Steroidal contraceptives.pptx

Steroidal contraceptives

1. STEROIDAL CONTRACEPTIVES

2. COMBINED ORAL CONTRACEPTIVES The most effective reversible method of contraception. Common used Progestins are Levonorgestrel , Norethisterone and the estrogens are principally confined to either ethinylestradiol or mestranol. Only MALA-N is available in market free of cost through government channels. Fourth Generation- Drospirenone which is an analog of spironolactone is used as a progestin. It has antiandrogenic and antimineralocorticoid action.

3. MECHANISM OF ACTION Both the hormones synergistically act on the HP axis. Estrogens suppress FSH and prevent follicular growth and progestins suppress LH and prevent ovulation. The release of GnRH is prevented through a negative feedback mechanism. There is thus no pulsatile release of FSH Or LH, so follicular growth is either not initiated or if initiated recruitment does not occur. There is NO OVULATION .

4. MECHANISM OF ACTION There is stromal edema, decidual reaction and regression of the glands making the endometrium non receptive. Alteration of the character of the cervical mucus so as to prevent sperm penetration. Probably interferes with the tubal motility. Estrogens inhibit FSH rise and prevent follicular growth . Progestins primarily have anovulatory effect and counteract the adverse effect of Estrogen on the endometrium.

5. HOW TO PRESCRIBE A PILL….? PATIENT INSTRUCTION- New users should ideally start their pill packet on Day 1 of their cycle. One tablet daily at bedtime for consecutive 21 days . Then there is a break of 7 days. Next pack should be started on the eighth day irrespective of bleeding. Thus a simple Regime of 3 weeks on and 1 week off is followed. 7 of the pills are dummy and contain either Iron or vitamin preperations.

6. MISSED PILLS Normally there is return of pituitary ovarian follicular axis during the pill free interval of 7 days. Breakthrough ovulation may occur which increases the risk of pregnancy. When one pill is missed the woman should take take the pill and continue the rest of the schedule When 2 pills are missed she should take 2 pills the next day. If more than 2 pills are missed she should use another form of contraception for the next 7 days.

7. Medical Eligibility Criteria For Contraceptive Use

8. Adverse Effects of Combined Oral Contraceptive Pills.

9. MINOR Nausea, vomiting Headache Mastalgia Weight Gain Breakthrough Bleeding Diminished Libido Leukorrhea MAJOR Depression Hypertension Venous Thromboembolism Cholestatic Jaundice Neoplasia Death

10. OCP’s ADVANTAGES Highly effective Good cycle control Well tolerated Low dose Progestins further reduce any risk Reversibility is prompt DISADVANTAGES Requires education and motivation Requires initial checkup Risk of drug interactions

11. TRIPHASIC PREPERATION In these preperations the hormonal doses of each compound vary over the course of the cycle. Minimum doses are provided for contraceptive effect in the early part of the cycle and higher doses in the later part of the cycle to prevent breakthrough bleeding.

12. CENTCHROMAN ( CHHAYA ) A research product of CDRI Lucknow. A non steroidal compound with potent antiestrogenic properties. Taken orally twice a week for first 3 months then once a week. Creates asynchrony between developing zygote and endometrium causing implantation failure. Does not prevent ovulation.

13. PROGESTOGEN ONLY PILLS

14. Devoid of any estrogen compound. It contains very low dose of progestin in any one of the following form, Levonorgestrel (75 ug), Norethisterone (350ug) , Desogesteral (75ug) HAS TO BE TAKEN FROM THE FIRST DAY OF THE CYCLE and then continuously. Works mainly by making cervical mucus thick and viscous thereby prevents sperm penetration.

15. ADVANTAGES Side effects attributed to estrogen are totally eliminated. No adverse effect on lactation Easy to take as there is no On and Off regimen. May be prescribed in patients having HTN, Fibroids, Diabetes HIV Reduce the risk of PID and endometrial cancer.

16. Injectable Progestins

17. The preparations commonly used are DMPA And NET-EN. Both are administered intramuscularly within 5 days of the cycle. DMPA (150mg every 4 months) NET EN ( 200 mg every 2 months)

18. MECHANISM OF ACTION Inhibition of ovulation by suppressing the mid cycle LH surge. Cervical mucus becomes thick and viscid thereby preventing sperm penetration. Endometrium is atrophic

19. ADVANTAGE It eliminates regular medications as imposed by oral pill. Can be used safely during lactation. No estrogen related side effects. Menstrual symptoms are reduced. Protective against endometrial cancer. Can be used as an interim contraceptive before vasectomy. Reduction in PID

20. DISADVANTAGES There is chance of irregular bleeding. Return of fertility is usually delayed. Loss of bone mineral density has been observed with long term use. Other side effects are depression and weight gain.

21. IMPLANTS Nexplanon is a progestin only delivery system containing etonogesteral. It is a long term reversible contraceptive. It releases the hormone 60ug gradually reduced to 30ug over a period of 3 years. It atrophies endometrium thickens the cervical mucus and inhibits ovulation for the first year. Capsule is inserted subdermally in the non dominant arm High Pearl Index and is considered reversible sterilisation.

22. NORPLANT–II (Jadelle) Two rods of 4 cm length with diameter of 2.5 mm are used. Each rod contains 75 mg of levonorgestrel. It releases 50 mcg of levonorgestrel per day. Contraceptive efficacy is similar to combined pills. Failure rate is 0.06 per 100 women years. It is used for 3 years. The rods are easier to insert and remove.

23. EMERGENCY CONTRACEPTIVES

24. PERMANENT SURGICAL CONTRACEPTION

25. MALE STERILIZATION VASECTOMY It is a permanent sterilisation operation done in males where a segment of vas deference of both the sides are resected and the cut ends are ligated.

26. ADVANTAGES The operative technique is simple and can be performed with minimal training Can be done as an OPD procedure. Complications immediate or late are few. Failure rate is minimal. The overall expenditure is minimal.

27. DISADVANTAGES Additional contraceptive protection is needed for 2 to 3 months following operations. Till the semen becomes free from sperm Frigidity or impotency when occur is mostly psychological SELECTION OF CANDIDATE Sexually active and psychologically adjusted husband having the desired number of children is an ideal candidate.

28. TUBECTOMY It is an operation where resection of a segment of both the Fallopian tubes is done to achieve permanent sterilisation. The approach may be ABDOMINAL VAGINAL

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