Garima NagGarima Nag

RECENT ADVANCES RECENT ADVANCES IN IN

HORMONAL HORMONAL CONTRACEPTIVESCONTRACEPTIVES

EvolutionEvolution

Decrease the side effectsDecrease the side effects

Improve effectivenessImprove effectiveness

Better complianceBetter compliance

Since 1960, when FDA approves the first COCSince 1960, when FDA approves the first COC

– Lower dose pillsLower dose pills

– Newer progestinsNewer progestins

– Extended cycle regimensExtended cycle regimens

– Innovative delivery system Innovative delivery system

EvolutionEvolution

Extended cycle COCExtended cycle COC

Ethinyl estradiol (0.03mg) Ethinyl estradiol (0.03mg) + + levonorgestrel (0.15mg) levonorgestrel (0.15mg) (Seasonale)(Seasonale)

FDA Approval - 2003FDA Approval - 2003 Daily for 84 days followed by hormone free pills Daily for 84 days followed by hormone free pills

for 7 days for 7 days Results in 4 withdrawal bleed/ yearResults in 4 withdrawal bleed/ year Pearl Index- 0.60 per 100 women yearsPearl Index- 0.60 per 100 women years

BenefitsBenefits

Relief from dysmenorrhoeaRelief from dysmenorrhoea MenorrhagiaMenorrhagia Premenstrual syndromePremenstrual syndrome Iron deficiency anemiaIron deficiency anemia EndometriosisEndometriosis HeadachesHeadaches Seizure disorderSeizure disorder CoagulopathiesCoagulopathies

Continuous useContinuous use 365 days – 20mcg EE + 90 365 days – 20mcg EE + 90

mcg levonorgestrel. (Lybrel)mcg levonorgestrel. (Lybrel) Higher patient acceptabilityHigher patient acceptability Side effects- unscheduled Side effects- unscheduled

spotting in the first 6 months.spotting in the first 6 months.

Desogestrel –only Desogestrel –only pil l(Cerazette)pil l(Cerazette)

75 mcg of desogestrel75 mcg of desogestrel wider therapeutic windowwider therapeutic window

Hormone - releasing IUDsHormone - releasing IUDs

LNG IUD 20LNG IUD 20

Releases 20 mcg of Releases 20 mcg of levonorgestrol / daylevonorgestrol / day

Suppression of Suppression of endometrial proliferationendometrial proliferation

Pearl Index - 0.1- 0.2 / Pearl Index - 0.1- 0.2 / 100 women years100 women years

Femilis and Femilis slimFemilis and Femilis slim

LNG containing IUDsLNG containing IUDs Releases - 14 mcg of LNG / dayReleases - 14 mcg of LNG / day Femilis slim can be use in Femilis slim can be use in

nulliparousnulliparous ““Push-in” techniquePush-in” technique Less pain, expulsion and easy Less pain, expulsion and easy

insertioninsertion

Frameless IUDsFrameless IUDs

Contain 6 copper sleeves Contain 6 copper sleeves stung on surgical nylon stung on surgical nylon thread with knot at one thread with knot at one end end

effective for 3yrseffective for 3yrs Low rate of bleeding or Low rate of bleeding or

painpain Difficult insertion and Difficult insertion and

high expulsion ratehigh expulsion rate( Gyne-FIX, FLEXIGARD)

Injectable ContraceptionInjectable Contraception

Progesterone 104 mg Progesterone 104 mg Subcutaneous injection; Subcutaneous injection;

slower and sustained slower and sustained absorptionabsorption

Effective for 3 mthsEffective for 3 mths Pearl Index- 0.25 per 100 Pearl Index- 0.25 per 100

women yearswomen years Approved by FDA (Dec. 2004)Approved by FDA (Dec. 2004)

DEPO- SubQ PROVERA 104

Combined injectablesCombined injectables

Progestin Estrogen

Cyclofem-DMPA (25mg)

Estradiol cypionate (5mg)

Mesigna – norethisterone

enanthate (50mg)

Estradiol valerate(5mg)

Given IM – every 30 daysGiven IM – every 30 days

Pearl Index – 0.2 - 0.4 / 100 women years Pearl Index – 0.2 - 0.4 / 100 women years

Lesser wt. gain & menstrual disturbances than Lesser wt. gain & menstrual disturbances than Progestogen Inj.Progestogen Inj.

