NEWER
CONTRACEPTIVES
Introduction
Contraception is the need of the hour
To control the galloping horse of population
To improve maternal and fetal mortality and
morbidity rates
To improve quality of life and raise standard of
living
Contraceptive choices
Natural
Barrier
Hormonal
IUCD
• Sterilization
• Male contraception
Advances in contraceptive
methods
Newer choices in contraception offers a wider
range of methods to choose from
Most advances are in newer drugs[steroids]
formulation with lesser side effects, more
acceptability
Different steroid delivery systems
Female condoms,
newer IUCD designs
• Modern easily reversible methods of sterilization
Barrier methods
Female condoms ( Reality condom ) :
- polyurethane pouch 15 cm long
- Internal ring covers the cervix
- outer ring covers the vulva
- effective protection for STI
- efficacy similar to diaphragm ( 21% as
used commonly , 5% when used
correctly )
Female Condom
Barrier methods
3 new types to reduce cost :
1. FC 2 condom – made of latex
2. VA feminine condom – sponge instead of
ring
3. PATH woman’s condom – dissolving
capsule
IUD
LNG 20 (Mirena)
- Polyethylene T frame surrounded by a
levonorgestrel-containing cylinder. The cylinder
is covered with a rate-controlling membrane. -
contains 52 mg LNG releasing 20mcg /d
- effective for 5 years
- failure rate < 0.5 per 100 women-years
- reduces menstrual blood loss
- insertion can be difficult due to thickness of
device
IUD
Frameless devices
( GyneFix /Cu Fix IUD )
- contains 6 Cu sleeves 330sq mm strung
on a nylon thread knotted at upper end
- It is inserted by a special stylet and the
knot is burried 9-10 mm into the
myometrium of the fundus
- Failure rate same as Cu-T 380A
Cu Safe T 300 IUD
Has a T-shaped radio-opaque plastic body
The ends of the flexible transverse arms are inwardly
bent providing a non-irritating,
fundus-seeking mechanism
Copper wires are would on the vertical stem of the
device
Has one monofilament tail
Push-in insertion
5 year life
Suitable for use as emergency contraception
OCPs
Newer Progestogen : Drospirenone
( Yasmin : 0.03 mcg EE & 3 mg DRSP )
Spironolactone analogue with anti-
mineralocorticoid activity
Anti-androgenic activity
Lessens acne, seborrhea and hirsutism
Effective in treatment of PMS / PCOD
Does not cause wt gain
Extended - use OCP
Seasonale
Seasonale is a fixed combination, extended cycle OCP
with a 91-day cycle. Seasonale contains 84 hormonally
active pills and 7 placebo pills.
Continuous use for 12 wks followed by withdrawal bleed
( 4 times/yr)
It contains 30 micrograms of EE and 150 micrograms of
LNG in each active pill.
Women who take Seasonale may have breakthrough
bleeding and spotting in the first year
Combined Injectable contraceptives
Cyclofem : DMPA 25 mg
Estradiol Cypionate 5 mg
every 28-30 days
Mesigna : Norethindrone 50 mg
Estradiol Valerate 5 mg
Transdermal contraception
Ortho Evra patch
4.45cmX4.45cm (20 sq cm)
1 patch per week x 3 ; 1st patch applied within
first 5 days of menstruation
Application at discrete areas( outer arms / torso /
lower abd except breasts)
Releases 20 mcg of EE & 150 mcg
Norelgestromin/day
Transdermal Contraception
Vaginal steroid contraception
NuvaRing
54 mm diameter & 4mm thick
Releases 15 mcg of EE & 120 mcg of
Etonogestrel / day
Used for 3 weeks and removed for 1 wk during
which withdrawl bleeding occurs
Failure rate same as OCPs
May be combined with Barrier/Spermicides
Vaginal Ring
Contraceptive implants
Implanon
Single Rod 40 mm long & 2mm in diameter
Contains 67mg Etonorgestrel releasing
30mcg/d for 3 years
Low androgenic effect
Easier insertion by a pre-loaded syringe on inner
side of upper arm s.c.
Prompt return of fertility as against injectables
Menstrual irregularity common as with other long
term progestogen use
Implanon
Norplant
Sterilization techniques
Essure
Hysteroscopic placement of polyester
bearing coils that evoke sterile fibroblastic
reaction resulting in tubal occlusion
HSG after 3 months to confirm
Effective in 85-90%
Can be performed in the OPD without
analgesia/anaesthesia
THANK YOU
