Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 62 Birth Control

2Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Birth Control  Interfering with the reproductive process at any step from gametogenesis to nidation (implantation of a fertilized ovum)

3Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Safety  Difficult to assess  A large quantity of our data was gathered when birth control was used in higher doses than are used today  Effectiveness vs. safety

4Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Selecting a Birth Control Method  Consider:  Effectiveness  Safety  Personal preference

5Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Oral Contraceptives  Mechanism: inhibit ovulation  Classification (two main categories)  Combination oral contraceptives (OCs) Estrogen and progestin Estrogen and progestin  Progestin-only OCs  Three major subgroups of combination OCs  Monophasic  Biphasic  Triphasic

6Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Combination Oral Contraceptives (OCs): Adverse Effects  Thromboembolic disorders  Hypertension  Cancer  Teratogenic effects  Abnormal uterine bleeding  Use in pregnancy and lactation  Benign hepatic adenoma  Glucose intolerance  Other adverse effects

7Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Noncontraceptive Benefits of OCs  Decrease risks of ovarian cancer, endometrial cancer, ovarian cysts, pelvic inflammatory disease, benign breast disease, iron deficiency, anemia, and acne  Favorable effect on menstrual cycles  Reduced cramps; lighter, shorter, more predictable flow

8Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Combination Oral Contraceptives—Drug Interactions  Drugs and herbs that reduce the effects of OCs  Rifampin  Ritonavir  Antiepileptic drugs  St. John’s wort

9Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Combination Oral Contraceptives: Drug Interactions  Drugs whose effects are reduced by OCs  Warfarin  Insulin  Oral hypoglycemics  Drugs whose effects are increased by OCs  Several agents, including theophylline, tricyclic antidepressants, diazepam, and chlordiazepoxide  Drugs that elevate potassium should be avoided by patients on yasmin (Yaz)

10Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Combination Contraceptives with Novel Delivery Systems  Transdermal contraceptive patch  Vaginal contraceptive ring

11Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Long-Acting Contraceptives  Subdermal etonorgestrel implants  Depot medroxyprogesterone acetate (MPA)  Intrauterine devices  Spermicides  Barrier devices  Condoms: male and female  Diaphragm  Cervical cap

12Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Drugs for Medical Abortion  Mifepristone (RU 486) with misoprostol  Blocks uterine progesterone receptors  Adverse effects Bleeding Bleeding Cramping Cramping Nausea Nausea Vomiting Vomiting Diarrhea Diarrhea Headache Headache

13Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Drugs for Medical Abortion  Methotrexate with misoprostol  Prostaglandins: misoprostol, carboprost, dinoprostone

14Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Emergency Contraception  Contraception implemented after intercourse  Following rape, failed contraception, or failure to use contraception  Plan B  2 high-dose tablets of levonorgestrel (progestin)  1 tablet within 72 hours and another 12 hours later  Alternatives to Plan B