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Hormonal and Surgical Contraception Tod C. Aeby, MD John A. Burns School of Medicine Department of...

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Hormonal and Surgical Contraception Tod C. Aeby, MD John A. Burns School of Medicine Department of Obstetrics, Gynecology and Women’s Health
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Page 1: Hormonal and Surgical Contraception Tod C. Aeby, MD John A. Burns School of Medicine Department of Obstetrics, Gynecology and Women’s Health.

Hormonal and Surgical Contraception

Tod C. Aeby, MD

John A. Burns School of Medicine

Department of Obstetrics, Gynecology and Women’s Health

Page 2: Hormonal and Surgical Contraception Tod C. Aeby, MD John A. Burns School of Medicine Department of Obstetrics, Gynecology and Women’s Health.

Learning Objectives

• Combination Oral Contraceptive Pills

• Progestin Only Contraceptive Pills

• Injections and Implants

• Patches and Rings

• Emergency Contraception

• Surgical Sterilization

Page 3: Hormonal and Surgical Contraception Tod C. Aeby, MD John A. Burns School of Medicine Department of Obstetrics, Gynecology and Women’s Health.

Average Failure Rates (%) During the First Year of Use of a Contraceptive Method

Methods Average NORPLANT SYSTEM 0.05 Male sterilization 0.15 Female sterilization 0.5Depo-Provera (injectable progestogen) 0.3Oral contraceptives 5 IUD Progesterone 2.0 Copper T 380A 0.8Condom

(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

Page 4: Hormonal and Surgical Contraception Tod C. Aeby, MD John A. Burns School of Medicine Department of Obstetrics, Gynecology and Women’s Health.

Combination Oral Contraceptive Pills

• Components

• Mechanisms of Action

• Health Risks

• Non-contraceptive Benefits

Page 5: Hormonal and Surgical Contraception Tod C. Aeby, MD John A. Burns School of Medicine Department of Obstetrics, Gynecology and Women’s Health.

Formulations

Monophasicdosage constant

Triphasicestrogen and

progestin may change

sequentialsno longeravailable

Progestinand Estrogen21 active pills

+/- 7 placebo pills

Page 6: Hormonal and Surgical Contraception Tod C. Aeby, MD John A. Burns School of Medicine Department of Obstetrics, Gynecology and Women’s Health.

Components through time

• Ethinyl Estradiol

• Norethindrone• Levonorgestrel• Desogestrel• Norgestimate• Gestodene 0

20

40

60

80

100

120

140

160

1960 1980 2000

EstrogenProgestin

Page 7: Hormonal and Surgical Contraception Tod C. Aeby, MD John A. Burns School of Medicine Department of Obstetrics, Gynecology and Women’s Health.

Mechanism of Action

• Inhibition of ovulation

• Cervical mucus changes

• Endometrial changes

• Tubal motility changes

Page 8: Hormonal and Surgical Contraception Tod C. Aeby, MD John A. Burns School of Medicine Department of Obstetrics, Gynecology and Women’s Health.

Advantages

• Reliable

• Convenient

• Discreet

Page 9: Hormonal and Surgical Contraception Tod C. Aeby, MD John A. Burns School of Medicine Department of Obstetrics, Gynecology and Women’s Health.

High Dose OCP Risk

• Heart Disease

• Thromboembolic Disease (blood clots)

• Glucose intolerance (diabetes)

• Liver cysts

• Breast and Cervix Cancer?

Page 10: Hormonal and Surgical Contraception Tod C. Aeby, MD John A. Burns School of Medicine Department of Obstetrics, Gynecology and Women’s Health.

Modern Health Risks

• Slight increase in blood clot formation

• Gallbladder disease

• Heart disease in smokers over age 35

Page 11: Hormonal and Surgical Contraception Tod C. Aeby, MD John A. Burns School of Medicine Department of Obstetrics, Gynecology and Women’s Health.

Non- contraceptive Benefits

• Menstrual regulation

• Protects against cancer

• Improves acne and hirsutism

• Decreased breast and ovarian cysts

• Better sex

Page 12: Hormonal and Surgical Contraception Tod C. Aeby, MD John A. Burns School of Medicine Department of Obstetrics, Gynecology and Women’s Health.

Non- contraceptive side effects

• Nausea

• Menstrual changes (spotting, amenorrhea)

• ??weight changes??

• Minimal impact on lactation

Page 13: Hormonal and Surgical Contraception Tod C. Aeby, MD John A. Burns School of Medicine Department of Obstetrics, Gynecology and Women’s Health.

Progestin only Pill

• “The Mini Pill”

• Less cycle control (often periods stop with time)

• Slightly higher failure rate

• Fewer health risks

Page 14: Hormonal and Surgical Contraception Tod C. Aeby, MD John A. Burns School of Medicine Department of Obstetrics, Gynecology and Women’s Health.

Depo Provera

• 150 mg shot every 12 weeks

• Progestin only side effect profile

• Duration unpredictable

Page 15: Hormonal and Surgical Contraception Tod C. Aeby, MD John A. Burns School of Medicine Department of Obstetrics, Gynecology and Women’s Health.

Norplant

• Levonorgesterel• Surgically implanted

and removed• Good for 5 years• Same side effects as

other progestin only methods

Page 16: Hormonal and Surgical Contraception Tod C. Aeby, MD John A. Burns School of Medicine Department of Obstetrics, Gynecology and Women’s Health.

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

Page 17: Hormonal and Surgical Contraception Tod C. Aeby, MD John A. Burns School of Medicine Department of Obstetrics, Gynecology and Women’s Health.

• Preven: estrogen + progestin

• Plan B: progestin only

Page 18: Hormonal and Surgical Contraception Tod C. Aeby, MD John A. Burns School of Medicine Department of Obstetrics, Gynecology and Women’s Health.

IUDs

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Mirena Progestasert Paragard

Page 19: Hormonal and Surgical Contraception Tod C. Aeby, MD John A. Burns School of Medicine Department of Obstetrics, Gynecology and Women’s Health.

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

Page 20: Hormonal and Surgical Contraception Tod C. Aeby, MD John A. Burns School of Medicine Department of Obstetrics, Gynecology and Women’s Health.

Male Surgical Sterilization: Vasectomy

• Outpatient surgical procedure

• .1% failure rate• No impact on sexual

functioning• No known long term

health risks

Page 21: Hormonal and Surgical Contraception Tod C. Aeby, MD John A. Burns School of Medicine Department of Obstetrics, Gynecology and Women’s Health.

Female Surgical Sterilization

• Electrocautery• Silastic band• Cut and tie• Clip• Springs

Page 22: Hormonal and Surgical Contraception Tod C. Aeby, MD John A. Burns School of Medicine Department of Obstetrics, Gynecology and Women’s Health.

Average Failure Rates (%) During the First Year of Use of a Contraceptive Method

Methods Average NORPLANT SYSTEM 0.05 Male sterilization 0.15 Female sterilization 0.5Depo-Provera (injectable progestogen) 0.3 Oral contraceptives 5 IUD Progesterone 2.0 Copper T 380A 0.8Condom

(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


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