17. contraception choice 2020 short-1.ppt

Good contraceptive presentation by Gosaye mokonin

1. 5/18/2024Gosaye M.
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CONTRACEPTIVES
Gosaye Mekonen
B.PHARM, MCS, CLINICAL PHARMACIST
PHARMACY DEPARTMENT
AMBO UNIVERSITY

2. Presentation outline
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Definition
Menstrual cycle overview
Desired outcomes
Methods of contraception
Evaluation of outcomes

3. Definition
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Contraceptionisgenerallydefinedasthe
preventionofpregnancyfollowingsexual
intercourseby:
inhibitingviablespermfromcominginto
contactwithamatureovumor
preventingafertilizedovumfrom
implantingsuccessfullyinthe
endometrium

4. Overview of MENSTRUAL
CYCLE
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Menstrual cycles are counted from the first day
of menstrual bleeding
Averagemenstrual cycle is 28 days
Divided into three phases:
the follicular phase (pre-ovulatoryphase),
the ovulation phase
the lutealphase (post-ovulatoryphase)

5. Cont…
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Influenced by the hormonal relationships
among the hypothalamus, anterior pituitary,
and ovaries
epinephrine and norepinephrine
gonadotropin-releasing hormone (GnRH)
gonadotropins,
(FSH), and (LH).
Estrogen and progestroneg
oAt the end, either pregnancy or
menstruation occurs

6. The Menstrual Cycle
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8. DESIRED OUTCOMEs of contraceptives use
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Primary goal
Prevention of pregnancy.
Secondary goals
prevention of STDs
improvements in menstrual cycle regularity
prevention of malignancies and other health
conditions
management of perimenopause

9. Metods of contraception
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Barrier methods
Spermicides
Sponges
Condoms
Diaphrams
Cervical cap
Hormonal methods
Oral pills
IUD
Injectables
Implants and viginalrings
Skin patches
Emergence contraception

10. Hormonal method
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Combined hormonal contraceptives
(CHCs)

11. Componets
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progestins
provide most of the contraceptive
effect
thickening cervical mucus to prevent
sperm penetration,
slowing tubal motility
delaying sperm transport,
inducing endometrial atrophy.
inhibits ovulation

12. Components cont…
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Estrogens
Theprimaryroleistostabilizethe
endometrialliningandprovidecyclecontrol
Alsopreventovulation
Mestranolandethinylestradiol

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Considerations with Combined
Hormonal Contraceptive Use(CHCs)

14. Points to be considered:
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A medical history and blood pressure
measurement before use
The benefits,
Adverse effects,
Risks should be considered

15. Adverse effects
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Estrogen excess
Nausea, breast tenderness, headaches, cyclic
weight gain due to fluid retention
Dysmenorrhea, menorrhagia, uterine fibroid
growth
Estrogen deficiency
Vasomotor symptoms, nervousness,
decreased libido
Early-cycle (days 1–9) breakthrough bleeding and
spotting Increase

16. ADRs cont….
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Progestin excess
Increased appetite, weight gain,
bloating, constipation
Acne, oily skin, hirsutism
Depression, fatigue, irritability
Progestin deficiency
Dysmenorrhea, menorrhagia

17. Safety concern
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WHO precautions in the provision of CHCs
4 categories of precautions
Category IV-Absolute contraindication
Category III-risk > benefit. Need
monitoring
Cate II-benefits > outweigh risks
Cate I-no contraindication

18. thromboembolicdisorder,
or a history of these
conditions
CVD, CAD, PVD
Diabetes with vascular
involvement or DM>20
years
Breast cancer
Uncontrolled HTN
Age >35 years and
currently smoking ≥15
cigarettes per day
Known hyperlipidemia
History of HTN
Hxof Ca
Cirrhosis
Breast-feeding women 6
weeks to 6 months
postpartum
Migraine headache without
aura in women ≥35 years
old
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Gosaye M.
Category 4 Category 3

19. Family history of
thromboembolism
Diabetes without
vascular disease
Migraine headaches
without aura in women
<35 years old
Breastfeeding women
≥6 months postpartum
Age ≥40 years
Varicose veins
History of gestational
diabetes
Nonmigrainous
headaches
Thyroid disease
Iron deficiency anemia
Depression
Epilepsy
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Gosaye M.
Category 2 Category 1

20. Oral Contraceptives
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Combined oral contraceptives (COCs) Vs
progestin only pills (POPs)

21. COCs
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Preparation with the lowest oestrogen &
progestogen which gives good cycle control &
minimal side-effects should be selected

22. Moa:
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Changing the body's hormone balanceso that you do
not ovulate.
Causing the mucusmade by the cervix to thicken
and form a 'mucus plug' in the cervix
Making the liningof the uterus thinner.

