Hormonal method of contraception

Contains :
Different types of hormonal contraception
Action
examples

1. HORMONAL METHOD OF CONTRACEPTION By: Kavya 1 st year MSc Nursing

2. Objectives describe the meaning of family planning list criteria for an ideal contraceptive enumerate classification of hormonal methods explain combined pills describes progesterone only pills enumerate the post coital pill describe once a month pill

3. explain male pill state advantage of oral pills enlist contraindications list few adverse effects explain depot formulations describe combined injections explain subdermal implant describe vaginal rings

4. Introduction: Meaning Family planning refers to the planning of when to have children , and the use of birth control. It allows individuals and couples to anticipate and have their desired number of children, and to achieve healthy spacing and timing of their births.

5. Purpose Reduces the need for abortion Family planning reinforces people’s rights to determine the number and spacing of their children. Prevents deaths of mothers and children Raising a child with significant amount of time, social, financial, environment

6. Types of contraceptives I Spacing methods 1.Barrier method 2. Intra-uterine devices 3. Hormonal method of contraceptive 4. Post- conceptional methods 5. Miscellaneous II. Terminal methods 1. Male sterilization 2. Female sterilization

7. Mechanism of action The Concept of Contraception based on prevention sperm to fertilize ovum or to prevent implantation of fertilized ovum .

8. Criteria for an ideal contraceptive Safe : it means that the contraceptives is free from any kind of side effects or complications Reliable: it means that the contraceptives is cent percent effective Easy to administer and convenient Cost effective Culturally feasible and acceptable

9. Hormonal contraception Hormonal contraceptives refers to birth control methods that act on the endocrine system . Action varies from one type to another Uses synthetic progesterone and estrogen

10. Classification of hormonal methods Oral pills Combined pills Progesterone only pills Post coital pill Once a month pill Male pill

11. 2. Depot Progesterone only injectable Depo metroxyprogesterone acetate (DMPA) Norethisterone enantate (NET EN) DMPA- SC B) Combined injectable

12. 1. Oral pills : a ) Combined pills Content : Contains estrogen and progesterone Mode of action : Inhibits ovulation of ovum by blocking the gonadotropin from pituitary gland . The progestogen alters the cervical mucosa which prevents entry of sperms into genital canal makes the uterine inner lining unsuitable for implantation of fertilized egg.

13. Duration : 21 or 28 days Taken for 21 consecutive days beginning from 5th day of menstruation. Effects : “ withdrawal bleeding” Points to remember: fixed time If the user forgets

14. Example Mala-N and Mala - D It is supplied by the government of India Content: Contains levonorgesterol .15 mg and ethinil estrodiol .003 mg Mala- D: 21 OCP and 7 iron tablets (60 mg ferrous fumarate tablet) available at the cost of Rs . 3 Mala-N: 21 OCP, supplied free of cost through PHC, Urban health centers.

15. Progesterone only pills ( Minipill / micro pill ) Content: Contains only progesterone Mode of action: The progestogen alters the cervical mucosa which prevents entry of sperms into genital canal makes the uterine inner lining unsuitable for implantation of fertilized egg . Duration : throughout the menstrual cycle

16. Commonly used progesterone are Norethirsterone and levonorgesterol Disadvantage: Increased pregnancy rate and poor cycle control Advantage: can be used in older women with cardiovascular risks

17. Post coital pill Post coital method is advocated as an emergency method eg . Contraceptives failure, rape, unprotected sex Duration: To be taken within 72 hours of unprotected intercourse Content: Contains hormone progesterone Action : It prevents ovary from releasing egg or prevents fertilization or implantation

18. Example: Levonorgesterol 0.75 is approved in India One tablet within 24 hours and the 2nd tablet after 12 hours of 1st dose Advantage: Failure rate less than 1 % Side effects: nausea, mild stomach upset, spotting, headache and tiredness

19. Once a month pill Its a long acting pill Combination of long acting estrogen ( quinestrol ) with short acting progesterone High pregnancy rate Irregular menstrual cycle

20. Male pill An ideal male contraceptive pill should decrease sperm count but does not affect testosterone levels. Eg . Gossypol- derivation of cotton seed oil Produces oligospermia or azoospermia 10% of men because permanently azoospermia after taking it for 6 months Not on practice

21. Advantage of oral pills Prevents pregnancy Eases menstrual cramps Regular period Decreases incidence of ovarian and uterine cancer Decease acne Provides protection against at least 6 disease: benign breast disorder, ovarian cysts, iron deficiency anaemia, pelvic inflammatory disease, ectopic pregnancy, ovarian cancer

22. Effectiveness Taken according to prescribed regimen, oral contraceptive of the combined type are almost 100% effective. In developed countries the annual pregnancy rate is less than 1%

