Recent advances in hormonal contraceptives (1)
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Garima NagGarima Nag
RECENT ADVANCES RECENT ADVANCES IN IN
HORMONAL HORMONAL CONTRACEPTIVESCONTRACEPTIVES
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EvolutionEvolution
Decrease the side effectsDecrease the side effects
Improve effectivenessImprove effectiveness
Better complianceBetter compliance
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Since 1960, when FDA approves the first COCSince 1960, when FDA approves the first COC
– Lower dose pillsLower dose pills
– Newer progestinsNewer progestins
– Extended cycle regimensExtended cycle regimens
– Innovative delivery system Innovative delivery system
EvolutionEvolution
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Extended cycle COCExtended cycle COC
Ethinyl estradiol (0.03mg) Ethinyl estradiol (0.03mg) + + levonorgestrel (0.15mg) levonorgestrel (0.15mg) (Seasonale)(Seasonale)
FDA Approval - 2003FDA Approval - 2003 Daily for 84 days followed by hormone free pills Daily for 84 days followed by hormone free pills
for 7 days for 7 days Results in 4 withdrawal bleed/ yearResults in 4 withdrawal bleed/ year Pearl Index- 0.60 per 100 women yearsPearl Index- 0.60 per 100 women years
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BenefitsBenefits
Relief from dysmenorrhoeaRelief from dysmenorrhoea MenorrhagiaMenorrhagia Premenstrual syndromePremenstrual syndrome Iron deficiency anemiaIron deficiency anemia EndometriosisEndometriosis HeadachesHeadaches Seizure disorderSeizure disorder CoagulopathiesCoagulopathies
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Continuous useContinuous use 365 days – 20mcg EE + 90 365 days – 20mcg EE + 90
mcg levonorgestrel. (Lybrel)mcg levonorgestrel. (Lybrel) Higher patient acceptabilityHigher patient acceptability Side effects- unscheduled Side effects- unscheduled
spotting in the first 6 months.spotting in the first 6 months.
Desogestrel –only Desogestrel –only pil l(Cerazette)pil l(Cerazette)
75 mcg of desogestrel75 mcg of desogestrel wider therapeutic windowwider therapeutic window
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Hormone - releasing IUDsHormone - releasing IUDs
LNG IUD 20LNG IUD 20
Releases 20 mcg of Releases 20 mcg of levonorgestrol / daylevonorgestrol / day
Suppression of Suppression of endometrial proliferationendometrial proliferation
Pearl Index - 0.1- 0.2 / Pearl Index - 0.1- 0.2 / 100 women years100 women years
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Femilis and Femilis slimFemilis and Femilis slim
LNG containing IUDsLNG containing IUDs Releases - 14 mcg of LNG / dayReleases - 14 mcg of LNG / day Femilis slim can be use in Femilis slim can be use in
nulliparousnulliparous ““Push-in” techniquePush-in” technique Less pain, expulsion and easy Less pain, expulsion and easy
insertioninsertion
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Frameless IUDsFrameless IUDs
Contain 6 copper sleeves Contain 6 copper sleeves stung on surgical nylon stung on surgical nylon thread with knot at one thread with knot at one end end
effective for 3yrseffective for 3yrs Low rate of bleeding or Low rate of bleeding or
painpain Difficult insertion and Difficult insertion and
high expulsion ratehigh expulsion rate( Gyne-FIX, FLEXIGARD)
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Injectable ContraceptionInjectable Contraception
Progesterone 104 mg Progesterone 104 mg Subcutaneous injection; Subcutaneous injection;
slower and sustained slower and sustained absorptionabsorption
Effective for 3 mthsEffective for 3 mths Pearl Index- 0.25 per 100 Pearl Index- 0.25 per 100
women yearswomen years Approved by FDA (Dec. 2004)Approved by FDA (Dec. 2004)
DEPO- SubQ PROVERA 104
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Combined injectablesCombined injectables
Progestin Estrogen
Cyclofem-DMPA (25mg)
Estradiol cypionate (5mg)
Mesigna – norethisterone
enanthate (50mg)
Estradiol valerate(5mg)
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Given IM – every 30 daysGiven IM – every 30 days
Pearl Index – 0.2 - 0.4 / 100 women years Pearl Index – 0.2 - 0.4 / 100 women years
Lesser wt. gain & menstrual disturbances than Lesser wt. gain & menstrual disturbances than Progestogen Inj.Progestogen Inj.
