Transcript Hormonal and Surgical Contraception

Hormonal and Surgical
Contraception
Tod C. Aeby, MD
John A. Burns School of Medicine
Department of Obstetrics, Gynecology
and Women’s Health
Learning Objectives
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Combination Oral Contraceptive Pills
Progestin Only Contraceptive Pills
Injections and Implants
Patches and Rings
Emergency Contraception
Surgical Sterilization
Average Failure Rates (%) During the First Year of
Use of a Contraceptive Method
Methods
NORPLANT SYSTEM
Male sterilization
Female sterilization
Depo-Provera (injectable progestogen)
Oral contraceptives
IUD Progesterone
Copper T 380A
Condom
(male) without spermicide
(female) without spermicide
Cervical cap Never given birth
Given birth
Diaphragm with spermicide
Spermicides alone
Periodic abstinence (all methods) 25
Withdrawal
No contraception (planned pregnancy)
Average
0.05
0.15
0.5
0.3
5
2.0
0.8
14
21
20
40
20
26
19
85
Combination
Oral Contraceptive Pills
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Components
Mechanisms of Action
Health Risks
Non-contraceptive Benefits
Formulations
Progestin
and Estrogen
21 active pills
+/- 7 placebo pills
Monophasic
dosage constant
Triphasic
estrogen and
progestin may change
sequentials
no longer
available
Components through time
• Ethinyl Estradiol
160
140
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Norethindrone
Levonorgestrel
Desogestrel
Norgestimate
Gestodene
120
100
Estrogen
Progestin
80
60
40
20
0
1960 1980 2000
Mechanism of Action
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Inhibition of ovulation
Cervical mucus changes
Endometrial changes
Tubal motility changes
Advantages
• Reliable
• Convenient
• Discreet
High Dose OCP Risk
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Heart Disease
Thromboembolic Disease (blood clots)
Glucose intolerance (diabetes)
Liver cysts
Breast and Cervix Cancer?
Modern Health Risks
• Slight increase in blood clot formation
• Gallbladder disease
• Heart disease in smokers over age 35
Non- contraceptive Benefits
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Menstrual regulation
Protects against cancer
Improves acne and hirsutism
Decreased breast and ovarian cysts
Better sex
Non- contraceptive side effects
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Nausea
Menstrual changes (spotting, amenorrhea)
??weight changes??
Minimal impact on lactation
Progestin only Pill
• “The Mini Pill”
• Less cycle control (often periods stop with
time)
• Slightly higher failure rate
• Fewer health risks
Depo Provera
• 150 mg shot every 12 weeks
• Progestin only side effect profile
• Duration unpredictable
Norplant
• Levonorgesterel
• Surgically implanted
and removed
• Good for 5 years
• Same side effects as
other progestin only
methods
Emergency Contraception
• Reduces risk of pregnancy after unprotected
intercourse by at least 74%
• No medical contraindication (except
pregnancy)
• Must be within 120 hours
• 2 doses, 12 hours apart
• Preven: estrogen + progestin
• Plan B: progestin only
IUDs
Mirena
Progestasert
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QuickTi me™ and a
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Paragard
QuickTime™ and a
TIFF (Uncompressed) decompressor
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Male Hormonal Contraception?
• Most methods suppress LH/FSH and then
replace testosterone
– GnRH or progestin
– Implants, shots, pills
• Inject vas deferens with polymer
• Anti-sperm compounds
• Anti-sperm vaccine
Male Surgical Sterilization:
Vasectomy
• Outpatient surgical
procedure
• .1% failure rate
• No impact on sexual
functioning
• No known long term
health risks
Female Surgical Sterilization
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Electrocautery
Silastic band
Cut and tie
Clip
Springs
Average Failure Rates (%) During the First Year of Use of a
Contraceptive Method
Methods
NORPLANT SYSTEM
Male sterilization
Female sterilization
Depo-Provera (injectable progestogen)
Oral contraceptives
IUD Progesterone
Copper T 380A
Condom
(male) without spermicide
(female) without spermicide
Cervical cap Never given birth
Given birth
Diaphragm with spermicide
Spermicides alone
Periodic abstinence (all methods)
Withdrawal
No contraception (planned pregnancy)
Average
0.05
0.15
0.5
0.3
5
2.0
0.8
14
21
20
40
20
26
25
19
85