Hormonal Contraception Lecture Notes

Overview

• Understanding hormonal contraceptives requires knowledge of the menstrual cycle.
• Exam questions will be based on presented objectives.

Menstrual Cycle

Endometrium

• Day zero: Period begins; endometrial lining thins (bleeding).
• Day five: Bleeding slows, lining thickens (preparation for fertilized egg).

Ovary & Ovulation (Day 14)

• Egg matures and is released (ovulation) around day 14.
• Estrogen spike: Prepares uterus for fertilized egg.
• Post-ovulation: Estrogen decreases, progesterone increases.
• If no pregnancy: Progesterone decreases, endometrium sloughs off (period).

Pregnancy Rates Without Contraception

• 25% of women get pregnant after one month of unprotected intercourse.
• 85% after one year.

Methods of Preventing Pregnancy

• Types: Hormonal, chemical, physical.
• Focus: Hormonal contraceptives.

Common Hormonal Contraceptives

Oral Contraceptives (The Pill)

• Taken daily.
• Types: Combined (progestin + estrogen) and progestin-only.
  • Progestin-only: Used in breastfeeding women.
  • Combined: More effective, but estrogen-related side effects limit use for some women.
• Mechanism: Prevent ovulation, thicken cervical mucus, hinder egg implantation.
• Side effects:
  • Estrogen excess: Headaches, nausea.
  • Estrogen deficiency: Mid-cycle bleeding.
  • Progestin excess: Fatigue, acne, weight gain.
  • Progestin deficiency: Late-cycle bleeding.
• Serious side effects: Stroke, heart attack, blood clots.

Extended Cycle Products

• Active pills taken for 3-6 months, causing no periods during this time.
• Placebo pills: Reminder to maintain daily routine.

Usage

• Start options: First day of menstruation or first Sunday after.

Contraindications

• Breast cancer, smoking + age >35, pregnancy, breastfeeding (for combined pills).

Other Uses

• Acne, endometriosis, dysmenorrhea, irregular periods.

NuvaRing

• Combination hormonal contraceptive, vaginal ring.
• Inserted for 3 weeks, removed for 1 week.
• Similar mechanism and side effects as oral contraceptives, plus vaginal effects.

Depo-Provera (Progestin-Only Injection)

• Injection every 3 months.
• Side effects: Weight gain, acne, amenorrhea, decreased bone density (reversible).

Implanon (Progestin-Only Implant)

• Rod inserted under arm skin; effective for 3 years.
• No bone density loss but other progestin-related side effects.

IUDs (Intrauterine Devices)

• Types: Hormonal and non-hormonal (e.g., Paragard - copper).
• Hormonal: Mirena, Skyla, Liletta, Kyleena.
  • Progestin-only devices inserted into uterus; effective 3-5 years.
  • Side effects: Cramping, bleeding changes, ovarian cysts, rare pelvic inflammatory disease.

Emergency Contraceptives

• Plan B: Taken within 72 hours of unprotected intercourse; over-the-counter.
• Ella: Taken within 5 days; prescription only; less effective with BMI >30.
• Not for regular use.

Return to Fertility Post-Contraception

• Immediate for NuvaRing, Implanon, Plan B/Ella.
• Combination pills: 1-6 months (most within 3 months).
• Depo-Provera: Up to 1 year.

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End of Notes.