Contraceptive ImplantsContraceptive Implants

3-keto-desogestrel (etonogestrel)3-keto-desogestrel (etonogestrel) 67 mg present in single rod 67 mg present in single rod

devicedevice Placed S/C on inner side of arm Placed S/C on inner side of arm

under L.A.under L.A. Dose: 30mcg/day for 3yrsDose: 30mcg/day for 3yrs Ovulation inhibition within 8 hrsOvulation inhibition within 8 hrs

IMPLANONIMPLANON

Advantages Disadvantages

1. Easy to use2. No estrogenic side

effects3. Immediate

postpartum4. Endometriosis, DM,

HT

1. Irregular vaginal bleeding

2. Amenorrhea3. Infection at site4. Ectopic pregnancy

LNG or Jadelle RodLNG or Jadelle Rod

Contains 70 mg on LNGContains 70 mg on LNG

Two rod systemTwo rod system– Release at 40mcg / dayRelease at 40mcg / day– Effective for 5 yearsEffective for 5 years

Pearl Index: 0.05 / 100 women yearsPearl Index: 0.05 / 100 women years

Contraceptive Vaginal RingContraceptive Vaginal Ring

15mcg EE + 120mcg ENG 15mcg EE + 120mcg ENG (Desogestrol) (Desogestrol)

Worn for 3 wksWorn for 3 wks Removal for 1wk (withdrawal Removal for 1wk (withdrawal

bleed)bleed) Should not be outside the Should not be outside the

vagina > 3 hrsvagina > 3 hrs

Nuva RingNuva Ring

Advantages Side effects1. Better compliance2. Less gastrointestinal

symptoms3. Lower incidence of

estrogenic side effects

4. Less breakthrough bleeding

5. Pearl Index: 0.3 per 100 women years

1. Cost2. Headache3. Leucorrhea

Transdermal ContraceptionTransdermal Contraception

Patch:Patch: 150 mcg norelgestromin 150 mcg norelgestromin

+ 20 mcg EE+ 20 mcg EE Applied over dry skin on Applied over dry skin on

buttocks, lower buttocks, lower abdomen, upper outer abdomen, upper outer arm, back but not on arm, back but not on breastbreast

Can be use with regular activities- bathing, Can be use with regular activities- bathing, swimming ,workingswimming ,working

First patch – within 5 days of menstruation, First patch – within 5 days of menstruation, followed by change/3 wks each time on new followed by change/3 wks each time on new locationlocation

Skin irritation , spotting, breakthrough bleeding Skin irritation , spotting, breakthrough bleeding

Pearl Index: 0.3 per 100 women yearsPearl Index: 0.3 per 100 women years

Transdermal ContraceptionTransdermal Contraception

Under ResearchUnder Research

LNG butonate injectableLNG butonate injectable - 5 - 10 mg LNG butonate- 5 - 10 mg LNG butonate - Effective for 3 mths - Effective for 3 mths

Progesterone receptor modulator-Progesterone receptor modulator-CDB-2914 CDB-2914

- Lacks effect on bone metabolism- Lacks effect on bone metabolism - Provide amenorrhea- Provide amenorrhea - Use as ring or IUD- Use as ring or IUD

ST-1435 single rod implantST-1435 single rod implant– Nestorone 100mcg/dayNestorone 100mcg/day– Effective for lactating motherEffective for lactating mother– Under Phase- II trialUnder Phase- II trial

Transdermal Spray or Gel Transdermal Spray or Gel – Contain NestoroneContain Nestorone– Useful for breastfeeding womenUseful for breastfeeding women– Suppress ovulation in 83%Suppress ovulation in 83%– Under Phase-I trialUnder Phase-I trial

Under ResearchUnder Research

ImmunocontraceptionImmunocontraception– ββ - subunit of HCG - subunit of HCG

linked with carrier- anti- linked with carrier- anti- HCG.HCG.

– Under Phase – II trialUnder Phase – II trial Others- Anti-Zona and Anti Others- Anti-Zona and Anti

sperm vaccinessperm vaccines

Male Contraception Male Contraception - testosterone- testosterone - DMPA- DMPA - cyproterone acetate- cyproterone acetate

Under ResearchUnder Research

Family planning brings more benefits Family planning brings more benefits to more people at less cost than to more people at less cost than any other single technology now any other single technology now

available to the human raceavailable to the human race

Thank youThank you

REFERENCESREFERENCES Practice of Fertility Control- S.K. Chaudhri.Practice of Fertility Control- S.K. Chaudhri. Obstetrics and Gynecology Clinics of Obstetrics and Gynecology Clinics of

North America ( March 2007)North America ( March 2007) Clinical Gynecologic Endocrinology – Clinical Gynecologic Endocrinology –

Leon Spreoff ( 8Leon Spreoff ( 8 thth edition) edition) William’s Obstetrics – 23William’s Obstetrics – 23 rdrd edition edition