CONTRACEPTIVES / ORAL CONTRACEPTIVES / HORMONAL CONTRACEPTIVES As per PCI Syllabus

1. ORAL
CONTRACEPTIVES

2. HORMONAL CONTRACEPTIVES
“HORMONAL PREPARATIONS ARE RESPONSIBLE FOR
REVERSIBLE SUPPRESSION OF FERTILITY”
 Anti fertility agents are the need of the day
 In 20th century condoms, diaphragms, spermicidal
creams, foam tablets etc
 Those are intimately related to sexual intercourse,
high failure rate it was despised by most couples.
 Rook & Pincus (1995) invented oral progestin for
contraception, when administered it prevent the
fertility from coitus
 Recently number of new drugs was identified with
better activities,
Eg. COMBINED PILLS

3. FEMALE CONTRACEPTION
Over 100 million women worldwide currently
using hormonal contraceptives
By this drug the fertility can be suppressed
whenever we need
100% liable fertility regains on discontinuing
therapy
Because of Good efficacy, convenience, low
cost, overall safety, the oral contraceptives are
widely used now.

4. CLASSIFICATION OF FEMALE CONTRACEPTIVES:
ORAL
COMBINED PILL
PHASED REGIMENS
MINI PILL
POST COITAL CONTRACEPTION
INJECTABLES
LONG ACTING PROGESTINE ALONE
LONG ACTING PROGESTIN + LONG ACTING
ESTROGEN
IMPLANTS

5. ORAL CONTACEPTIVES:
COMBINED PILL:
 It contain both estrogen and progestin – FIRST
GENERATION PILL, but the drugs get accumulated in
the body
 Amount of estrogen & progestin is reduced without
affecting efficacy – SECOND GENERATION PILLS
 Newly identified progestins – THIRD GENERATION
PILL, Eg: DESOGESTREL.
 They are mostly used in combination with progestin
 Progestin is having anatiovulatory action

6. COMPOSITION OF COMBINED PILL
PROGESTIN ESTROGGEN
 NORGESTREL 0.3mg + ETHINYL ESTRADIOL - 30 g
 NORGESTREL 0.5mg +ETHINYL ESTRADIOL - 50 g
 LEVONORGESTREL 0.25mg +ETHINYL ESTRADIOL - 50 g
 LEVONORGESTREL0.15mg +ETHINYL ESTRADIOL - 30 g
 DESOGESTREL 0.15mg +ETHINYL STRADIOL - 30 g
 DESOGESTREL 0.15mg +ETHINYL ESTRADIOL - 20 g

7. Both progestin and estrogen synergize to
inhibit ovulation.
1 tablet daily for 21 days starting on the 5th
day of menstruation
The next dose started after a gap of 7 days in
which bleeding occurs, thus a cycle of 28 days
maintained.
Calendar packs of pills are available now
It is the popular and most efficacious method.

8. PHASED REGIMEN
Recommended for women’s more than 35
years
Introduced to permit reduction in total steroid
dose without compromising efficacy
They are biphasic or triphasic
Dose of estrogen kept constant in between 30-
40 g
FIRST PHASE: Amount of progestin is low
SECOND PHASE: Progressively high dose of
progestin
THIRD PHASE: Higher dose of progestin

9. COMPOSITION OF COMBINED PILL
PROGESTIN + ESTROGGEN
LEVONORGESTREL - 50 – 75 – 125 g +
ETHINYLESTRADIOL 30 – 40 - 35 g
NORETHINDRONE - 0.5 – 0.75 – 1mg +
ETHINYL ESTRADIOL 35 – 35 - 35 g

10. MINI PILL:
Also known as Progestin only pill
It designed to eliminate estrogen because long
term use may lead to severe risks.
Low dose progestin only, one pill taken daily,
Produce contraception in women.
Low efficacy 96 - 98%
Eg:
• NORETHINDRONE – 0.35MG
• NORGESTREL - 75 g

11. POSTCOITAL CONTRACEPTION:
It is an emergency contraception
Used in women not taking any contraceptive who had sexual
intercourse risking unwanted pregnancy
LEVONORGESTEREL 0.5mg+ ETHNYLESTRADIOL 0.1mg
This method is known as YUZPE METHOD.
Taken as early as possible
72 hours of unprotected intercourse, repeated after 12
hours.
It is the most popular method
50% women experience nausea
20 women experience vomiting

12. Commonly used and standard regimen is
 LEVONORGESTEREL 0.25mg
+ ETHNYLESTRADIOL 50 mic gm
 LEVONORGESTEREL 0.75mg
Taken twice within 12 hour gap with 72 hours of intercourse.
Less side effect than others, 6% women feel vomiting
Next period may be somewhat changed
2001 released essential drug list this method replaced the YUZPE
METHOD
 LEVONORGESTEREL 1.5mg
 single dose with in 72 hours
 This regimens having 2-3 times more effective and better tolerated
than YUZPE METHOD

13. ULIPRISTAL
In 2010 ULIPRISTAL, a new drug approved for
emergency contraception
Single dose of ULIPRISTAL 30mg as soon as
possible with 120 hours of intercourse
Have failure rate of 1-3%

14. MEFEPRISTONE 600mg
Single dose daily
Taken within 72 hours of intercourse
This is used in china, Europe, few other
countries
Has lesser side effect than YUZPE method
All this should be preferred only for
unexpected / accidental exposure (Eg: Rape,
Condom rupture). Because all regimens have
higher failure rate & side effect than regular
low dose combined pill

15. MALE CONTRACEPTIVE:
Only way to suppress male fertility by drugs is
to inhibit spermatogenesis.
Complete suppression of spermatogenesis is
difficult.
Risk of adverse effects.
Gonadotropin suppression inhibits
testosterone secretion.

16. THANK U & ALL THE BEST