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Contraception and Contraception and antifertilityantifertility

Renata VeselaRenata Vesela

renata.vesela@pharm.gu.serenata.vesela@pharm.gu.se

Methods:Methods:

HormonalHormonal Natural methodsNatural methods Barrier methodsBarrier methods Chemical methodsChemical methods Intrauterine device (IUD)Intrauterine device (IUD) SterilizationSterilization CondomCondom

HormonalHormonal Three main mechanisms of action:Three main mechanisms of action:

1. inhibition of ovulation1. inhibition of ovulation2. thickening of cervical mucus 2. thickening of cervical mucus 3. an alteration of the endometrium 3. an alteration of the endometrium

Progestins (gestoden, desogestrel,…) Progestins (gestoden, desogestrel,…) and estrogens (ethinylestradiol or and estrogens (ethinylestradiol or mestranol)mestranol)

Mono-phaseMono-phase CombinedCombined

HormonalHormonal

Effects of progestin:Effects of progestin: Inhibition of ovulation by suppressing Inhibition of ovulation by suppressing

luteinizing hormone (LH) luteinizing hormone (LH) Thickening of cervical mucus, thus Thickening of cervical mucus, thus

hampering the transport of sperm hampering the transport of sperm Possible inhibition of sperm capacitation Possible inhibition of sperm capacitation

Effects of estrogen:Effects of estrogen: Alteration of secretions and cellular Alteration of secretions and cellular

structures of the endometrium within the structures of the endometrium within the uterus uterus

Hormonal- types:Hormonal- types: OralOral

Monthly injectionMonthly injection

Transdermal patchTransdermal patch

Vaginal ring Vaginal ring (the hormones are (the hormones are absorbed by the vagina)absorbed by the vagina)

Hormonal- progestin onlyHormonal- progestin only

Oral: Mini-pill, exact same time of pill Oral: Mini-pill, exact same time of pill administration requiredadministration required

Injection: Injection: Emergency contraception (morning Emergency contraception (morning

“after” pill)- usually progestin only, but “after” pill)- usually progestin only, but can be also a combinationcan be also a combination

Natural methodsNatural methods

Intermittent Intermittent intercourseintercourse

Counting of fertile Counting of fertile and infertile daysand infertile days

Control of the mucusControl of the mucus Method of sexual Method of sexual

abstinenceabstinence Measuring of basal Measuring of basal

temperaturetemperature

Barrier methodsBarrier methods

Vaginal diaphragmVaginal diaphragm

Cervical capCervical cap

Chemical methodsChemical methods

Spermicide gels, creams and foamsSpermicide gels, creams and foams Mechanism: inserted into a woman's Mechanism: inserted into a woman's

vagina to kill or disable sperm thus vagina to kill or disable sperm thus preventing a sperm from fertilizing an egg preventing a sperm from fertilizing an egg

Intrauterine device (IUD)Intrauterine device (IUD) Mechanism of action: two types: a copper IUD Mechanism of action: two types: a copper IUD

progestin-impregnated progestin intrauterine progestin-impregnated progestin intrauterine system (IUS)system (IUS)

have multiple mechanisms of action that have multiple mechanisms of action that provide for contraceptive protectionprovide for contraceptive protection

Both IUDs can alter the uterine lining so that it Both IUDs can alter the uterine lining so that it becomes unfavorable for implantationbecomes unfavorable for implantation

Release of copper ions- alters fluid in the Release of copper ions- alters fluid in the uterine cavity in a manner that impairs the uterine cavity in a manner that impairs the viability of sperm, thereby inhibiting fertilization. viability of sperm, thereby inhibiting fertilization. This mechanism may be responsible for the This mechanism may be responsible for the high efficacy of copper IUDs as emergency high efficacy of copper IUDs as emergency contraception. contraception.

Intrauterine device (IUD)Intrauterine device (IUD)

Female sterilizationFemale sterilization

Male sterilizationMale sterilization

CondomsCondoms

Usually made from latexUsually made from latex Protection against Sexually Transmitted Protection against Sexually Transmitted

DiseasesDiseases (STDs)!!!(STDs)!!!

Thank you for your attentionThank you for your attention

Pictures adapted from: Pictures adapted from: http://www.google.se/imgres?imgurl=http://www.mhhe.com/socscience/sex/http://www.google.se/imgres?imgurl=http://www.mhhe.com/socscience/sex/common/ibank/ibank/0117.jpg&imgrefurl=http://www.mhhe.com/socscience/sex/common/ibank/ibank/0117.jpg&imgrefurl=http://www.mhhe.com/socscience/sex/common/ibank/set-6.htm&usg=__EClGEzM73xP3fSc-common/ibank/set-6.htm&usg=__EClGEzM73xP3fSc-0rIo8vdXxic=&h=480&w=640&sz=86&hl=sv&start=5&itbs=1&tbnid=a0aI3AdHdKS0rIo8vdXxic=&h=480&w=640&sz=86&hl=sv&start=5&itbs=1&tbnid=a0aI3AdHdKSReM:&tbnh=103&tbnw=137&prev=/images%3Fq%3Dvaginal%2Bdiaphragm%26hlReM:&tbnh=103&tbnw=137&prev=/images%3Fq%3Dvaginal%2Bdiaphragm%26hl%3Dsv%26sa%3DG%26gbv%3D2%26tbs%3Disch:1%3Dsv%26sa%3DG%26gbv%3D2%26tbs%3Disch:1