Hormonal Contraceptive Methods
Hormonal Contraceptive Methods
Hormonal Contraceptive Methods
Types of COCs
The pill comes in a packet of 21 or 28 pills. In the 28
pill packet, only the first 21 pills are active i.e. they
contains hormones.
b. Triphasic
The active pill contains three different dose
combination of oestrogen and progesterone out of a
cycle of 21 active pill. 6 might contain one combination,
5 pills contains another combination, while10 pills
contain other combination e.g. Logynon, Trinordial
ct
NB.
Low oestrogen content pill are preferred for
teenagers and women over 35years and those
with acne
c. Biphasic
The active pills in the packet contains two
different dose combination of oestrogen and
progesterone e.g.in a cycle of active pills, 10
may contain one combination while 11
contain another e.g. Biphasil
Mechanism of action
Slows done the motility of the fallopian tubes
delaying implantation
Irregular bleeding
Missed periods or no monthly periods
Ordinary headache
Nausea or dizziness
Breast tenderness
Weight changes
Mood change or changes in sex drive
Acne
NB
students to write short notes on management
of the above side effects
Danger signs of COCs
Health provider should ensure the clients is
aware of complications associated with COCs.
I. A- Abdominal pains
II. C- Chest pain or shortness of breath
III. H- Headache, frontal in nature
IV. E- Eye disturbance such us blurring or flashes
V. S- Severe calf muscle pain
Advantages of COCs
Contraceptive benefits
COCs are highly effective and are effective
immediately when started within the first five
days of the menstrual periods
COCs are safe for the majority women
COCs are easy to use
COCs can be provided by untrained non-clinical
service provider
Pelvic exam is not required to initiate use of
COCs
Non-contraceptives health benefits
Reduction of menstrual flow (lighter, shorter
periods)
Decrease in dysmenorrhoea (painful periods)
Reduction of symptoms of endometriosis
Protection against ovarian and endometrial
cancer
Possible protection from symptomatic pelvic
inflammatory diseases
Treatment for acne
Characteristic of COCs
Monophasic pill
Eugynon
oestrogen - Ethinyl-estradiol 0.05mg
Progesterone- Norgestral 0.5mg
Neogynon
Oestrogen Ethinyl-estradiol 0.05mg
progesterone levonorgestral 0.25mg
Microgynon
Oestrogen Ethinyl-estradiol 0.03mg
progesterone levonorgestral 0.15mg
Nordette
Oestrogen Ethinyl-estradiol 0.03mg
progesterone levonorgestral 0.15mg
ct
Triphasic
Logynon
6 brown Ethinyl-estradiol 0.05mg levonorgestral 0.5mg
5 white Ethinyl-estradiol 0.04mg levonorgestral 0.75mg
10 yellow Ethinyl-estradiol 0,03mg levonorgestral 0.125
Trinordial
6 brown Ethinyl-estradiol 0,03mg levonorgestral 0.5mg
5 white Ethinyl-estradiol0.04mg levonorgestral 0.75mg
10 yellow Ethinyl-estradiol 0.03mg levonorgestral 0.125
Progestin only pills(POPs)
Pops are pills that contains low doses of
synthetic progestin
Mechanism of action
The cervical mucus is thickened, which impairs
penetration by spermatozoa
Inhibits ovulation(suppression of ovulation)
Regresses endometrium(thinning of the
endometrial lining making implantation
unlikely
Types of POPs
1. Microlutte
2. Levonorgestral
3. Microval
4. Ovrette
Contraceptive benefits of POPs
• Highly effective if correctly used
• Immediate return of fertility on discontinuation
• Pelvic examination is not required to initiate use
Non-contraceptive benefits
• Does not affect breast-feeding
• Lighter, shorter periods
• Decrease in breast tenderness
ct
• Does not increase blood clotting
• Decreases dysmenorrhoea
• Protect against endometrial cancer
• Protects against benign breast disease
Those who can not use POPs
• Breast mothers less then 4wks post-partum
• Women who are pregnant or suspected of being
pregnant
• Women with abnormal unexplained vaginal bleeding
• Women with active liver problems and tumors
ct
• On concurrent drugs e.g. anti-tuberculosis, that
is Rifampicin, anti-fungal, anti-epileptic
• Women with recurrent DVT
