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Report on Hormonal method of contraception. Counseling, side effects contraindication.

It’s a method of family planning, it includes all measures, temporary or permanently designed to prevent
pregnancies/unwanted pregnancy due to coital act. Its important bcos it plays a main role in diff side as
cultural, economic, education, psychology. , it controls the unwanted preg abortions and complications.
*. Ideal contraception method should be safe, highly effective, method independent, and inexpensive and minimal
effort for supervision and maintenance as well. Factors which could be taken in to consideration before we
suggest a method: Age-menarche, menopause, pregnancy history, age of the last child, future child bearing, how
frequent sexual life, relationship with the partner, media. What to explain: Mechanism, effectiveness, side
effect, contraindication, instruction of using the method, When to change the method: if she has or afraid for
the side effect, if couple hv decided the not to hv children in the future, change of partner or partner doesn’t like
the method., lactation period is over.
Effectiveness of the method( % of failure): I. % general population,
II. Pearl index : Total failure/ accidental pregnancies per 100 women years/ months of using the method =
Total failurex 100 women years/ months used. Methods is better less failure.
Hormonal method of contraception could be oral, inject able, implants, iud+ hmnes.)
1). Oral concept. 2 methods.
(A). combined oral c.cep. pills(cocp) 13% women use.: a) synthetic estrogen+ progesterone.
Ethynilestradiol+levonegestrol(2nd gen), norethisterone(1st gen), Dezogesteol(3rd )
b) EE dosage can be higher as > 50micg( if >50micg= ENOVIT) or low dosage 30,20micg,15 on investigation.
C) pearl index 0.5(<1/1, 2). D) Mode of action: est and prog of the pill inhibit the ovulation through the
feed back system that control hypothalamus-pit—ovary functionproduction of GnRh decrease FSH and LH
decrease, endometrial proliferation, secretory phase changes, its hostile to implantation, cervix is thick and
viscous- hostile to sperm ascent and activity. E). Mode of use; a) MonophasicI . 21 tab starting 1st – 5th day
of cycle(>7 d effectiveness is less),regardless whether bleeding has stopped or not, a/f 21 days – 7 days interval
/ free of pills . during this interval withdrawal bleeding may occur. Even if doesn’t female should start the next
cycle. Pills should be taken every day(all contains the same dosage and EE and G)
b).Biphasic: 1. I pill contain the one dosage of EE and G( 40micg/25micg) 2). Next 15 pill contain another dosage
of EE G( 30,125micg)
c)Triphasic. EE G
st
1 6 pills 30 50
2nd 5 pills 40 75
next 10 pills 30 125 mic/g.
( if by forgotten take a pill must take it within 12 hrs and next day pills must be taken as wel )
F). indication – menarche age-- 45 years, G). side effects :a).EE- nausea,vomiting, headache, edema,
cloasma , b).PGN-leg cramps,weight gain,acne c)menstrual cycle effect dismenorrhea, hypomenorrhea with <30
yrs cycle control may be less .20-15micg worse cycle regulations—maybe spotting. G). Complications: F> 35
yrs smoking heavily( mortality increase), pulmonary and cerebral embolism bcos increase platelet ,plt
adhesiveness, decrease antithrobitic activity, hypertension increase angiotensin production, impaired of glu
tolerance bcos of decreased cell insulin as peripheral insulin resistant is due to PGN, increase cholestasis of preg,
increase risk of carcinoma of breast and cervix. F). contraindication: smoking f >35 yrs of age, pregnancy,
liver dis, pt with DM, HT also vascular changes, estrogen dependent tumors, long term migraine G). benefits;
menstrual cycle regulations, decrease abnormal uterine bleeding, anemia prophylaxis, decrease of dis
menorrhea, decrease of pm tension, endometrial hyperplasia treatment, decrese risk of dev. Myoma, and ovarian
cyst formations. H). Steps before prescribing combine oral contraceptive: careful history, breast palpations,
weight, BMI,BP measurement, Gynecological examination(PAP smear usually)
B). progesterone only pills/mini pills : consist of levenogestrol and must be taken ,precisely at same time
daily, 2) pearl index 1.0(1,2), 3). Advantages : can be given to breast feeding female, can be given to
hypertensive , DM, or estrogen dependent tumors. 4). Menstrual cycle changes -- break through bleeding, there
is a risk for breast and cervical cancer, specially before the birth of 1st child, amenorrhea after stopping the
pills.5) mode of action ovulation suppression mainly by blocking or decrease LH, endometrial
hypoplasia and atrophic, cervical mucosal changes which may affected or change the ability of sperms to
penetrate.
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Progesterone injections(injectables): I/M injections, depo hormones
Depot medroxyprogesterone acetate (DMPA), Depo provers 150 mg/3m/im, norethisterone 200mg/2m/ Im , 2).
Pearl index 0.25, 3). Sideffects—nausea, vomiting, increase body weight, headache. 4). Can use
endometrial hyperplasia treatment and prophylaxis can be given for breast feeding mothers, female with
DM, hypertension risk or with estrogen dependent tumors. 5). Menstrual cycle changes—with injectable
mainly amenorrhea may occur, other methods.
Progesterone subdermal implants: Norplant levonegestrol 36mg in 1 capsule .6 capsules, for 5 yrs( need to
remove after 5 yrs), not popular bcos , need trained people,surgical methods, cosmetic problem, pearlindex 0.25.
Combined monthly injections: Cyclo provera(progestin+oestradiol) not in Latvia.
Emergency contraception: after unprotected coitus during 72hrs ,effectiveness higher if used immediately
,dosages are higher. situation which may need emergency contraception if barrier method breaks during ,
coitus in violence what to use,
1). Gestagen method --Postinor:
0.75 mg Levonegestrol 1 tab immediately within 1st 72hrs) then 2nd tablet 12hrs after it.( total dosage 1.5mg)/
pearl index 1-3,, most popular cheap, easy method.( if pt. takes follicular phase -no bleeding , but if 16-18th
day bleeding can occur).
2) Yuzpe method: combine ethynil estradiol 0.1mg and levonegestrol not less than 0.5mg. combination
within 72hrs and then after 12hrs. disadvantages to calculate the amount of EE according to one pill
content.
3). Antigonadotropins- danazol(400mg 3x/12hrs), 4). Mifepristone( norethisterone derivative- anti
progesterone)- 600 mg 27th day of cycle or till 72hrs)
( side effect of emergency contraception –nausea, vomiting, irregular uterine bleeding, headache, usually no
contraindications, but female with high risk for DVT, history of migraine better use levonogestrol)
functions blocks ovulation, endometrium becomes hostile to implantation, blocks fertilization or
implantation, increased tubular peristalsis leading the ovum to migrate in to the uterine cavity before the
endometrium is receptive.

