Barbora kubešová

ContraceptionTechniques to prevent pregnancy - family planning - population control

Pearl index … number of pregnancies-----------------------------------------------------x 100 number of couples using the method

Methods used by the femaleBarriers (diafragm, cervical cap, femidom)Chemical (pessaries, creams, foams,

vaginal globules, medicated spongies)IUD – inert, with metall, with progestinHormonal - combined oral, emergency pill (high dose oestrogen with progesteron), mini-pill (progesteron only) - injectable hormones – progestin - implantable hormones-

progestin - transdermal patches

A/ Mirena LNG-IUS

B/Nova

C/Multiload

D/Orthogynae T

Mechanism of action COCInhibition of ovulation (E)Changes of cervical mucos (P)Changes of contractility of smooth muscles

of genital organs (P)Modifications of endometrium (P)

Hormonal contraception:

*Estrogen- ethinylestradiol*Gestagen-gestagens I generation (mestrano)

gestagens II generation (NES) - gestagens III generation

(desogestrel, gestoden,norgestimate, levonorgestrel) -gestagens IV generation (drospirenon)

Monophasic, biphasic, triphasic

Examination before COC:Anamnesis, gynaecol.examonation (colposcopy and cytology, blood pressure, (biochemic examination), genetic examination in risk group of women (hypercoagulation Leiden mutation)

Absolute contraindications of COC :-pregnancy, six weeks after delivery-trombembolism (include in  anamnesis)- Leiden mutation-hypertension (160/100 and more)-liver disease (acute hepatitis, liver tumores,cirhosis)-hormonal dependent tumors-breast cancer (first 5 years after treatment)

Relative contraindications :- age over 35 years + nicotinism-ischaemic coronary disease, stroke, congenital coronary disease-migraine

Advantages COC:

-high effective and reversibile prevention of pregnancy (Pearl index 0.1-0.2 )-prevention GEU-decrease of number inflamatory pelvic disease (barierre for infections)-regulation of menstrual disorders, less blood lost during menstruation

(prevention of anemia)-endometriosis – decrease of algomenorrhoea-positive influance into dysmenorrhoea and premenstrual syndrom- influance into hyperandrogenic effect – acne, hirsutism, PCO

(gestagens with antiandrogenic effect)-positive influance into osteoporosis -decrease number of benign mastopathy and ovarian cysts-reduction incidence of endometrial cancer

-reduction ovarian cancer (about 50 %)- inhibition of ovulation-decrease of incidence colorectal cancer

Negative effects (adverse effects) :

- tromboembolism (nicotinism !!) , estrogens increase blood coagulation and trombocytes adhesivity

- increase body weight (retence of fluid)- mastodynia (estrogen)- hypertension (nonsignificant and reversibile)- hedeache, ophtalmologic symptoms – lower tolerance for contact lens- epilepsia- depresion, changes of libido- increase risk of cardiovascular diseases (age, blood pressure, nicotinism)- hepatocelular adenoma (today very rare, in pasture Mestranol)

COC don´t increase the risk of breast cancer and cervical cancer

Gestagen only contraception :

Forms: tablets (Exluton, Cerazette ), implants (Implanon), IUD(Mirena),

injectable (Depo-Provera)

Disadvantages: comonner irregular bleedind or spotting, higher Pearl index

For : during lactation , contraindication of combin COC

The only absolut contraindication – breast cancer ( 5 years after treatment)

Emergency postcoital contraception:

*Estrogen-progestagen ( EE 0.1 mg + LNG 0.5 mg until 72 hour after coitus., the same dose after 12 hod.)

Minisiston 4 tbl – 4 tbl

*High dose of gestagens ( LNG 0.75 – 1 mg in 1hour)- Postinor l tbl.,event. Postinor 2x1 tbl á 12 hod in 72 hod.

Rizika CC