sperm and egg viability . In the unlikely event that fertilization does occur, the same inflammatory actions are directed against the blastocyst, and the endometrium is transformed into a hostile site for implantation.

  18. Cramping and Bleeding • Menorrhagia • Infection • Pregnancy with an IUD

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