Hormonal and Surgical Contraception

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

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 0.5 Depo-Provera (injectable progestogen) 0.3 Oral contraceptives 5 IUD Progesterone 2.0 Copper T 380A 0.8 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

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

Formulations

Components through time Ethinyl Estradiol Norethindrone Levonorgestrel Desogestrel Norgestimate Gestodene

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

Advantages Reliable Convenient Discreet

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

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

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

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

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

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

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

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

Preven: estrogen + progestin Plan B: progestin only

IUDs Mirena Progestasert Paragard

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

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

Female Surgical Sterilization Electrocautery Silastic band Cut and tie Clip Springs

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 0.5 Depo-Provera (injectable progestogen) 0.3 Oral contraceptives 5 IUD Progesterone 2.0 Copper T 380A 0.8 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