4. ORAL CONTRACEPTIVES
1. COMBINED PILLS (Combination of estrogen and
progestin )
Monophasic-each tablet contain fixed amount of E
and P
Biphasic-each tablet contain fixed amount of E
,while the amount of P increases in the second half
of the cycle .
Triphasic – the amount of E may be fixed or
variable ,while the amount of P increases in 3 equal
phases .
5. • In combined pill commonly used
Progestin are - norethindrone ,norgestrel,
levonorgestrel,desogestrel and gestodene
PROGESTIN CONTENT ranges from 0.15mg -1mg
Usual oestrogen – Ethinyl estradiol
OESTROGEN CONTENT ranges from 20-30mcg
6.
7. MEHANISM OF ACTION
• Estrogen and Progesterone causes
feedback inhibition of FSH and LH
secretion from pituitary gland to
inhibit ovulation (Main mechanism )
• Progestin thicken the cervical
mucous and prevent the entry of
sperm
• Make the endometrium less suitable
for implantation
• Causes tubal and uterine contraction
that may interfere with fertilisation
8. PROGESTIN ONLY PILLS(MINIPILL)
These contain low dose of progestin only.
Used as an alternative for women in whom estrogen is
contraindicated.
It is taken daily continuously without any gap.
MOA- 1. by altering the cervical mucus
2.interfering implantation
3.inhibiting ovulation
AE - 1. Causes menstrual irregularities
2. increased risk of ectopic pregnancy
EFFICACY-96-98%
9. POSTCOITAL PILLS (EMERGENCY PILLS)
These are used for women who are not taking
contraceptive and had a sexual intercourse risking
unwanted pregnancy.
MOA- it interfers with implantation and ovulation
LEVONORGESTREL tablet 0.75mgtwo doses 12 hrs apart
or 1.5mg single dose taken before 72hrs of unprotected
intercourse
ULIPRISTAL 30mg single dose is effective within 120hrs
of intercourse.
MIFEPRISTONE 600mg single dose taken within 72hrs of
intercourse.
10.
11. PARENTERAL CONTRACEPTIVES
Injectables
• Depot medroxyprogesterone acetate (DMPA) -150mg
deep i,.m once in 3 months.
• Norethindrone enanthate (NEE) – 200mg i.m once in 2
months .
DRAWBACKS
Menstrual irregularities
Headache
Mood change
Weight change
Acne
Decrease in HDL and increase in LDL
12. Implants
1. Norplant-it is subdermal implant which consist of 6
flexible rods containing 216mg of levonorgestrel.
Effective for 5 yrs
2. Implanon – it is a subdermal single rod containing
68mg of desogestrel. Effective for 3 yrs
SIDE EFFECTS
Infection
Local irritation
Pain at the insertion site