Now I’m going to talk about rings and patches which are methods of hormonal contraception :
Transdermal Patch – ORTHOERVA
• Patch applied to buttocks, lower abdomen, outer arm which releases fixed amount of EE and norergrstromin every day.
• For 3 weeks patch is applied
• For 1 week after every 3 weeks, patch is not used which is known as the patch free week
• It has slightly less risk of Venous thromboembolism due to no 1st pass metabolism in liver.
NUVA rings
• It acts by inhibiting ovulation.
• It is inserted in vagina on day 1 of the cycle and is kept for 3 weeks.
• After this for 1 week it is removed known as ring free week.
• Every month a new ring is used.
• It is blue or white colored vaginal ring.
• This ring releases a fixed amount of EE and Etonorgestral everyday.
• For 3 hrs every day the ring can be removed which is known as safe period.
ANNOVERA
• It is also a ring which is inserted in vagina.
• One ring can be used for 1 year (~13 cycles).
• It releases a fixed amount of EE and Segeterone acetate everyday.
Progesterone only contraceptives:
Progesterone only pills are also known as MINIPILL. Progesterone only pills are mainly used in conditions where estrogen is contraindicated.
It’s main advantage is that it is contraception of choice in breast feeding ladies.
Earlier available Progesterone only pills had following advantages
– Cervical mucus thickening
– Altered tubal motility
– Thin endometrium (inhibits implantation)
Now available progesterone only pills i.e., CERAZETTE has additional advantage of inhibiting ovulation also.
It’s adverse effect is that it causes irregular vaginal bleeding.
It is contraindicated in breast cancer and undiagnosed vaginal bleeding.
EMERGENCY CONTRACEPTIVES:
Emergency contraception is not regular method of contraception.
Emergency contraception is used in following cases:
• Unprotected intercourse
• Rape
• Forgotten to take regular pills
• Condom slips or breaks
Forms of emergency contraception:
• Levinorgestral (most common method)
• Combined pills (not preferred due to GIT adverse effects)
• Ulipristal acetate
• IUCD
• Mifepristone
Levonorgestral Pill
• Also known as I-PILL.
• It is most common form of emergency contraceptive method.
• For this no prescription is required. It is available over counters without any prescription.
• It can be used by any woman.
• Dose – 1.5 mg (single dose)
• It is not a drug which aborts foetus (it is not abortifacient) i.e., if implantation has occurred it will not abort the established pregnancy.
• It is not a substitute of regular contraceptive devices.
• Taken as soon as possible, preferably within 72 hrs of unprotected intercourse.
• It is more effective if taken within 12-24 hrs of unprotected sex.
• It mainly acts by inhibiting ovulation
• Progesterone component also alters tubal motility and also helps in cervical mucus thickening.
• It also prevents fertilization.
• It doesn’t cause any metabolic adverse effects.
• No medical complications are reported.
Ulipristal acetate
• ELLA
• It is not available over the counter. Can be obtained only on doctor’s prescription.
• If woman is in her fertile period (midcycle) and it has been >72 hrs of unprotected sex, then ulipristal acetate is a better option.
• It is effective upto 120 hrs (5 days) after unprotected intercourse.
• Dose – 30mg
• It is selective progesterone receptor modulator.
IUCD – CuT
• It is most effective form of emergency contraception.
• It is also effective up to 5 days after unprotected sex.
• It prevents fertilization and also prevents implantation.
Contributor- Medico Eshika Keshari
