Contraception Reversible method of birth control

I. Male contraception: 1. Behavioral (physiological)>>>avoiding sexual intercourse in the period when the female is highly fertile(by recording body temp daily…when it rise slightly…avoid intercourse 2 days after and 2 days before!!!)>>>failure rate=20-30% 2. Mechanical (e.g. condoms(protect against STDs) ± spermicidal agent (nonoxynol-9)>>>associated with failure rate due to rapture of the condom or leakage of sperms 3. Drugs (-ve feedback at the level of pituitary)>>>male will become 100% sexually dead (impotent) Estrogens; progestins; danazol; GnRH agonists & antagonists; spermicidal agents; gossypol 4. Surgical procedures e.g. vasectomy>>> successful …ligation of vas deferense All except behavioral consider failure

II. Female contraception: 1. Behavioral 2. Mechanical Diaphrams; condoms ± spermicidal agents( nonoxynol-9); IUD’s >>>most used mechanical method>>>making the endometrium not proper for implantation…fertalization may occur in fallopian tube (legal aspect…is it contraception or abortion??), each female require specific size, should be placed by a gynecologist, pregnancy may occur, predispose female to pelvic infection,menstrual irregularity and bleeding ± progestins (progestasert)>>>associated with failure rate 3. Drugs - Estrogen alone Morning after pill or postcoital pill (after sexual intercourse) Ethinylestradiol; DES; mestranol….. ×5 days

- Progesterone alone (from day 5 up to days) The minipill >>>( suggested exam Q: only Progesterone ) يستعمل في العمرة أو الحج * Norethisteron... Tab * I.M medroxyprogesterone Depo-provera (effect lasts in 3-6 months) * Subdermal progesterone implants Levonorgesrel (effect lasts in 5-6 years) no menses Pregnancy may occur any time>>>she should check her urine every now and then.

4. Sequential Estrogen followed by progesterone 5. Combined oral contraceptive pills (COCP ’ s) ethinylestradiol or mestranol + Norgestrel ethinylestradiol or mestranol + Norethisterone * Estrogen + progesterone in different ratios (lowest E highest P to achieve the lowest or zero failure rate)>>>failure is only due to forgetting of one tablet or she take one of placebo tablets in day 16 for example !!! حبوب خفيفة يعني اقل كمية ممكنة من الاستروجن وأكثر كمية ممكنة من البروجسترون

MOA of OCP ’ s: -Inhibition of ovulation (major mechanism)>>Question in exam At the level of the pituitary -↑ viscosity of cervical mucus -Change in Fallopian tube motility Q:possible mechanisms: all of the above

OCP ’ s side effects: (if happens: OCP is contraindicated) -Nausea, vomiting, dizziness, headache, migraine, nervousness, depression -Salt & water retention → ↑ BP -Thromboembolic disease, embolism, MI -Vaginal yeast growth -Postpill amenorrhea and infertility (10%)most serious -Wait 1-2 years >>time for the axis to become normal -The longer the duration of OCP use the increase effect on the axis -Universal side effect of antihypertensive drugs is erectile dysfunction

OCP ’ s contraindications: -History of thromboembolic disease -Severe headache -Severe nausea & vomiting -Liver dysfunction -Pregnancy -Abnormal menstrual cycles

OCP ’ s drug-drug interactions: -Drugs inhibiting enterohepatic circulation Ampicillin; cephalosporins; teracyclines; sulfonamides; co-trimoxazole -Drugs ↑ metabolism Phenobarbitone; phenytoin; ethosuximide; rifampicin; griseofulvin… -Miscellaneous interactions + anticoagulants →↓ activity of anticoag. + insulin → ↑ insulin need