23. Types of cocs
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Mono-phasic
Fixed amount of estrogen and progesterone in 21 pills
Bi-pahsic:
Fixed amount of estrogens and changeable levels of
progesterones
Tri-phasiccontraceptives: 3 different strength pills
are available
Extended cycle pills –84 days + 7days placebo
Continuous combined pills-few /no placebo pills
Third generation pills -newer progseg.Desogestrel,
norgestimateetc…

24. advantages
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1.Reduced dysmenorrhoeaand menorrhagia.
2.Reduced incidence of premenstrual tension.
3.Reduced risk of ovarian and endometrial cancer.
4.Reduced risk of pelvic inflammatory disease, which
may be a risk with intra-uterine devices.

25. Choice of cocs
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are similarly effective in preventing pregnancy,
the initial choice is based on
the hormonal content and dose,
preferred pattern of pill use,
coexisting medical conditions

26. Pops(minipills)
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The 28 days active hormone per cycle
less effective than combination OCs
associated with irregular menstrual bleeding.
must be taken every day at approximately the
same
the risk of ectopic pregnancy is higher than
with other hormonal contraceptives.

27. What if dose missed????
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28. Transdermal patch
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includes 0.75 mg of EE and 6 mg of
norelgestromin,
abdomen, buttocks, upper torso, or upper arm
Applied at the beginning of the menstrual cycle
Replaced every week for 3 weeks
compliance > ocs
risk of increased estrogen exposure

29. Vaginal Rings
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It is a 54-mm flexible ring, 4 mm in thickness
contains EE and etonogestrel (NuvaRing)
It stays there for 21 days. You then remove the ring for 7 days
The ring can be used as a continuous-dose form of birth
control.
To use it this way, a new ring is inserted every 3 weeks with
no ring-free week in between
precise placement is not an issue

30. implant
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Etonogestrel-releasing (Implanon®)
•Consistingofasingleflexiblerod;therodisinserted
subdermallyintothelowersurfaceoftheupperarmandit
provideseffectivecontraceptionforupto3years.
•Ifawomenwishtobecomepregnant,theimplantcanbe
removedbyhealthcareprovider,andfertilityreturnswithout
delay
•Theimplantcanbeusedbywomenwhoarebreastfeeding

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32. Injectable Progestins.
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DMPA 150 mg (Depo-Provera)
administered by deep intramuscular injection
in the glutealor deltoid muscle
within 5 days of onset of menstrual bleeding
inhibits ovulation for more than 3 months
DMPA (Depo-SubQProvera104)
a new formulation approved by the FDA contains
104 mg of DMPA
injected subcutaneously
into the abdomen or thigh
Reduces BMD (need monotoring)

33. Intrauterine Devices
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small, "T-shaped" devices made of flexible
plastic that inserted into a woman's uterus.
It is one of the most effective reversible forms
of birth control available.

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35. Types
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IUD that slowly
releases
progesterone
(hormonal)
Copper containing
IUD
(non-hormonal)
The hormonal IUD works for up
to 5 years
The copper IUD works for up to
10 years.

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No need to remember it every day.
The hormonal IUD may help decrease and, in
some cases, treat menstrual pain .
If a woman wishes to become pregnant, she
can have the IUD removed.
It can be used by women who are
breastfeeding.
The copper IUD has no effect on a woman’s
natural hormones.

37. RISKS OF IUD
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There is an increased risk that the pregnancy will be
ectopic.
The IUD should be removed from pregnant women
when possible.
The woman having STD or at risk to have, she’s at
risk of Pelvic inflammatory disease (PID) is an
infection of the uterus and fallopian tubes specially
in the first 3 weeks after insertion of an IUD.

38. Emergency Contraception
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is used to prevent unwanted pregnancy after
unprotected sexual intercourse
It is effective if taken within 3-5 days of unprotected
intercourse.
Ulipristalacetate
Hormonal emergency contraception involves the use of
levonorgestrel
Currently plan B is FDA approved
Post coital insertion of IUD also method of emergency
contraception.
Also 4 pills of COCs & then 2 pills after 12 hrs

39. EVALUATION OF OUTCOMES
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At least annual blood pressure monitoring is
recommended for all users of CHC
history of glucose intolerance or overt diabetes
mellitus begins or discontinues the use of
CHC, glucose levels
at least annual (more frequent if they are at
risk for STDs) cytologic screening

40. outcomes evaluation cont…
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Women using Implanonshould be monitored
annually for
menstrual cycle disturbances,
weight gain,
local inflammation or infection at the implant site,
acne, breast tenderness, headaches, and hair loss.
Women using DMPA should be asked at 3-
month follow up visits about
weight gain,
menstrual cycle disturbances, and
STD risks.

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Thank you !!!