contraceptives

Progestin Only Contraceptives

• Types: Pills, implants, injectables, IUDs

• Mechanism of Action (MOA):

  • Thicken cervical mucus

  • Slow tubal motility

  • Cause atrophy of endometrium

  • Suppress LH surge

Progestin Only Pill (POP)

• Efficacy:

  • Perfect Use: 0.3% failure rate

  • Typical Use: 9% failure rate

• Examples: Norethindrone, Norgestrel, Drospirenone

• Advantages:

  • Immediate fertility return

  • Positive effects on menstrual cycles

  • Safe during breastfeeding

  • Suitable when estrogen contraindicated

• Disadvantages:

  • Irregular menses

  • Strict compliance required

Injectable Contraceptives

• Efficacy:

  • Perfect Use: 0.2% failure rate

  • Typical Use: 6% failure rate

• Example: Depot medroxyprogesterone acetate (DMPA)

• Advantages:

  • Improved compliance

  • Safe for breastfeeding

  • Efficacy not affected by obesity

• Disadvantages:

  • Delayed fertility return (9-12 months)

  • Requires periodic visits

Implantable Contraceptives

• Efficacy:

  • Perfect Use: 0.05% failure rate

  • Typical Use: 0.3% failure rate

• Example: Etonogestrel (Nexplanon)

• Advantages:

  • High efficacy

  • Quick return to fertility

• Disadvantages:

  • Unpredictable bleeding

Progestin IUDs

• Efficacy:

  • Perfect Use: 0.2% failure rate

  • Typical Use: 0.2% failure rate

• Examples: Mirena, Kyleena, Skyla

• Advantages: Same as implants

• Disadvantages: Same as implants

Progestin Only Contraindications

• Absolute Contraindications: Breast cancer

• Relative Contraindications: Severe hepatic disease

Emergency Contraception

• Prevents pregnancy post unprotected intercourse

• Methods:

  • Emergency contraceptive pills (ECP), Copper IUD

• Levonorgestrel (Plan B):

  • 1.5 mg, effective within 72 hours, OTC

  • Efficacy: 1.1-2.4% failure rate

• Ulipristal (Ella):

  • 30 mg, effective within 120 hours, prescription only

  • Efficacy: 2% failure rate

• Copper IUD: Most effective, 0.04-0.19% failure rate

Non-Hormonal Contraceptives

• Methods:

  • Male/female condoms, spermicide, sponge, cervical cap, diaphragm, Copper IUD, sterilization, natural family planning

• Spermicides:

  • Nonoxynol-9: 28% failure rate

  • Phexxi: 13.7% failure rate

• Non-Hormonal IUD:

  • Copper IUD (ParaGard), 0.6% perfect use, lasts 10 years

  • Advantages: Hormone-free, cost-effective, quick fertility return

  • Disadvantages: May cause heavy bleeding and cramping

Contraindications for Non-Hormonal IUD

• Absolute Contraindications:

  • Cervical/endometrial cancer, current PID/STI

• Relative Contraindications: None.