1. Hormonal contraception

2. Permanent
temporary

3. Hormonal contraception Intrauterine devices Barrier contraception
Temporary contraceptives
Hormonal contraception
Intrauterine devices
Barrier contraception
Natural family planning methods

4. ORAL CONTRACEPTIVES

5. ORAL CONTRACEPTIVES
Oral contraceptives are medicines taken by mouth to help prevent pregnancy.
They are also known as “birth control pills”.
Birth control (contraceptive) medications
contain hormones (estrogen and progesterone, or progesterone alone).
Efficacious
Low cost
Overall safety
Complete return of fertility on discontinuation

7. Primary action is inhibition of ovulation
MECHANISM OF ACTION
Primary action is inhibition of ovulation

8. Mechanism of oral contraceptives
Hormonal birth control medications prevent pregnancy through the following ways:
By blocking ovulation (release of an egg from the ovaries), thus preventing pregnancy
By altering mucus in the cervix, which makes it hard for sperm to travel further
By changing the endometrium (lining of the uterus) so that it cannot support a fertilized egg
By altering the fallopian tubes (the tubes through which eggs move from the ovaries to the uterus) so that they cannot effectively move eggs toward the uterus

9. FSH
Progestogen- LH

11. mode of action
Inhibition of Gn release from pituitary by reinforcement of normal feedback inhibition.
estrogen
inhibits secretion of FSH via negative feedback on the anterior pituitary, and thus suppresses development of the ovarian follicle
progestogen
inhibits secretion of LH and thus prevents ovulation; it also makes the cervical mucus less suitable for the passage of sperm
oestrogen and progestogen
act in concert to alter the endometrium in such a way as to discourage implantation.
They may also interfere with the coordinated contractions of cervix, uterus and fallopian tubes that facilitate fertilisation and implantation.

12. Ovulation

13. ORAL CONTACEPTIVE VIDEO
..\..\VIDEOS\ORAL CONTRACEPTIVE VIDEO\Birth Control Pills.mp4
..\..\VIDEOS\PARTURATION PROCESS\Parturition - Pregnancy, Hormones, Giving Birth.mp4

14. Types ORAL Combined pill- Efficacy 98-99.9% Estrogen+Progestin
2nd generation pills- ↓estrogen+progestins
3rd generation pills- newer progestins-desogestrel
COURSE
1 tablet daily(starting on 5th day of menstruation)-21 days
Next course after gap of 7 days

15. 2. Phased regimens
Reduction in total steroid dose without compromising efficacy
-Biphasic
-Triphasic
Estrogen - Constant(or varied b/w 30-40µg)
Progestin- Low in 1st phase-progressively higher in 2nd and 3rd phase
3. Minipill
Low dose Progestin only pill
Taken continuously without any gap
Efficacy %

16. 4. Postcoital (emergency) contraception
3 regimens
Levonorgestrel 0.5mg- Ethinylestradiol 0.1mg
within 72 hrs & repeated after 12 hrs
‘YUZPE method’
Levonorgestrel 0.75mg
Twice with 12 hr gap within 72 hrs
WHO essential drug list(2001)- recommended replacement of YUZPE method by this regimen
c) Mifepristone 600mg- single dose within 72 hrs

17. COMBINED ORAL CONTRACEPTIVE PILLS

18. The combined pill
This is the most popular and most efficacious method.
It contains an estrogen and a progestin in fixed dose for all the days of a treatment cycle (monophasic).
With accumulated experience
It has been possible to reduce the amount of estrogen and progestin in the ‘second generation’ oc pills
Without compromising efficacy, but reducing side effects and complications.
‘Third generation’pills containing
Newer progestins like desogestrel with improved profile of action.
Ethinylestradiol 30 µg daily is considered threshold but can be reduced to 20 µg/day if a progestin with potent antiovulatory action is included.
The progestin is a 19-nortestosterone because these have potent antiovulatory action.

19. The combined pill
The estrogen in most combined preparations (second-generation pills)
Ethinylestradiol, although a few preparations contain mestranol instead.
The progestogen may be
Norethisterone, levonorgestrel, ethynodiol, or
In 'third-generation' pills-desogestrel or gestodene
Are more potent
But which probably cause a greater risk of thromboembolism than do second- generation preparations.
Well tolerated and gives good cycle control in the individual woman.
This combined pill is taken for 21 consecutive days followed by 7 pill-free days, which causes a withdrawal bleed.
Normal cycles of menstruation usually commence fairly soon after discontinuing treatment.

