CONTRACEPTION AND ITS METHODS

DEFINITION OF CONTRACEPTION:-

Contraception is also known as birth control. It is designed to obstruct the pregnancy by causing the interruption with the normal physiological processes of ovulation, fertilization & implantation.

METHODS OF CONTRACEPTION:-

There are several methods of contraception such as,

1. Barrier methods (diaphragms, cervical cap, condom and sponge)

2. Short acting hormonal method (mini pills, injection, pills, vaginal ring and patch)

3. Long acting reversible contraceptive method (contraceptive implants and intrauterine devices)

4. Male and female Sterilization (male vasectomy and female tubal occlusion or ligation)

5. Natural rhythm methods (avoiding sexual intercourse)

                    BARRIER METHODS:-

·        CONDOM:-It is the only type of contraception which protects against lots of sexually transmitted diseases and also prevents the pregnancy. It acts like a physical barrier by preventing the sexual fluids to pass between the peoples during the sexual intercourse.

·        DIAPHRAGM:-It is a small and soft silicon dome structure, which is used to stop the entrance of sperm in the uterus by placing it inside the vagina.

·        CERVICAL CAP:-It is the deep silicon cup which is placed inside the vagina and fits over the cervix tightly. It is also used to prevent the entrance of sperm within the uterus. This cup is reusable.

       

·        SPONGE:-It is a soft, small and disk shaped structure, it contains spermicide by killing or blocking the sperms and prevent the entry of sperm within the uterus.

      ii.            SHORT ACTING HORMONAL METHODS:-

       MINI PILL:-It is one of the all birth control pills. It contains only progestin hormone and it works by thinning the uteral lining, thickens the cervical mucus and also suppresses the ovulation.

·        PILLS:-These contraceptive pills mostly are the “combination pills” (means containing mixture of both estrogen and progesterone hormones). These pills are used to prevent ovulation, thicken the mucous and also used to thinning the uterus wall.

·        INJECTION:-It is a shot which contains hormones, either a combination of progestin and estrogen or only a progestin alone.

·        PATCH:-It is also the form of contraception and it contains both progestin and estrogen hormones. It is applied on the skin and works similarly like the contraceptive pills.

·        VAGINAL RING:-It is a circular, flexible device which is placed inside the vagina, where it releases hormones and these hormones through vaginal wall move into the bloodstream. These hormones are useful to prevent pregnancy.

    iii.            LONG ACTING REVERSIBLE CONTRACEPTIVE METHODS:-

·        CONTRACEPTIVE IMPLANTS:-It is a small, flexible and plastic rod which is placed under the skin of upper arm, where it slowly releases appropriate amount of progesterone hormone to prevent pregnancy.

·        INTRA-UTERINE DEVICE (IUD):-It is a small sized object, which is placed inside the uterus. It is of 2 types, copper IUD (contains copper) and hormonal IUD (contains hormone progesterone). It prevents fertilization and implantation.

    iv.            MALE AND FEMALE STERILIZATION:-

·        MALE VASECTOMY:-Vasectomy is a type of male contraception, which occurs by blocking or cutting the tubes (vas deferens) that carry sperm.

·        TUBAL LIGATION:-It is also known as tubal sterilization. It occurs in female. In this type of contraception, fallopian tubes are tied, cut or blocked to prevent pregnancy permanently.

ORAL CONTRACEPTIVE DRUGS:-

In oral contraceptive drugs, estrogen and progestin hormones are used.

Estrogen medications are the ‘Ethinylestradiol-30micrograms’ and ‘Mestranol-50micrograms’.

Progesterone medications are the ‘Norethindrone-1mg’, ‘Norethindrone acetate-5mg’, ‘Norgestimate-0.180mg’, ‘Desogestrel-150micrograms’ , ‘Norgestrel-0.5mg’ and ‘Levonorgestrel-150 micrograms’.

Different types of oral contraceptive pills are found:-

·        Combined pills

·        Progestin only pills

·        Postcoital (Emergency) pills.