IUD:5% of female use in Latvia. 2 types:- I. CU containing—multiload CU 250,Tcu380a,375( no

indicates the weight of the CU). Plastic+CU,plastic+Ag; plastic+Ag and CU II: IUD+ Hormonal,
levenogestrel containing-50micg. IUD 1st gen( only plastic-lippes loop), 2nd gen:plastic+cu or Ag or
both- pearl index 1.5(2), 3rd –IUS( MIRENA)- 0.15(2).
Mode of action: a). mild inflammatory effect on endothelium invasion of macrophages and polymorpho
neutrophilsendometrium becomes thin.
Cervical mucous becoming thick and viscous, accent of sperm is difficult., increase tubular mortality , as a
result quick migration of fertilized ovum before endometrium becomes receptive. *IUS is used other than
for contraception also for menorrhagia and endometrial hyperplasia.
Time for insertion: During or just after menstruation, when cervix is open ,uterine cavity is enlarged and
mostly during menstruation ., following spontaneous abortion or induced abortion, 6-12wks following
delivery ( following delivery high risk for expulsion and perforation).
Side effects: pain during periods, Hypermenorrhea, PID- due to ascending infection, ectopic pregnancy
Complication: Expulsion, perforation, menorrhagia, inflammation
How to insert: length of the uterus is identified, device is loaded into an introducer which is inserted
through cervix and which will stop at level of external os. As the introducer is withdrawn deice is
extended into uterine cavity, the thread is cut leaving 3 cm out of cervix.
*. Before insertion must do a bimanual examination to check the size, shape, position of uterus.
*. Before putting check PAP, hygiene, for STD and after putting can check it by US and by speculum
weather its in the place.
Contraception—counseling: I. What kind she was, II. If not why? III. What should be used
Contraindication to use IUD—Current pregnancy, abnormal vaginal bleeding,PID in history or now ,STD ,
Multiple sexual partners.

Report on Hormonal method of contraception. Counseling, side effects and contraindication.

Report prepared by
1. Dr. Sajid Mahmood, MD (EU), Accident & Emergency Department, NHS Royal infirmary Liverpool United Kingdom.
2. Dr. Adnan Akram, MD (EU), Department of Infectious Diseases. University Hospital Riga Latvia.
3. Dr. Aftab Ahmed, MD (EU), Infection Control Department, Kaunas Medical University Clinic. Lithuania.

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