Barbora kubešová

Contraception Techniques to prevent pregnancy - family planning - population control Pearl index … number of pregnancies x 100 number of couples using the method

Methods used by the female Barriers (diafragm, cervical cap, femidom) Chemical (pessaries, creams, foams, vaginal globules, medicated spongies) IUD – inert, with metall, with progestin Hormonal - combined oral, emergency pill (high dose oestrogen with progesteron), mini-pill (progesteron only) - injectable hormones – progestin - implantable hormones- progestin - transdermal patches

A/ Mirena LNG-IUS B/Nova C/Multiload D/Orthogynae T

Mechanism of action COC Inhibition of ovulation (E) Changes of cervical mucos (P) Changes of contractility of smooth muscles of genital organs (P) Modifications of endometrium (P)

Hormonal contraception : *Estrogen- ethinylestradiol *Gestagen-gestagens I generation (mestrano) gestagens II generation (NES) - gestagens III generation (desogestrel, gestoden,norgestimate, levonorgestrel) -gestagens IV generation (drospirenon) Monophasic, biphasic, triphasic Examination before COC: Anamnesis, gynaecol.examonation (colposcopy and cytology, blood pressure, (biochemic examination), genetic examination in risk group of women (hypercoagulation Leiden mutation)

Absolute contraindications of COC : -pregnancy, six weeks after delivery -trombembolism (include in anamnesis) - Leiden mutation -hypertension (160/100 and more) -liver disease (acute hepatitis, liver tumores,cirhosis) -hormonal dependent tumors -breast cancer (first 5 years after treatment) Relative contraindications : - age over 35 years + nicotinism -ischaemic coronary disease, stroke, congenital coronary disease -migraine

Advantages COC: -high effective and reversibile prevention of pregnancy (Pearl index ) -prevention GEU -decrease of number inflamatory pelvic disease (barierre for infections) -regulation of menstrual disorders, less blood lost during menstruation (prevention of anemia) -endometriosis – decrease of algomenorrhoea -positive influance into dysmenorrhoea and premenstrual syndrom - influance into hyperandrogenic effect – acne, hirsutism, PCO (gestagens with antiandrogenic effect) -positive influance into osteoporosis -decrease number of benign mastopathy and ovarian cysts -reduction incidence of endometrial cancer -reduction ovarian cancer (about 50 %)- inhibition of ovulation -decrease of incidence colorectal cancer

Negative effects (adverse effects) : - tromboembolism (nicotinism !!), estrogens increase blood coagulation and trombocytes adhesivity - increase body weight (retence of fluid) - mastodynia (estrogen) - hypertension (nonsignificant and reversibile) - hedeache, ophtalmologic symptoms – lower tolerance for contact lens - epilepsia - depresion, changes of libido - increase risk of cardiovascular diseases (age, blood pressure, nicotinism) - hepatocelular adenoma (today very rare, in pasture Mestranol) COC don´t increase the risk of breast cancer and cervical cancer

Gestagen only contraception : Forms: tablets (Exluton, Cerazette ), implants (Implanon), IUD(Mirena), injectable (Depo-Provera) Disadvantages: comonner irregular bleedind or spotting, higher Pearl index For : during lactation, contraindication of combin COC The only absolut contraindication – breast cancer ( 5 years after treatment)

Emergency postcoital contraception: *Estrogen-progestagen ( EE 0.1 mg + LNG 0.5 mg until 72 hour after coitus., the same dose after 12 hod.) Minisiston 4 tbl – 4 tbl *High dose of gestagens ( LNG 0.75 – 1 mg in 1hour)- Postinor l tbl., event. Postinor 2x1 tbl á 12 hod in 72 hod.

Rizika CC