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Contraceptive ImplantsContraceptive Implants
3-keto-desogestrel (etonogestrel)3-keto-desogestrel (etonogestrel) 67 mg present in single rod 67 mg present in single rod
devicedevice Placed S/C on inner side of arm Placed S/C on inner side of arm
under L.A.under L.A. Dose: 30mcg/day for 3yrsDose: 30mcg/day for 3yrs Ovulation inhibition within 8 hrsOvulation inhibition within 8 hrs
IMPLANONIMPLANON
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Advantages Disadvantages
1. Easy to use2. No estrogenic side
effects3. Immediate
postpartum4. Endometriosis, DM,
HT
1. Irregular vaginal bleeding
2. Amenorrhea3. Infection at site4. Ectopic pregnancy
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LNG or Jadelle RodLNG or Jadelle Rod
Contains 70 mg on LNGContains 70 mg on LNG
Two rod systemTwo rod system– Release at 40mcg / dayRelease at 40mcg / day– Effective for 5 yearsEffective for 5 years
Pearl Index: 0.05 / 100 women yearsPearl Index: 0.05 / 100 women years
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Contraceptive Vaginal RingContraceptive Vaginal Ring
15mcg EE + 120mcg ENG 15mcg EE + 120mcg ENG (Desogestrol) (Desogestrol)
Worn for 3 wksWorn for 3 wks Removal for 1wk (withdrawal Removal for 1wk (withdrawal
bleed)bleed) Should not be outside the Should not be outside the
vagina > 3 hrsvagina > 3 hrs
Nuva RingNuva Ring
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Advantages Side effects1. Better compliance2. Less gastrointestinal
symptoms3. Lower incidence of
estrogenic side effects
4. Less breakthrough bleeding
5. Pearl Index: 0.3 per 100 women years
1. Cost2. Headache3. Leucorrhea
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Transdermal ContraceptionTransdermal Contraception
Patch:Patch: 150 mcg norelgestromin 150 mcg norelgestromin
+ 20 mcg EE+ 20 mcg EE Applied over dry skin on Applied over dry skin on
buttocks, lower buttocks, lower abdomen, upper outer abdomen, upper outer arm, back but not on arm, back but not on breastbreast
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Can be use with regular activities- bathing, Can be use with regular activities- bathing, swimming ,workingswimming ,working
First patch – within 5 days of menstruation, First patch – within 5 days of menstruation, followed by change/3 wks each time on new followed by change/3 wks each time on new locationlocation
Skin irritation , spotting, breakthrough bleeding Skin irritation , spotting, breakthrough bleeding
Pearl Index: 0.3 per 100 women yearsPearl Index: 0.3 per 100 women years
Transdermal ContraceptionTransdermal Contraception
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Under ResearchUnder Research
LNG butonate injectableLNG butonate injectable - 5 - 10 mg LNG butonate- 5 - 10 mg LNG butonate - Effective for 3 mths - Effective for 3 mths
Progesterone receptor modulator-Progesterone receptor modulator-CDB-2914 CDB-2914
- Lacks effect on bone metabolism- Lacks effect on bone metabolism - Provide amenorrhea- Provide amenorrhea - Use as ring or IUD- Use as ring or IUD
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ST-1435 single rod implantST-1435 single rod implant– Nestorone 100mcg/dayNestorone 100mcg/day– Effective for lactating motherEffective for lactating mother– Under Phase- II trialUnder Phase- II trial
Transdermal Spray or Gel Transdermal Spray or Gel – Contain NestoroneContain Nestorone– Useful for breastfeeding womenUseful for breastfeeding women– Suppress ovulation in 83%Suppress ovulation in 83%– Under Phase-I trialUnder Phase-I trial
Under ResearchUnder Research
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ImmunocontraceptionImmunocontraception– ββ - subunit of HCG - subunit of HCG
linked with carrier- anti- linked with carrier- anti- HCG.HCG.
– Under Phase – II trialUnder Phase – II trial Others- Anti-Zona and Anti Others- Anti-Zona and Anti
sperm vaccinessperm vaccines
Male Contraception Male Contraception - testosterone- testosterone - DMPA- DMPA - cyproterone acetate- cyproterone acetate
Under ResearchUnder Research
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Family planning brings more benefits Family planning brings more benefits to more people at less cost than to more people at less cost than any other single technology now any other single technology now
available to the human raceavailable to the human race
Thank youThank you
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REFERENCESREFERENCES Practice of Fertility Control- S.K. Chaudhri.Practice of Fertility Control- S.K. Chaudhri. Obstetrics and Gynecology Clinics of Obstetrics and Gynecology Clinics of
North America ( March 2007)North America ( March 2007) Clinical Gynecologic Endocrinology – Clinical Gynecologic Endocrinology –
Leon Spreoff ( 8Leon Spreoff ( 8 thth edition) edition) William’s Obstetrics – 23William’s Obstetrics – 23 rdrd edition edition