hormonal method of contraception
TRANSCRIPT
HORMONAL METHOD OF CONTRACEPTION
By: Kavya
1st year MSc Nursing
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
• 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
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.
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
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
Mechanism of action
• The Concept of Contraception based on
prevention sperm to fertilize ovum or to prevent
implantation of fertilized ovum.
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
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
Classification of hormonal methods
1.Oral pills
a)Combined pills
b)Progesterone only pills
c)Post coital pill
d)Once a month pill
e)Male pill
2. Depot
A)Progesterone only injectable
oDepo metroxyprogesterone acetate (DMPA)
oNorethisterone enantate (NET EN)
oDMPA- SC
• B) Combined injectable
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.
• 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
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.
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
• 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
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
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
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
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
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
• 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%
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
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
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.
• 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
Uses:
• Highly effective
• Long acting
• Reversible
• Estrogen free
• Protection for several months
• Ex: Injectable, subdermal implants, vaginal rings
Injectable contraceptives
• Types:
A) Progesterone only injectable
B) Combined injectable contraceptives
Progesterone only injectable
• 1. Depo metroxyprogesterone acetate (DMPA)
• 2. Norethisterone enantate (NET EN)
• 3. DMPA- SC
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
• 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
DMPA- SC
• Administration: Subcutaneous injection of 104 mg
at 3 months intervals
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
• Effectiveness: Higher pregnancy rate than DMPA
(0.4%)
• Points to remember
• Given deep IM in gluteus maximus
• Injection site should never be massaged
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
B. Combined injectable
• Content: Contains progesterone and estrogen
• Duration: Given at monthly intervals
• Mode of action: Action mainly ovulation suppression
• Ex: Cyclo provera
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
• NORPLANT 1
• Six capsules
• Five years effectiveness
• NORPLANT 2
• Two capsules
• Three years
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
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.
Summary
• family planning
• criteria for an ideal contraceptive
• classification of hormonal methods
• combined pills
• progesterone only pills
• the post coital pill
• male pill
• advantage of oral pills
• adverse effects
• depot formulations
• Progesterone only and combined injectable
• subdermal implant
• vaginal rings
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
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
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_con
trol/article.htm