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Life Table analysis – calculates failure rate for each month of use of
contraceptive method. It is a good method for comparing various
methods for specific length of time.
Long term contraception is any method that can be used for a month and
above.
Types of contraceptive methods
• Hormonal methods
• Intrauterine conceptive device
• barrier method
• Natural/traditional method
hormonal method of contraception
• Combined oral contraceptive pill
- Contains synthetic oestrogen and progesterone
• Dosage composition of oral contraceptive pill
Synthetic oestrogen:
Ethinyl oestradiol – 20; 30; 35; and 50mcg or mestranol – 50mcg
Synthetic progesterone:
1st generation:
Norethindrone, others – norethynodrel, ethynodiol diacetate, norethindrone enanthate,
norethindrone acetate (all convert to norethindrone before their activity).
2nd generation:
Norethisterone – 0.5; 1.0; and 1.5mg or levonogestrel – 0.15
and 0.25mg (i.e. norgestrel and levonorgestrel) levonorgestrel is the biologically active form.
3rd generation:
Gestodene – 0.075mg; desogestrel – 0.15mg or norgestimate
0.25mg.( where designed to enhance progestational activity and reduce androgenicity by
increasing biologic selectivity).
Low dose pill contain 30-35mcg
• COC pill for 21 days with pill free interval of 7
day or the 28 day pill usually with 7 day
placebo
Side effects
• Increased incidence of irregular menstrual
bleeding.(20% discontinue POP)
Indications for POP Relative contraindications
contraindication to oestrogen • Severe obesity –
CVD; migraine; DM; mild HT. reduced efficacy and
aggravate wt gain
smoking; obesity; family hx of
• Breast cancer
arterial dz
• Severe hypertension
Breastfeeding women • Chronic liver disease
• Molar pregnancy until
Contraindications to POP urine is free of hCG
Absolute contraindications • Hx of recurrent ovarian
cyst.
• Pregnancy – high dose
androgenic progestogen (NET-
EN) may masculinize a female
fetus
• Undiagnosed genital bleeding
• Current cardiovascular dz
Side effect of POP
• High incidence of Long term effect of POP
functional ovarian cyst • DMPA protects against
• Irregular vag bleeding endometrial carcinoma;
• Headache; nausea; may also protect against
bloating; breast ovarian cancer (no data)
tenderness; mood • The risk of breast cancer
change is increased after 5yr of
• Oily skin & acne – with use, but after 5yr of non-
the more androgenic use, the risk become
levonorgestrel and same with that in non-
norethisterone users
Injectable Progest Only method
• Norethisterone • Mode of action – due to
oenanthate (NET-EN) high dose, inhibit
Warm before it can be ovulation
drawn up for After 1yr of injectable use
administration. • 80% - ammenorrhea or scanty
menses
Dose – i.m 200mg x 8 week • 2% - menorrhagia which may be
• Depot Rx temporary with oestrogen
(COC)
medroxyprogestrone
acetate (DMPA) – 150mg
x 12 week
New injectables
• Cyclofem (HRP-112) – 25mg
medroxyprogestone acetate +
oestradiol cypionate 5mg
• Mesygina (HRP) – 50mg NET-EN
+ oestradiol valerate 5mg
Side effects of injectable
• Delayed return of fertility after stoppage –
may be up to 1yr
• Abnormal vag bleeding may continue after
stopping method
• Weight gain
• Reduced bone mineral density – reversible
Progestogen only implants
Non-biodegradable implants
• Norplant – long acting hormonal method, comprised 6 flexible
silastic caps – 3.4cm x 2.4mm and contains 36mg of
levonorgestrel
Usually inserted subdermally by minor surgery, in the inner aspect
of the non-dominant arm. 70-80mcg---12months
Norplant releases 30-35mcg /24hr after 18months
• Highly effective----2nd year----30—40mcg
• Last for 5years
• Fertility returns rapidly after removal (serum levonorgestrel clear within 120hrs of
removal)
• Low failure rate
Draw back
• It is expensive
• Menstrual disturbance – ammenorrhea; menorrhagia (50%
discontinue for this reason) worse during 1 year of use, thereafter improves
st
• Persistent ovarian follicle; headache (10-30%); weight gain; acne; hair loss hirsuitism; mood change
Norplant II (Jadelle) – 2 silastic rods, same 36mg of levonogestrel as well as
release rate, advantages – easy insertion and removal