1. Contraception 1

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

3. 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

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

5. 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

6. 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

7. 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

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

9. 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

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

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

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

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

14. 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