Hormonal contraceptives

Question 1

Method of contraceptive?

Answer 1

• Hormonal (inject)

- non- hormonal(natural, permanent)

Question 2

Hormonal?

Answer 2

• Oral
• parenteral (inj, implant, transdermal patch)
• device (IUD, vaginal ring)

Uses:

• reversible suppress fertility
• increase birth rate
• high failure rate w other contra method

MOA:
(-inhibit Ganadotropin release
-estrogen reduce follicle stimulating hormone FHS, pregestin reduce luteinizing hormone LH) -> no ovulation

-uterine & tubal contract -> make endometrium unsuitable for implant.

Prevent ovulation by
inhibit gonadotropin

• progestational agent (suppress LH secretion)
• Estrogenic agent (suppress FSH secretion)

MOA:
Combine estrogen-progestin birth control pill and progestin only pills or implants prevent the pituitary glands release of hormone that stimultae ovulation.

Question 3

OCP (pill)

Answer 3

1. combined pill
   - popular & effective

-estrogen + progestin -> inhibit ovulation
(Ethinyl estradiol + a progesin)

• progestin (block endometrual CA, prompt bleeding)
  start: 5th day menses, 1 tab/day (21day) -> 7D gap -> restart

2. phased
Bi/triphasic
(ethinyl estradiol w levonorgestrel)
-reduce progestin 
Recommend -35 yo

3. Minipill
   -Progestin only
   (norethindrone)
   -less eficacy
4. Postcoital
   YUZPE method - 2OVRAL after coitus -> repeat after 12 hour
   or levonorgestrel 0.75mg asap -> 1 tab after 12hr

-tk within 72 hr of coitus

Question 4

Emergency contraceptive (ECP)

Answer 4

1. use within 72hr
2. IUD (insert within 5D & long term use)

MOA:
-ovulation inhibit

• alter endometrial receptivity for implant
• dislodge implant blastocyst
• production cervical mucus -> decrease sperm penetrate
• alter tubular transport(sperm, egg/ embryo)
• Ormeloxifene/Centchroman
• 1st 3 mth (2/7) -> 1/7

Question 5

other Types:

Answer 5

Inj contraceptive
(close supervision, IM)
-depot medroxyprogesterone acetate / norethindrone ananthate

S/C DMPA

Combine inj: monthly IM

Impant (arm)

insertion & removal(sub derma, non dominant hand)

Transdermal (combi progestin & estrogen)

Spray On

IUD

Contraceptove rings

Male contraceptive
Transdermal testosterone gel，testosterone DMPA inj , etonogestrel implant & testosterone undecanoate inj

permanent: Vasectomy(x sperm), tubul occlusion/tubectomy, hysterectomy

Question 6

Miss pill

Answer 6

2 tab next day & cont usual

if miss >2tab -> use alternate method, start pill on 5th menses

if breakthrough bleeding:

1. switch high estrogen pill
2. use progestin only pill (if estrogen contra)
3. use desogestrel if androgenic side effect occur