Contraception 1

Birth Control Interfering with the reproductive process at any step from gametogenesis to nidation (implantation of a fertilized ovum) 2

Safety Difficult to assess A large quantity of our data was gathered when birth control was used in higher doses than are used today Effectiveness vs. safety 3

Selecting a Birth Control Method Consider: Effectiveness Safety Personal preference 4

Oral Contraceptives Mechanism: inhibit ovulation Classification (two main categories) Combination oral contraceptives (OCs) Estrogen and progestin Progestin-only OCs Three major subgroups of combination OCs Monophasic Biphasic Triphasic 5

Combination Oral Contraceptives (OCs): Adverse Effects Thromboembolic disorders Hypertension Cancer Teratogenic effects Abnormal uterine bleeding Use in pregnancy and lactation Benign hepatic adenoma Glucose intolerance Other adverse effects 6

Noncontraceptive Benefits of OCs Decrease risks of ovarian cancer, endometrial cancer, ovarian cysts, pelvic inflammatory disease, benign breast disease, iron deficiency, anemia, and acne Favorable effect on menstrual cycles Reduced cramps; lighter, shorter, more predictable flow 7

Combination Oral Contraceptives—Drug Interactions Drugs and herbs that reduce the effects of OCs Rifampin Ritonavir Antiepileptic drugs St. John’s wort 8

Combination Oral Contraceptives: Drug Interactions Drugs whose effects are reduced by OCs Warfarin Insulin Oral hypoglycemics Drugs whose effects are increased by OCs Several agents, including theophylline, tricyclic antidepressants, diazepam, and chlordiazepoxide Drugs that elevate potassium should be avoided by patients on yasmin (Yaz) 9

Combination Contraceptives with Novel Delivery Systems Transdermal contraceptive patch Vaginal contraceptive ring 10

Long-Acting Contraceptives Subdermal etonorgestrel implants Depot medroxyprogesterone acetate (MPA) Intrauterine devices Spermicides Barrier devices Condoms: male and female Diaphragm Cervical cap 11

Drugs for Medical Abortion Mifepristone (RU 486) with misoprostol Blocks uterine progesterone receptors Adverse effects Bleeding Cramping Nausea Vomiting Diarrhea Headache 12

Drugs for Medical Abortion Methotrexate with misoprostol Prostaglandins: misoprostol, carboprost, dinoprostone 13

Emergency Contraception Contraception implemented after intercourse Following rape, failed contraception, or failure to use contraception Plan B 2 high-dose tablets of levonorgestrel (progestin) 1 tablet within 72 hours and another 12 hours later Alternatives to Plan B 14