Transcript Progestin-Only Pills

Prevention and
management of side
effects
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Found that too early, frequent and late
childbirth and abortion is one of the major
causes of maternal and perinatal
mortality. Often this is the result of
contraceptive failure, and in most cases,
lack of access to reproductive health
services. For forming healthy families and
improve the reproductive health needs to
rational use of modern contraceptives in
view of individual selection.
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Progestin-only pills containing progestin only (POC)
Types:
• Progestin-Only Pills (POP, the "mini-pill" esklyuton)
Pack of 35 tablets: 300mcgs or 350 mcg
levonorgestrelnorethindrone
Pack of 28 tablets 75 mg nopgestrel
• Progestogen injection (POIC)
DMPA (Depo-Provera): 150 mg of depotmedroxyprogesterone acetate, is injected every 3 months
NET-EN (Noristerat): 200 mg norethindroneenantant,
injected every 2 months
• Subcutaneous implants: Norplant 6 thin flexible
capsules filled with levonorgestrel, Implanon 1 capsule for
3 years.
• IUD: releasing progesterone and levonorgestrel
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Mechanism of action of POCs
• Amendment to the endometrium, making it
difficult for implantation (severity appears as
duration of use of the drug)
• thickening of the cervical mucus,
preventing sperm penetration
• suppression of ovulation (POIC)
POC Rules of admission
• At any time when there is confidence in the
absence of pregnancy;
• C1-th to the 7 th day of the menstrual
cycle;
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• After the birth:
- After 6 months, if it uses the lactational
amenorrhea method (LAM)
- After 6 weeks if breastfeeding, but
should not be LAM
- Immediately or within 6 weeks if not
breastfeeding
• Post-abortion (immediately or within 7 days)
• Packaging POP contains 28 active pills of the
same color, they must be used every day,
regardless of onset of menstruation (ie not
recommended weekly intervals, as in the COC).
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Explains how to use poc
IMPORTANT: every day take one pill every day
continuously. If a woman is not breastfeeding, it
is best to take one pill every day at the same
time. Even if a woman takes a pill a few hours
later than usual time, it increases the risk of
pregnancy. Pass two or more pills in a row
greatly increases the risk of pregnancy.
• Start a new package:
After over a package, strictly for the next day
to take the first pill from a new package. All
tablets are active, ie hormonal. Tablet-free
interval between packages is not done.
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Instructions in case if a woman forgets to take one
or more pills:
• It should take one tablet as soon as you remember, and
then continue taking one tablet every day, as usual, and
for the next 2 days to use a backup method of
contraception.
• breast-feeding woman using POP as a backup method,
will remain protected against pregnancy, even if she misses
a pill.
• If it has been more than 3 hours from the time when a
woman had to take a pill, and yet she is not breastfeeding
or breast-feeding, but it resumed menstruation, in the next
48 hours to either abstain from sex or use condoms or
spermicide. It should take the missed tablet as soon as
possible and then continue one tablet every day, as usual
How to inject Necessary medical
equipment and supplies:
 • One dose of DMPA (150 mg)
 • antiseptic solution and cotton wool
 • Injection of 2 or 5 ml and a needle for
intramuscular injection 21-23 size.
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Sequencing
1. Wash your hands and wash your hands and put on clean gloves
2. If necessary, clean the suspected injection with soap and water
and wipe it with antiseptic (if any) in a circular motion in the
direction of the injection to the periphery.
 3. Slightly (but not too much so as not to form foam) Shake
with DMPA use, wipe the top of the cork and antiseptic syringe
and dial the desired dose.
 4. Deeply enter a sterile needle into the top of the shoulder
(deltoid) or buttock (in the upper outer square of the gluteus
maximus), pull back the Porsche syringe to make sure that did
not get into the vessel, it may lead to a too rapid absorption of
DMPA. If caught in a vessel puncture to do elsewhere. Enter the
contents of the syringe.
 5. Do not massage the injection site. Tell the patient that you
can not massage or rub the injection site. Explain that this can
result in too rapid absorption of DMPA.
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Requiring the use of POCs:
• Women of any reproductive age and with any number of pregnancies in the history who
wish to avoid pregnancy
• nursing mothers;
• Patients after abortion
• Women over 35 years who are at risk of cardiovascular disease in the absence of
estrogen component;
• Women who want a highly effective method of oral contraception, but can not tolerate
the side effects of COCs;
• patients with a history of anemia.
• Women with moderate to severe menstrual pain
• Women smokers
• Women with a high BP
• Women with cerebrovascular disease;
• with long flowing diabetes;
Advantages POC:
• Effective immediately (<24 hours), if taken at the same time every day (POP);
• Before using the pelvic examination is not required (except for the progestin IUD)
• Do not interfere with intercourse
• Return of fertility after discontinuation of the drug - POP;
• convenience and ease of use;
• the patient can independently control pills
• does not reduce the amount of breast milk during
• Lack of estrogen component (does not cause nausea, headaches, increased blood
pressure)
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Noncontraceptive benefits
• reduces the amount of blood lost at the
time of
• Reduce spasms of smooth muscles of
the uterus.
• Prevents endometrial cancer
• Reduces the risk of benign breast
disease
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POP disadvantages:
• The effectiveness of drugs depends on the organization of the patient requires constant motivation and daily use (POP);
There may be intermenstrual bleeding due to the constant changes in the level
of serum progestins, slowing exclusion layer of the endometrium;
 • Do not protect against STIs, HIV, AIDS, and reproductive tract infections.
 • Perhaps some weight gain (POIC) or loss
 Side effects most commonly reported:
 • Amenorrhea: occurs in up to 40% used DMPA, with 20-30% of the IUD does not require treatment to the exclusion of Pathology
 • Violation of the menstrual function while using POIC as spotting
 bleeding (especially in the first few months). This is explained by supporting
level of progestin in the blood serum, which leads to a slower rejection of the
uterine lining. Typically, such a pattern is observed in the first months of use of
the drug;
 • The addition or loss of weight (change in appetite)
 • Acne
 • Pain in the lower abdomen / pelvis
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Depo-Provera may be introduced or
Noresterat nurses.
Injectable contraceptives, as well as other
hormonal methods have noncontraseptive
effects, which are to reduce the risk of
endometrial cancer, ectopic pregnancy,
inflammatory diseases of the pelvic organs.
Using Depo-Provera and Noresterata a
positive trend of anemia, endometriosis,
ovarian cysts, prevention of growth
miomatous node cancer and benign tumors
of the breast.
For forming healthy families and improve the
reproductive health needs to rational use of
modern contraceptives in view of individual
selection.