When to initiate use of POPs
• If the woman is breastfeeding and has not
resumed her menses any time between 6wks
and 6months after child birth
• After child birth and non breastfeeding, any time
within the first 3wks
• After miscarriage within the first 7days method
can be initiated without needs for backup
ct
• Having menstrual cycle. Any time if reasonably sure that
she is not pregnant. If initiated within 5 days after
menstrual cycle, no backup method needed
Clients instruction
• POPs are usually started on the first day of menses
• Take pills daily at the same time until packet is finished
(35 days)
• After you finish the packet of mini pills, state the next
packet the next day. NEVER MISS A PILL, AND NEVER
REST in between the packet
• Take pills every day without stopping
• If you forget a pill, take it as soon as you remember and
take you next pill at the regular time
ct
• If forget to take two pills in a packet, take one pill
twice a day for 2 days, then one pill daily. But use a
backup method such as condoms and foaming tablets
• If you do not have a menstrual period within 45days
of your last periods, you should go to the clinic for
pregnancy test
• Some women get spotting, continue taking the pills
during the spotting and bleeding periods according to
your routine
• Report to the clinic immediately if any of the warning
signs are noted
Common side effects of POPs
• Irregular spotting or bleeding, frequent or infrequent bleeding
• Prolonged bleeding, amenorrhea. Bleeding changes are
common but not harmful
• Headache , dizziness, nausea
• Breast tenderness
• Mood changes
NB
ECPs do not cause abortion because they work
before implantation. Any woman who is
pregnant should not take ECPs thinking that the
pills will cause abortion
..ct..
The success of ECPS depend on knowledge,
and awareness of its availability and
efficacy prior to an unprotected,
unplanned act.
Types of ECPs
Combined oral contraceptives
Contain the hormones oestrogen and
progestin and they prevent about 75% of
expected pregnancies. Two standard
dosage options:
..ct..
50mcg oestrogen pill e.g. Eugynon. Two
tablets to be taken as soon as unprotected
intercourse , but within 120hrs. Repeat the
same dose in 12hrs. Total of four pills are
required
Standard dosage
One 750mcg levonorgestral pill to be taken as
soon as possible after unprotected intercourse,
but with 120hrs. Repeat the same dose in 12hrs.
A total of 2pills are required
..ct..
Two 750mcg levonorgestral to be taken as
soon as possible after unprotected sex, but
within 120 hours
Assignment :
Students to manage common side effects of ECPs
Medical eligibility criteria(MEC) categories
for COCs
• Women who should not use COCs includes
MEC categories 3 and 4.
Types of CICs
Provide confidentiality
Non-contraceptives health benefits
Amenorrhea. Prevent iron deficiency anaemia
III. Amenorrhoea
Description
They are small rods that are inserted under the skin of a
woman upper arm to release the hormone progestin
slowly and prevent pregnancy.
They do not contain oestrogen, therefore they are free
from side effects associated with that hormone
Mechanism of action
Make cervical mucus too thick for sperms to pass through
Suppresses ovulation
• Highly effective
Non-contraceptives
• Reduce menstrual flow
• F-Fertilization interference
• I –Implantation prevention
Who should not use IUCD
• Post partum women after 48hrs and before 4wks
• Women with puerperal sepsis or immediately post septic
abortion
• Unexplained vaginal bleeding
• Benign or malignant
• Pelvic cancer
ct
• Recurrent PID
• Congenital uterine abnormality
• Women with fibroids distorting the uterine
cavity
Warning signs
• P –Periods late
• A –Abdominal pains lower
• I –Infections
• N –Not feeling well
• S –Strings missing
Common side effects
1. Cramping pains.
Rule out PID, perforation of the uterus or
cervix or ectopic pregnancy
2.Amenorrhoea.
Do speculum and pelvic exam to check for
strings and rule out pregnancy