1.      COMBINED PILLS:-These contraceptive combined pills, containing both synthetic (men made) estrogen and progestin hormones. These pills are more effective in temporary contraception.

There are different types of combined contraceptive pills exist.

·        Monophasic pills

·        Biphasic pills

·        Triphasic pills

a)      MONOPHASIC PILLS:-These pills contain fixed amount of estrogen and progestin hormones in each hormonally active pill which is given throughout the cycle.

For example:-Brevicon (ethinylestradiol and norethindrone)

                        Previfem (ethinylestradiol and norgestimate)

DOSING SCHEDULE:-Monophasic pills are available in both 21 days pill pack and 28 days pill pack. In both conditions, these pills have same amount of hormones (estrogen and progestin) for 21 days.

·        If women taking 21 day formulation so she would take active hormones for 21 days and followed by 1 week in which she will not take any pill.

·        If women taking 28 day formulation so she would also take the active hormones for 21 days ₊  placebo pills for 7 days.

USES:-

1.      These pills are used to prevent pregnancy.

2.       Used by some other women who have polycystic ovary syndrome (PCOS) so these pills regulate their menstrual cycles.

3.      Also helpful in improving the symptoms of menstrual cycles, like lightening of bleeding, reducing pain and cramps and easing the premenstrual syndrome (PMS).

ADVERSE EFFECTS:-Adverse effects of monophasic pills are;

1.      Bleeding or spotting between the periods.

2.      Depression / mood changes.

3.      Possible weight gain

4.      Breast tenderness

5.      Nausea

These monophasic pills can also cause some serious and dangerous medical conditions like;

1.      Severe abdominal or chest pain.

2.      Swelling or pain in the legs.

3.      Severe headache

4.      Blurred vision

These symptoms could be the signal of blood clot presence due to which heart attack or stroke can occur.

b)      BIPHASIC PILLS:-These pills have fixed amount of estrogen but progestin amount varies according to the phases of menstrual cycle.

For example:-Amethia Lo (ethinylestradiol and levonorgestrel extended – cycle)

                        Azurette (ethinylestradiol and desogestrol)

                        Lo Seasonique (ethinylestradiol and levonorgestrel)

DOSING SCHEDULE:-If any woman is using biphasic 21 day schedule, so she would take one strength (color) pills for 7 or 10 days (first phase). After that in (second phase) she would take medicines of other strength (color) for next 11 or 14 days. So in this woman has taken 21 tablets. But for biphasic 28 days schedule, she would also take extra 7 inactive tablets (3^rd color).

USES:-Due to increase in the biphasic pills doses over the cycle reduces the occurrence of bleeding and spotting and also the occurrence of amenorrhea which is associated with the utilization of low dosed monophasic combined drug.

ADVERSE EFFECTS:-Biphasic contraceptive pills are less effective as compared to monophasic contraceptive pills in pregnancy prevention. These biphasic pills cause more side effects and poorly control the cycle and also have less continuation rates.

   

c)      TRIPHASIC PILLS:-The amount of estrogen may be constant or variable but the quantity of progestin increases equally in 3 phases.

For examples:-TriNessa (ethinylestradiol and norgestimate)

                        Enpresse (ethinylestradiol and levonorgestrel)

                        Caziant (ethinylestradiol and desogestrel)

DOSING SCHEDULE:-If any woman is using triphasic 21 days schedule, so she would take one strength (color) pills for 5, 6 or 7 days (first phase). After that in (second phase) she would take medicines of second strength (color) for next 5, 7 or 9 days. And then in (3^rd phase) she would take 3^rd strength (color) pills for next 5, 7, 9 or 10 days. So in this way woman has taken 21 tablets. But for triphasic 28 days schedule, she would also take extra 7 inactive tablets (4^th color).

USES:-

·        These triphasic pills are useful in the prevention of pregnancy.

·        It decreases the chances of ovarian cyst development and also helps in the regulation of menstrual cycle.

·        It also improves acne problems.

ADVERSE EFFECTS:-These pills can develop different breast problems, dysmenorrhea, water retention & premenstrual syndrome along with irritability. And also causes headache and nervousness.

