hormonal contraceptives - 2 M.S.SOUNDHARRAJAN

OTHER TYPES : 1.INJECTABLES 2.IMPLANTS 3.VAGINAL RINGS 4.TRANSDERMAL CONTRACEPTIVE PATCH

INJECTABLES :CLASSIFICATIONPROGESTERONE CONTAINING injectables :1.DEPOT MEDROXYPROGESTERONE ACETATE:

◦ - DOSE: 150mg IM every 3 months (microcrystal aqus.suspn)◦ - given within first 7 days of menstrual cycle

SIDE EFFECTS:1st 3 months – irregular bleeding , prolonged bleedingat 1 year - amenorrhea ,infrequent bleeding , irregular

bleeding

2.NORETHINDRONE ENANTHATE: - 200 mg IM every 2 months

SIDE EFFECTS: Weight gain , Abdominal bloating and discomfort

Headache , Mood changes , less sex drive, Loss of bone density

Dizziness

ADVANTAGES OF PROGESTERONE ONLY INJECTABLES :Its long acting, reversible method

DMPA is least androgenic

Side effects of lipids and carbohydrate metabolism are low

Suited to lactating women

Avoids estrogenic side effects

Incidence of PID, ECTOPIC PREGNANCY, FUNCTIONAL OVARIAN CYST , ENDOMETRIAL CANCER are low

ESTROGEN AND PROGESTRONE CONTAINING INJECTABLES :

CYCLO-PROVERA or CYCLOFEM

◦ 25mg DMPA & 5mg estradiol cypionate◦ Once a month ,deep IM

ADVANTAGES :

Less menstrual irregularitiesEasily reversible

MESIGYNA :50mg NET +5mg estradiol valerate

IMPLANTS Subdermal drug delivery system ADV: - long acting , reversible, progesterone only TYPES OF IMPLANTS 1.Norplant – has 6 rods 2.Jadella & Norplant 2 – has 2 rods 3.Implanon – has 1 rod

NORPLANT DOSAGE:

Contains 6 capsules or rodsEach containing 36mg of levonorgestrel (totally 216 mg)Length – 34mm , 2.4mmg diameterDuration – 5 years

Under LA ,medial aspect of upper arm , capsule has to be removed

NORPLANT -2 (Jadelle) DOSAGE:

◦ 75 mg of levonorgestrel◦ Has two rods, each of length 43mm & 2.5mm in

diameter◦ Inserted on medial aspect of upper arm

ADVANTAGE : Easy to administer than norplant1

IMPLANON Long acting single rod subdermal implant Length – 4 cm ,2mm diameter

DOSAGE: 68mg of crystalline etonogetrel in ethylene vinyl acetate copolymer

DURATION : 3 years

Effects are reversible with in a month of removal

ADVANTAGES :

Long acting sustainable contraceptive Low systemic side effects Can be used by lactating mothers

DISADVANTAGES :

Ectopic pregnancy- 1.3% Local infection EXPENSIVE Has to insert & remove the capsules

CONTRACEPTIVE VAGINAL RINGS They were tried and abandoned. TYPES: Combined progesterone estrogen rings, progesterone ring, 3- keto desogestrel rings DOSE: 120 microgram of etonogestrel & 15 micrograms of ethinyl estriol DURATION : Used for 3 weeks with one week gap

CONTRACEPTIVE VAGINAL RINGS

TRANSDERMAL CONTRACEPTIVE PATCH DOSAGE : 150 micrograms of progestogen norelgestromin + 20 micrograms of ethinyl estriol. DURATION : 7 Days. FAILURE RATE :0.7 PER 100 Woman years. ADVERSE EFFECTS : nausea and/or vomiting , application site reaction , breast discomfort, engorgement or pain , headache , and emotional liability , spotting ,breakthrough bleeding.

RECENT ADVANCES UNDER DEVELOPMENT

VACCINES :

Research is on to produce vaccines which can be manufactured at relatively low cost with long lasting reversible contraceptive effects

Vaccines researched at present :

Anti HCG vaccine

Anti zona – pellucida vaccine

Anti sperm vaccine

OTHER METHODS UNDER DEVELOPMENT : Gene therapy , Regulatory peptides