1. Hormonal and Surgical Contraception

2. Learning Objectives Combination Oral Contraceptive Pills
Progestin Only Contraceptive Pills
Injections and Implants
Patches and Rings
Emergency Contraception
Surgical Sterilization

3. Average Failure Rates (%) During the First Year of Use of a Contraceptive Method
Methods Average
NORPLANT SYSTEM
Male sterilization
Female sterilization 0.5
Depo-Provera (injectable progestogen) 0.3
Oral contraceptives 5
IUD Progesterone
Copper T 380A
Condom
(male) without spermicide 14
(female) without spermicide 21
Cervical cap Never given birth 20
Given birth
Diaphragm with spermicide 20
Spermicides alone 26
Periodic abstinence (all methods) 25
Withdrawal
No contraception (planned pregnancy) 85

4. Combination Oral Contraceptive Pills
Components
Mechanisms of Action
Health Risks
Non-contraceptive Benefits

5. Formulations

6. Components through time
Ethinyl Estradiol
Norethindrone
Levonorgestrel
Desogestrel
Norgestimate
Gestodene

7. Mechanism of Action Inhibition of ovulation Cervical mucus changes
Endometrial changes
Tubal motility changes

8. Advantages
Reliable
Convenient
Discreet

9. High Dose OCP Risk Heart Disease Thromboembolic Disease (blood clots)
Glucose intolerance (diabetes)
Liver cysts
Breast and Cervix Cancer?

10. Modern Health Risks Slight increase in blood clot formation
Gallbladder disease
Heart disease in smokers over age 35

11. Non- contraceptive Benefits
Menstrual regulation
Protects against cancer
Improves acne and hirsutism
Decreased breast and ovarian cysts
Better sex

12. Non- contraceptive side effects
Nausea
Menstrual changes (spotting, amenorrhea)
??weight changes??
Minimal impact on lactation

13. Progestin only Pill “The Mini Pill”
Less cycle control (often periods stop with time)
Slightly higher failure rate
Fewer health risks

14. Depo Provera 150 mg shot every 12 weeks
Progestin only side effect profile
Duration unpredictable

15. Norplant Levonorgesterel Surgically implanted and removed
Good for 5 years
Same side effects as other progestin only methods

16. Emergency Contraception
Reduces risk of pregnancy after unprotected intercourse by at least 74%
No medical contraindication (except pregnancy)
Must be within 120 hours
2 doses, 12 hours apart

17. Preven: estrogen + progestin
Plan B: progestin only

18. IUDs
Mirena
Progestasert
Paragard

19. Male Hormonal Contraception?
Most methods suppress LH/FSH and then replace testosterone
GnRH or progestin
Implants, shots, pills
Inject vas deferens with polymer
Anti-sperm compounds
Anti-sperm vaccine

20. Male Surgical Sterilization: Vasectomy
Outpatient surgical procedure
.1% failure rate
No impact on sexual functioning
No known long term health risks

21. Female Surgical Sterilization
Electrocautery
Silastic band
Cut and tie
Clip
Springs

22. Average Failure Rates (%) During the First Year of Use of a Contraceptive Method
Methods Average
NORPLANT SYSTEM 0.05
Male sterilization
Female sterilization 0.5
Depo-Provera (injectable progestogen) 0.3
Oral contraceptives 5
IUD Progesterone
Copper T 380A
Condom
(male) without spermicide 14
(female) without spermicide 21
Cervical cap Never given birth 20
Given birth 40
Diaphragm with spermicide 20
Spermicides alone 26
Periodic abstinence (all methods) 25
Withdrawal 19
No contraception (planned pregnancy) 85