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contraceptives
This is a mind map about contraceptives, Main content: Emergency Contraception, Chemical Male Contraception, hormonal contraceptives, Barrier Methods, Intrauterine Devices (IUDs), Sterilization.
Edited at 2025-06-16 19:06:48
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contraceptives
Emergency Contraception
within 72 hrs. of unprotected intercourse (99%)
POP : Levonorgestrel Plan B One-Step ,one pill or plan B : 2 pills (one mini-pill every 12 h) COC : PREVEN - Two does each of two pills of Levonorgestrel and Ethinyl estradiol,separated by 12 hours.
Ulipristal Acetate (UPA): - Selective progesterone receptor modulator PRM with high affinity binding to progesterone receptor. Mechanism of action: like POP - Major : Inhibition of ovulation. - Secondary : Impair implantation through an effect on the endometrium. - A single dose no later than 120 h (5 days) after intercourse.
Mifepristone:(luteolytic effect+ abortification) Mifepristone on day One + Misoprostol on Day 3.
Chemical Male Contraception
No oral contraceptives yet
Hormonal
Weekly testosterone inj+ daily levonorgestrel pills -->azoospermia
Non-Hormonal (expermintal)
Gossypol : - spermatogenesis inhibitor, discontinued. - destroy elements of the seminiferous epithelium but does not alter the endocrine function of the testis.
Ca² Channel Blockers, HC-056456 - targeting Catsper channe which is Essential for the hyperactivity of sperm flagellum.
hormonal contraceptives
Combined Estrogen-Progestin Contraceptives
Oral COC
The estrogen = Ethinyl estradiol ,Few preparations contain Mestranol The progestin = Norethisterone Levonorgestrel Ethynodiol - The newer compounds Desogestrel or Gestodene - More potent,Have less androgenic action,Cause less change in lipoprotein metabolism. - COC pills can be either 21 day(all active) or 28 day pills(7 inactive).
Monophasic
Pills have the same amount of estrogen and progestin (norethindrone)
Low dose pills: Have the least amount of estrogen(20 mcg)
Regular dose pills: average amount of estrogen (30-35 mcg)
High dose pills: high amount of estrogen (50 mcg)
Biphasic
same amount of estrogen but to memic the menstrual cycle physiology, after 10 to 14 days, progesterone levels are increased
Triphasic
- Across 3 phases progestin increases while estrogen may stay steady or adjust slightly. - More similar to normal physiology
Mech
Estrogen: Inhibits the release of FSH (suppresses the development of the ovarian follicle). Progestin : Inhibits the release of LH (prevents ovulation). + Thickened the cervical mucus. Together: - They alter the endometrium in such a way as to discourage implantation. - They also interfere with coordinated contractions of cervix, uterus and fallopian tubes (importent for fertilization).
side effects
contraindications
Transdermal patches
- Norelgestromin + Ethinyl estradiol. -buttocks, lower abdomen, upper torso (excluding the breasts), upper arm. - changed every week for 3 weeks followed by a hormone free week. - Similar in efficacy to COC - Less effective in women who weigh >90 kg Adverse effects: -Similar to those of COC pills but with more frequent breast discomfort, dysmenorrhea, nausea and vomiting. -Skin irritation at the application site.
Vaginal Contraceptive Ring
- Etonogestrel + Ethinyl estradiol. -Inserted from the 1st-5 th day of menstruation - Left in the vagina for 21 days with 7 days free period. _Efficacy is similar to that of COC pill with less reported: nausea,acne, irritability and depression Advantages: - Excellent cycle control. - Rapid return to fertility after removal Adverse effect: - Device related discomfort. - Headaches. - Vaginal discharge
Mech
Side effects
-contraindecated with lactation (should not be initiated unless after 6 weeks postpartume )
Progestin-Only Contraceptives
-Oral -taken daily without interuption (28 days )
Norethisterone Levonorgestrel Ethynodiol
IM
-Depot Medroxyprogesterone Acetate (DMPA). -every 3 months.