23. Contraindications Absolute Relative  Cancer of breast and genital  History of thrombo -embolism  Cardiac abnormality  Abnormal uterine bleeding  Congenital hyperlipidemia  Age above 40 years  Smoking  Mild hypertension  Epilepsy  Migraine  Lactating mother

24. Adverse effects Cardiovascular disease Risk of breast cancer Risk of cervical cancer Risk of thromboembolism Risk of liver adenoma Lipid metabolism disorder Nausea Depression Post-pill amenorrhea Weight gain Headache Migraine Breast tenderness

25. Duration of use The pill should be used primarily for spacing pregnancies in young women, those over 35 years should go for other method of contraception because of increased risk of cardiovascular disease.

26.   The administration of a sustained-action drug formulation that allows slow release and gradual absorption, so that the active agent can act for much longer periods than is possible with standard injections. Depot injections are usually given deep into a muscle . B. Depot formulation

27. Uses: Highly effective Long acting Reversible Estrogen free Protection for several months Ex: Injectable, subdermal implants, vaginal rings

28. Injectable contraceptives Types: A ) Progesterone only injectable B) Combined injectable contraceptives

29. Progesterone only injectable 1 . Depo metroxyprogesterone acetate (DMPA) 2. Norethisterone enantate (NET EN) 3. DMPA- SC

30. Depo metroxyprogesterone acetate (DMPA) Safe , effective and acceptable contraceptive that needs minimum motivation Good use among multipara women>35 years who have completed family Administration : IM injection of 150 mg every 3 months Duration: Given at 1st 5 days of menstrual cycle, timing is to rule out pregnancy

31. Effectiveness: 99% protection from pregnancy Mode of action: Stops ovulation and thickens cervical mucus Side effects: weight increase, irregular menstrual bleed, prolonged infertility Points to remember Given deep IM in the gluteus maximus Injection site should never be massaged

32. DMPA- SC Administration : Subcutaneous injection of 104 mg at 3 months intervals

33. Norethisterone enantate Less extensively used than DMPA Administration: IM injection of 200 mg every 2 months Duration : Given deep at 1st 5 days of menstrual cycle Mode of action: Inhibition of ovulation and thickening of cervical mucus

34. Effectiveness : Higher pregnancy rate than DMPA (0.4%) Points to remember Given deep IM in gluteus maximus Injection site should never be massaged

35. Contraindications for injectable contraceptives Cancer of breast, genitals Undiagnosed abnormal uterine bleeding Deep vein thrombosis History of stroke, heart attack High BP>160/100 mm of hg

36. B. Combined injectable Content : Contains progesterone and estrogen Duration: Given at monthly intervals Mode of action: Action mainly ovulation suppression Ex : Cyclo provera

37. 2. Subdermal implants Administration : Implants are placed in the body filled with hormone that prevents pregnancy Physically inserted in simple 15 minute outpatient procedures Plastic capsules the size of paper matchsticks inserted under the skin in the arm Effectiveness: 99.95% effectiveness rate

38. NORPLANT 1 Six capsules Five years effectiveness NORPLANT 2 Two capsules Three years

39. 3. Vaginal rings Vaginal rings containing levonorgesterol have been found to be effective Hormone is slowly absorbed through vaginal mucosa Rings is worn 3weeks of the cycle and removed

40. Conclusion: Every contraceptive methods have its own pros and cons. Hence it should be utilized by individual in a very cautious manner. Role of Nurse is to provide information regarding wide range of family planning method but not force any individual .

41. Summary family planning criteria for an ideal contraceptive classification of hormonal methods combined pills progesterone only pills the post coital pill

42. male pill advantage of oral pills adverse effects depot formulations Progesterone only and combined injectable subdermal implant vaginal rings

43. Evaluation Questions 1 . list the classification of oral pills 2. describe the progesterone only pills 3. give example for Combined oral pill 4. list few advantage of oral pills

44. ASSIGNMENT 1 . explains the nurses role in educating public about contraception SL NO: CRITERIA FOR EVALUATION MARKS ALLOTED 1 introduction 2 2 Critical thinking 5 3 Completeness 2 5 Submission on time 1 total 10

45. References 1 . Park, K. (2015). Park's textbook of preventive and social medicine (23rd ed.). Jabalpur: M/S Banarsidas Bhanot . 2. Kumari , N. (2011). A Text Book of community health nursing. Jalandhar: S.vikas and company (medical ) India 3 . Stöppler , M. M. ( n.d. ). Hormonal Methods of Birth Control: Learn About Pros and Cons. Retrieved April 05, 2017, from http:// www.medicinenet.com/hormonal_methods_of_birth_control/article.htm