counselling – ocp's

8/10/2019 Counselling OCP's

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Dr.Anant khot

Counselling OCP's


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Contraceptive Methods

Oral steroidal contraceptives

Injected steroidal contraceptives

Intrauterine devices

Transdermal and transvaginal steroidal

contraceptives

Physical, chemical, or barrier techniques

Sexual abstinence around the time of

ovulation

Breast feeding

Permanent sterilization


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Hormonal contraceptives

Types of Hormonal Contraceptives:

Oral:

i. Combination Oral Contraceptives

ii. Progestin-Only Contraceptives

iii. Phased regimens

iv. Postcoital (emergency) contraception

Injectable

1) Long acting progestin alone

2) Long acting progestin+ long acting


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Phased regimens

Formulations may be :

1. Monophasic (each tablet contains a fixed

amount of estrogen and progestin);

2. Biphasic(each tablet contains a fixed amountof estrogen, while the amount of progestin

increases in the second half of the cycle); or

3. Triphasic(the amount of estrogen may be fixed

or variable, while the amount of progestinincreases in 3 equal phases).


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MECHANISM OF ACTION

The contraceptive actions of COCs aremultiple

Most important effect is toprevent ovulation

by suppression of hypothalamic gonadotropin-releasing factors, which in turn prevents

pituitary secretion of FSH & LH

Estrogen suppresses FSH release & stabilizes

the endometrium to prevent metrorrhagia


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Progestins inhibit ovulation by suppressing

LH, they thicken cervical mucus to retard

sperm passage, & they render the

endometrium unfavorable for implantation.

Transit of sperm, the egg, and fertilized

ovum are important to establish pregnancy,

and steroids are likely to affect transport inthe fallopian tube.


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Table 5-6 Some Benefits of Combination Estrogen Plus Progestin Oral

Contraceptives

Increased bone density

Reduced menstrual blood loss and anemia

Decreased risk of ectopic pregnancy

Improved dysmenorrhea from endometriosis

Fewer premenstrual complaints

Decreased risk of endometrial and ovarian cancer

Reduction in various benign breast diseases

Inhibition of hirsutism progression

Improvement of acne

Prevention of atherogenesis

Decreased incidence and severity of acute salpingitis

Decreased activity of rheumatoid arthritis


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1. < 6 weeks postpartum if breastfeeding

2. Smoker over the age of 35 ( 15 cigarettes per day)3. Hypertension (systolic 160mm Hg or diastolic 100mm

Hg)

4. Current or past history of venous thromboembolism (VTE)

5. Ischemic heart disease6. History of cerebrovascular accident

7. Complicated valvular heart disease

8. Migraine headache with focal neurological symptoms

9. Breast cancer (current)10. Diabetes with retinopathy/nephropathy/neuropathy

11. Severe cirrhosis

12. Liver tumor (adenoma or hepatoma)

ABSOLUTE

CONTRAINDICATIONS


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Relative contraindications

1. Smoker over the age of 35 (< 15 cigarettes perday)

2. Adequately controlled hypertension

3. Hypertension (systolic 140159mm Hg,

diastolic 90

99mm Hg)4. Migraine headache over the age of 35

5. Currently symptomatic gallbladder disease

6. Mild cirrhosis

7. History of combined OC-related Cholestasis8. Users of medications that may interfere with

combined OC metabolism


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Emergency contraception

LNG 0.5 mg+ EE 0.1mg-2 tabs takenimmediately and at 12 hrs

LNG 0.75 mg twice

Mifepristone-600mg single dose

Copper-Containing Intrauterine

Devices

Ulipristal aceate


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Con tracept ion du r ing Lactat ion

Use of combination OCs generally is notadvised during lactation because they reduce

the amount and quality of breast milk

Combination OCs can be used after 6 weeks,once milk production is established.

Progestin-only OCs, implants, and injectable

contraception do not affect milk quality orquantity

FDA- progestin-only OCs can be started 2 to 3

days postpartum, DMPA or implants at 6 wks


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counselling – ocp's

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