Side Effects: - Irregular bleeding. - Amenorrhea : The return of fertility can be delayed for 6 18 months (median 10 months) after the last injection. - Weight gain - headache - decreases in bone density (osteoporosis).
Long term DMPA use: -Reduces menstrual blood loss -Decreased risk of endometrial cancer
Implants
Levonorgestrel Implant: -Six flexible, nonbiodegradable polymeric silicone capsules. - Effective for 5 years. Side effects: - Irregular menstrual bleeding - Headache dizziness, bloating . -Weight gain of 1-2 kg. -Reversible reduction of glucose tolerance.(reversible drug-induced diabetes) Advantages: - Long term = continuous contraception. - Fertility return within the first month after the removal of the capsules(excpet DMPA)
Etonogestrel Implant -Non bio-degradble -Effective for 3 years - side eefects and advantages same as levenorgestrel.
Mech
- Major : Thickening of the cervical mucus - Secondary : Hinders implantation through: =its effect on the endometrium(become thinner). = slowes down the motility of fallopian tubes. = change composition of uterus secretions (less supportive for implantation) .
Advantages:
-for whom estrogen administration is undesirable: Patients with hepatic disease, hypertension, psychosis or mental retardation, prior thromboembolism. - Recommended for breastfeeding women.
Barrier Methods
Condoms: - Prevent both pregnancy and STIs( HIV). Male Condoms: - Latex - polyurethane, lamb intestine= for latex sensitivity. -Lamb condoms do not protect against viral infection. - Polyurethane condoms --> break = less effective comp to latex Female condoms - Improved coverage of the external genitalia = better protection against STIs. - They can be used with either an oil or water based lubricant.
Diaphragms and Cervical Caps: - Used + spermicide. Diaphragms: -placed over the cervix 6 hours before intercourse and should not be removed for 6 hours afterward. - Should not be left in place for >24 hours (toxic shock syndrome ,TSS= staphylococcus) - require Spermicide reapplication each intercourse Cervical caps: - can be left in place for up to 48 hours - No need for additional spermicide with repeated intercourse. - Protective effects against HIV or other STIs is unclear
Sponge:(nonoxynol-9) _ It is moistened in water and placed over the cervix - Effective immediately and up to 24 hrs - Should remain in place for 6 hours after the intercourse. - It should be removed after 24-30 hours (TSS). - Inferior to diaphragms in both effectiveness and adherence.
Spermicides: Nonoxynol-9 (foam, film, gel,cream, suppository, tablet). - used in the vagina no more than 1 hour before intercourse and reapplied before each intercourse - Suppositories, films and tablets need to dissolve in order to be effective. - Nonoxynol may prevent some STIs but No protective effect against HIV. - Frequent use may increase the transmission of HIV ( due to irritation)
Intrauterine Devices (IUDs)
Non-Hormonal
The ParaGard T380A: - Copper containing device (copper is spermicidal). - Effective for 10 years. - In a small number of women. effective for up to 15 20 years Adverse Effects Heavy bleeding and cramping.
Hormonal
The Mirena device: - Levonorgestrel (progesten). - FDA approved for 5 years contraception. - Shown to be effective for up to 7 years.
Benefits of IUD
- No adherence is required. - Long term contraception. - Fertility is restored as soon as they are removed. - Mirena markedly decreases blood loss from menses - FDA approved for treatment of menorrhagia and dysmenorrhea.
Adverse Effects
Mirena IUD increases irregular bleeding in the first 3-6 months after placement, but reduces total bleeding after that - Increased incidence of ovarian cysts (Mirena). - IUD associated infection mainly related to insertion.
Sterilization
Female: Abdominally: sergary to remove fallopian tubes Hysteroscopically - Involve placing devices into the fallopian tubes that result, after several months, in tubal occlusion. - Essure and Adriana (Adriana is discontinued)
Male: Vasectomy.