2.      PROGESTIN PILL ONLY:-This pill contains progestin only without estrogen and also known as minipill.

For example:-Micronor (norethindrone-0.35mg)

                        Norgest (norgestrel-0.075mg)

DOSING SCHEDULE:-Take one pill daily without any gap.

USES:-These pills are good for those women who cannot take estrogen due to health issues or other reasons. And also decrease the dysmenorrheal, menstrual blood loss and premenstrual syndrome symptoms.

ADVERSE EFFECTS:-These pills can also cause some side effects like, acne, mood changes, breast enlargement and tenderness, headache and vomiting.

3.      EMERGENCY CONTRACEPTIVE PILLS:-These pills are also known as “The Morning After Pill”. These are more effective and safe pills, after unprotected sex.

For example:-Postinor-1 (levonorgestrel-0.75mg)

                        EllaOne (ulipristal acetate-30mg)

DOSING SCHEDULE:-Take 2 doses of levonorgestrel-0.75mg in every 12 hours within 72 hours of unprotected sexual intercourse. OR take single dose of ulipristal acetate-30mg, within 72 hours after intercourse.

USES:-

·        These pills are used to prevent the unwanted pregnancy.

·        Reduce the blood loss and prevent anemia.

·        Prevent endometrial and ovarian carcinomas.

ADVERSE EFFECTS:-

·        Gall stones

·        Headache

·        Nausea and vomiting

·        Genital carcinoma

·        Weight gain

INJECTABLE CONTRACEPTIVE DRUGS:-

DMPA (Depot Medroxyprogesterone Acetate) is the contraceptive injection and it is similar to the progesterone hormone that is produced by the ovaries within the body.

Depo-provera is the brand name of DMPA.

DOSING SCHEDULE:-Contraceptive injection can be injected into the muscles of upper arm or buttock. It is mostly given first five days of menstrual cycle.

USES:-

It inhibits the ovulation.

·        It decreases the risk of ovarian and endometrial carcinomas.

·        It does not contain estrogen so can be taken by those women who cannot take estrogen.

·        It is also safe and effective for breastfeeding mothers.

ADVERSE EFFECTS:-

·        It causes rapid and irregular menstrual bleeding.

·        Amenorrhea

·        Spotting

·        Depression

·        Weight gain

TOPICAL CONTRACEPTIVE PATCH:-

The contraceptive patch is applied on the clean area of upper arm, shoulder, abdomen or buttock. It is less effective on 90kgs woman.

For example:-Ortho Evra (norelgestromin/ethinylestradiol)

DOSING SCHEDULE:-The (Ortho Evra) patch is applied each week for 3 weeks (21 days). But on the 4^th week, patch is not applied, during this time withdrawal bleeding is expected.

USES:-

·        This patch can easily use to prevent the pregnancy.

·        It also improves the acne problems.

·        Making the periods lighter and regular.

·        And relieve the menstrual cramps.

ADVERSE EFFECTS:-

·        Breast pain

·        Nausea, vomiting

·        Menstrual cramps

·        Headaches

·        Skin irritation

·        Spotting

·        And can cause blood clotting problems.

CONTRACEPTIVE IMPLANTS:-

It is the long-term contraception option for the women. It is small, matchstick like rod which is implanted under the skin of upper arm. It releases low and accurate dose to prevent the pregnancy.

For example:-Nexplanon (etonogestrel implant).

DOSING SCHEDULE:-This contraceptive implant is implanted between the 1^st day (menstrual bleeding) and 5^th day (menstrual cycle), even if the woman is still bleeding.

USES:-

·        It is the effective method to get the contraception.

·        It prevents pregnancy for 3 years.

·        If the implant is removed, fertility can be reversed.

·        It is good for that woman who cannot take estrogen.

ADVERSE EFFECTS:-

·        It causes weight gain, nausea, ovarian cyst and breast pain etc.

·        It does not provide protection against sexually transmitted diseases.

·        This technique is very costly.

·        Require a doctor for insertion.