20. First generation:-
50 μg ethinyl estradiol and Progesterone (Norethynodrel, norethisterone acetate and lynestrenol)
:ovral
Second generation:-
20-30μg ethinyl estradiol and Progesterone (Norgestrel, levonorgestrel)
Without compromising efficacy, but reducing side effects and complications.
:ovral –L, malaN , malaD
Third generation:
Containing newer progestins with improved profile of action.
Ethinylestradiol 30 μg and progesterone (Desogestrel, gestodene, norgestimate)
:novelon , femilon

21. Phased regimens
These have been introduced to permit reduction in total steroid dose withaut Compromising efficacy.
These are biphasic or Triphasic.
The estrogen dose is kept constant (or Varied slightly between µg), while the Amount of progestin is low in the first phase and Progressively higher in the second and third Phases.
Phasic pills
Particularly recommended for Women over 35 years of age or when other risk Factors are present.

22. Phased regimens
Biphasic (each tablet contains a fixed amount of estrogen, while the amount of progestin increases in the second half of the cycle); or
Estrogen - constant(or varied b/w 30-40µg)
Progestin- low in 1st phase-progressively higher in 2nd and 3rd phase
Triphasic (the amount of estrogen may be fixed or variable, while the amount of progestin increases in 3 equal phases).

24. Minipill (progestin only pill)
It has been devised to eliminate the estrogen, because many of the long-term risks have been ascribed to this component.
A low-dose progestin only pill is taken daily continuously without any gap.
The menstrual cycle tends to become irregular and ovulation occurs in 20-30% women, but other mechanisms contribute to the contraceptive action.
The efficacy is lower (96-98%) compared to % with combined pill.
This method is less popular.

25. Postcoital (emergency) contraception
3 regimens
Levonorgestrel 0.5mg+ethinylestradiol 0.1mg
within 72 hrs & repeated after 12 hrs
‘YUZPE method’
Levonorgestrel 0.75mg
twice with 12 hr gap within 72 hrs
WHO essential drug list(2001)-
recommended replacement of YUZPE method by this regimen
Mifepristone 600mg- single dose within 72 hrs
Emergency postcoital contraception should be reserved
For unexpected or accidental exposure (rape, condom rupture) only
Because all emergency regimens have higher failure rate and side effects than regular low-dose combined pill.

26. Adverse effects A. Nonserious side effects
These are frequent, Specially in the first 1-3 cycles and then disappear Gradually.
Nausea and vomiting, Headache, migraine, bleeding or spotting, Amenorrhoea, Breast discomfort.
B. Side effects that appear later
1. Weight gain, acne and increased body hair
2. Chloasma: pigmentation of cheeks, nose and Forehead
3. Pruritus vulvae
4. Carbohydrate intolerance and precipitation Of diabetis
5. Mood swings, abdominal distention

27. Adverse effects 1 . Leg vein and pulmonary thrombosis
C. Serious complications
1 . Leg vein and pulmonary thrombosis
2. Coronary and cerebral thrombosis
3. Rise in BP
4. raise plasma HDL/LDL ratio
5. Genital carcinoma
6. Benign hepatomas
7. Gallstones

28. Other health benefits
lower probability of developing endometrial and ovarian carcinoma; probably colorectal cancer as well.
Reduced menstrual blood loss and associated anaemia; cycles if irregular become regular
endometriosis and pelvic inflammatory disease are improved.
reduced incidence of fibrocystic breast disease .

29. Contraindications The combined oral contraceptive
Absolutely contraindicated in:
Thromboembolic, coronary and cerebrovascular disease or a history of it.
2. Moderate-to-severe hypertension; hyperlipidaemia.
3. Active liver disease, hepatoma or jaundice during past pregnancy
4. Suspected malignancy of genitals/breast.
5. Prophyria.
6. Impending major surgery—to avoid excess risk of postoperative thromboembolism.
Relative contraindications (requiring avoidance/cautious use under supervision) 1. Diabetes 2. Obesity 3. Smoking 4. Undiagnosed vaginal bleeding 5. Mentally ill 6. Age above 35 years 7. Mild hypertension 8. Migraine 9. Gallbladder disease

30. Interaction With Drugs…
Contraceptive failure may occur if the following drugs are used concurrently:
Enzyme inducers:
Phenytoin, phenobarbitone, primidone, carbamazepine, rifampin, ritonavir. Metabolism of estrogenic as well as progestational component is increased.
Suppression of intestinal microflora:
Tetracyclines, ampicillin, etc.
Deconjugation of estrogens excreted in bile fails to occur → their enterohepatic circulation is interrupted → blood levels fall.

31. Indications of Withdrawal :
Severe migraine
Visual or speech disturbances
Sudden chest pain
Unexplained fainting attack or acute vertigo
Severe leg cramps
Excessive weight gain
Severe depression
Prior to surgery ( Atleast 6 weeks )
Patient wants pregnancy … 

32. THANK YOU - PHARMA STREET