Contraception

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Contraception

• Barbora kubešová

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Contraception

• Techniques to prevent pregnancy
• - family planning
• - population control
• Pearl index number of pregnancies
• --------------------------------------------------
  ---x 100
• number of couples using
• the method

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Methods used by the female

• Barriers (diafragm, cervical cap, femidom)
• Chemical (pessaries, creams, foams, vaginal
  globules, medicated spongies)
• IUD inert, with metall, with progestin
• Hormonal - combined oral, emergency pill
• (high dose oestrogen with progesteron),
• mini-pill (progesteron only)
• - injectable hormones
  progestin
• - implantable hormones-
  progestin
• - transdermal patches
  

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A/ Mirena LNG-IUS B/Nova C/Multiload D/Ort
hogynae T
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Mechanism of action COC

• Inhibition of ovulation (E)
• Changes of cervical mucos (P)
• Changes of contractility of smooth muscles of
  genital organs (P)
• Modifications of endometrium (P)

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Hormonal contraception Estrogen-
ethinylestradiol Gestagen-gestagens I
generation (mestrano)
gestagens II generation
(NES) - gestagens III generation
(desogestrel, gestoden,norgestimate,
levonorgestrel)

-gestagens IV generation (drospirenon)
Monophasic, biphasic, triphasic Examination
before COC Anamnesis, gynaecol.examonation
(colposcopy and cytology, blood pressure,
(biochemic examination), genetic examination in
risk group of women (hypercoagulation Leiden
mutation)
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Absolute contraindications of COC -pregnancy,
six weeks after delivery -trombembolism (include
in  anamnesis) - Leiden mutation -hypertension
(160/100 and more) -liver disease (acute
hepatitis, liver tumores,cirhosis) -hormonal
dependent tumors -breast cancer (first 5 years
after treatment) Relative contraindications -
age over 35 years nicotinism -ischaemic
coronary disease, stroke, congenital coronary
disease -migraine
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Advantages COC -high effective and reversibile
prevention of pregnancy (Pearl index 0.1-0.2
) -prevention GEU -decrease of number inflamatory
pelvic disease (barierre for infections) -regulati
on of menstrual disorders, less blood lost
during menstruation (prevention of
anemia) -endometriosis decrease of
algomenorrhoea -positive influance into
dysmenorrhoea and premenstrual syndrom -
influance into hyperandrogenic effect acne,
hirsutism, PCO (gestagens
with antiandrogenic effect) -positive influance
into osteoporosis -decrease number of benign
mastopathy and ovarian cysts -reduction incidence
of endometrial cancer
-reduction ovarian cancer (about 50 )-
inhibition of ovulation -decrease of incidence
colorectal cancer
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• Negative effects (adverse effects)
• - tromboembolism (nicotinism !!) , estrogens
  increase blood coagulation
• and trombocytes adhesivity
• - increase body weight (retence of fluid)
• - mastodynia (estrogen)
• hypertension (nonsignificant and reversibile)
• hedeache, ophtalmologic symptoms lower
  tolerance for contact lens
• epilepsia
• - depresion, changes of libido
• - increase risk of cardiovascular diseases (age,
  blood pressure, nicotinism)
• - hepatocelular adenoma (today very rare, in
  pasture Mestranol)
• COC dont increase the risk of breast cancer and
  cervical cancer

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Gestagen only contraception Forms
tablets (Exluton, Cerazette ), implants
(Implanon), IUD(Mirena),

injectable (Depo-Provera) Disadvantages
comonner irregular bleedind or spotting,
higher Pearl index For
during lactation , contraindication of combin
COC The only absolut contraindication breast
cancer ( 5 years after treatment)
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Emergency postcoital contraception Estrogen-pr
ogestagen ( EE 0.1 mg LNG 0.5 mg until
72 hour after
coitus., the same dose after 12
hod.) Minisiston 4 tbl 4 tbl High dose of
gestagens ( LNG 0.75 1 mg in 1hour)- Postinor l
tbl., event. Postinor 2x1 tbl á 12 hod in 72
hod.
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Rizika CC