Hormonal and Surgical Contraception Tod C. Aeby, MD John A. Burns School of Medicine Department of...
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Hormonal and Surgical Contraception
Tod C. Aeby, MD
John A. Burns School of Medicine
Department of Obstetrics, Gynecology and Women’s Health
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Learning Objectives
• Combination Oral Contraceptive Pills
• Progestin Only Contraceptive Pills
• Injections and Implants
• Patches and Rings
• Emergency Contraception
• Surgical Sterilization
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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 0.5Depo-Provera (injectable progestogen) 0.3Oral contraceptives 5 IUD Progesterone 2.0 Copper T 380A 0.8Condom
(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
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Combination Oral Contraceptive Pills
• Components
• Mechanisms of Action
• Health Risks
• Non-contraceptive Benefits
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Formulations
Monophasicdosage constant
Triphasicestrogen and
progestin may change
sequentialsno longeravailable
Progestinand Estrogen21 active pills
+/- 7 placebo pills
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Components through time
• Ethinyl Estradiol
• Norethindrone• Levonorgestrel• Desogestrel• Norgestimate• Gestodene 0
20
40
60
80
100
120
140
160
1960 1980 2000
EstrogenProgestin
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Mechanism of Action
• Inhibition of ovulation
• Cervical mucus changes
• Endometrial changes
• Tubal motility changes
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Advantages
• Reliable
• Convenient
• Discreet
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High Dose OCP Risk
• Heart Disease
• Thromboembolic Disease (blood clots)
• Glucose intolerance (diabetes)
• Liver cysts
• Breast and Cervix Cancer?
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Modern Health Risks
• Slight increase in blood clot formation
• Gallbladder disease
• Heart disease in smokers over age 35
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Non- contraceptive Benefits
• Menstrual regulation
• Protects against cancer
• Improves acne and hirsutism
• Decreased breast and ovarian cysts
• Better sex
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Non- contraceptive side effects
• Nausea
• Menstrual changes (spotting, amenorrhea)
• ??weight changes??
• Minimal impact on lactation
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Progestin only Pill
• “The Mini Pill”
• Less cycle control (often periods stop with time)
• Slightly higher failure rate
• Fewer health risks
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Depo Provera
• 150 mg shot every 12 weeks
• Progestin only side effect profile
• Duration unpredictable
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Norplant
• Levonorgesterel• Surgically implanted
and removed• Good for 5 years• Same side effects as
other progestin only methods
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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
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• Preven: estrogen + progestin
• Plan B: progestin only
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IUDs
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Mirena Progestasert Paragard
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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
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Male Surgical Sterilization: Vasectomy
• Outpatient surgical procedure
• .1% failure rate• No impact on sexual
functioning• No known long term
health risks
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Female Surgical Sterilization
• Electrocautery• Silastic band• Cut and tie• Clip• Springs
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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 0.5Depo-Provera (injectable progestogen) 0.3 Oral contraceptives 5 IUD Progesterone 2.0 Copper T 380A 0.8Condom
(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