Contraceptives

Definition: Drugs or derives which are used to avoid unwanted contraception are called contraceptives.

Characteristics of ideal contraceptives:

1)      Highly effective.

2)      Safe.

3)      Effect should be quick in onset.

4)      Available.

5)      Acceptable.

6)      Inexpensive.

7)      Comletely & totaly,quickly reversible.

Composition of oral contraceptive pill:

[A]OCP:     

1)      Synthetic oestrogen→Ethenyl estradiol or Mestranol(It is a prodrug.It is converted to EE in the liver.It may produce hepatoma)

2)      Progesterone→Levonogestril,Desogestril

[B]POP:Progesteron only pill(Minipill)    

        

Adverse effects of oral  contraceptive pills:

[A]Major:

1.Cardiovascular effects	OCP causes increased risk of a)      Thromboembolism. b)      Coronary artery disease. c)      Atherosclerosis. d)     HTN.
2.Metabolic effects	↓HDL. ↑Cholesterol ↑LDL
3.Hepatic effects	Ca of liver.Chloestatic jandice.
4.Psychological effects	Depression-due to lack of vit
5.Supress lactation
6.Neoplasia	Fibro-adenoma of breast Fibroid uterus

[B]Minor:

1)      Nausea,Vomiting.

2)      Headache.

3)      Leg crump.

4)      Wt gain.

5)      Break through.

6)      Hypomenorrhoea.

7)      Amenorrhoea.

8)      Menorrhagea.

Contraindications of OCP:

Absolute	Relative	Special prcaution
1.History of CVS disease. 2.Liver disease(ch Hepatitis) 3.Breast cancer	1.HTN. 2.Obesity. 3.Migraine. 4.Endogenous smoking. 5.Heavy smoking.	1.DM. 2.Collagen disease. 3.Osteosclerosis. 4.Sever varicose Veins. 5.Sickle cell disease. 6.Surgical operation. 7.History of depression. 8.Age over 35 years.

Advantages of OCP:

1)      Disease risk of:

·         Benign breast disease.

·         Fibroadenoma of breast.

·         Endometriosis.

·         PID.

·         Iron deficiency anaemia.

2)      ↓risk of ectopic pregnancy.

3)      Prevention of dysmenorrhoea.

4)      Relief of premenstrual tension.

Therapeutic indication of oral pill:

1)      Menstrual irregularity (3month)

2)      Endometriosis-most effective treatment is pregnancy.

Indication of Progesterone:

1)      Disorder of menstruation & ovulation:

·         Amenorrhoea.

·         DUB.

·         Spasmodic dysmenorrhoea.

·         Premenstrual syndrome.

2)      Conceptioin & pregnency:

·         Contraception.

·         Infertility

3)      Endometriosis.

4)      Hormone replacement therapy.

5)      Pelvic cancer.

6)      Breast condition.