Transcript Slide - Youth Support Hub

“New Hormonal Contraceptive Options For
The Sexually Active Adolescent”
Zeev Harel, MD
Associate Professor of Pediatrics
Hasbro Children’s Hospital and
Brown Medical School, Providence, RI
Teenage Pregnancy Rate
1,000,000/year
980,000/year
Decrease in teenage pregnancy rate
The availability of a
variety of contraceptive
methods increases the
likelihood of successful
contraception
More adolescents
abstain or postpone
sexual activity
Prevention of Teenage
Pregnancy
While programs working towards
abstinence or postponing sexual activity
are extremely important, it is also essential
that adolescents who do become
sexually active receive the proper
contraceptive method.
Barrier Contraception Hormonal
Methods
Methods
Physical
Barriers
Chemical
Barriers
Short
Acting
Long
Acting
•Male condom
•Female
•Spermicides
(Nonoxynol 9)
•Gel
•Foam
•Cream
•Film
•Suppository
•Sponge
•OCP
•Injection
•Implants
•IUS
•Transdermal
Patch
•Vaginal ring
condom
•Diaphragm
•Cervical Cap
•IUD
•Sponge
Interception
Morning after pills
(emergency contraception)
Condoms
Despite all the efforts, consistent
condom
use among adolescents is only around
30%
Condoms
Care Provider's Role
Advocate consistent condom use
Go into specific details and be
prepared to provide information
regarding various condoms
Condoms
The message being not to give up on
condom use, but to try different brands
until the adolescent finds a condom that
he or she is satisfied with.
Condoms
Dislike
of one brand of latex condom
Try
a different brand of latex condom
Condoms
Dislikes
latex condoms or is allergic to latex
Try a condom made of polyurethane
Condoms Made of
Polyurethane
Avanti 
Trojan Supra 
Male condoms
Reality 
The female condom
The Polyurethane Condom
(Avanti )
Advantages
May be used by patients with latex allergy
Stronger, resists oil-based lubricants
Transparent, odorless, thinner than latex
May fit less restrictively than latex condom
The Polyurethane Condom
(Avanti )
Disadvantages
 Higher frequency of slippage
and breakage
 Costs more
Female Polyurethane Condom
"Reality" in Adolescents
• The majority of users rated it as an
"acceptable" barrier method
• Female condom users reported comfort using
vaginal products and were more likely to have
used a vaginal douche
• The high rate of STD reported among girls who were
given female condoms and educational materials
indicated inconsistent use of this method
Oral Contraceptive Pills (OCP)
Estrogen Dose Evolution
1960
Mestranol 150 mcg
(105 mcg ethinyl estradiol)
Present
Ethinyl Estradiol 20-25-35 mcg
Oral Contraceptive Pills (OCP)
Estrogen related side effects
Nausea
Breast tenderness/swelling
Fluid retention
Headache
Heavy menstrual bleeding
Less Estrogen Related Side Effects
Ethinyl
35mcg
Estradiol
25mcg
20mcg
Better Cycle Control
Oral Contraceptive Pills (OCP)
Progestin Evolution
•Dose reduction
-From 10 mg (1960) to 0.15-1 mg
-Phasic regimens
•Development of more selective
(less androgenic) agents
-Norgestimate
-Desogestrel
-Drospirenone
Oral Contraceptive Pills (OCP)
Progestin related side effects
Weight gain
Acne
Hair growth
New Oral Contraceptive Pills:
Cycle Control
•Cyclessa: triphasic desogestrel /
EE 25 mcg
•Ortho Tri-Cyclen Lo: triphasic norgestimate /
EE 25 mcg

High rate (97%) of scheduled menstrual bleeding
Low rate (10%) of intermenstrual (breakthrough)
bleeding and spotting
New Oral Contraceptive Pills (OCP)
Yasmin
(Ethyinyl estradiol 30 mcg / Drospirenone 3 mg)
Approved by the FDA in May 2001
Progestine (drospirenone) - a spironolactone
analogue with antimineralocorticoid and
antiandrogenic activity
(similar to 25 mg dose of spironolactone)
Adolescents with acne and hirsutism may
benefit from its use
Potassium levels should be examined periodically
New Oral Contraceptive Pills (OCP)
YASMIN
Additional Contraindications / Warnings
Contraindicated to use in patients with
conditions that predispose to hyperkalemia (renal
insufficiency, hepatic dysfunction, adrenal
insufficiency)
Patients on medications that may increase serum
potassium (ACE inhibitors, Angiotensin-II
receptor antagonists, potassium-sparing diuretics,
heparin, Aldosterone antagonists,
and NSAIDs) should have their serum potassium
level checked during the first cycle.
OCP
Careprovider's responsibilities
Address misperceptions
Review for contraindications
Tailor the appropriate OCP for
the patient
Provide counseling before use and
during use, and immediately address
any concern or problem associated
with the use of OCP
Misperceptions About OCP
2000 ACOG Gallup Poll
• 41% of women believe OCP carry
substantial health risks
• Among these women, the most common
(16%) health risk believed to be
associated with OCP use was cancer
• Only 8% of women were aware that OCP
might reduce the risk of ovarian and
endometrial cancers
*The risks of
malignancies with the
new methods (patch,
ring) are unknown.
Breast Cancer
OCP
(combine
d
estrogen
progestin)
() slightly
(promotional effect,
localized disease)
DepoProvera
(progestin
only
no change
Endometrial Cancer
() risk
() risk
Ovarian Cancer
() risk
no change
Cervical Cancer
Colorectal Cancer
() risk in
women with HPV
infection
() risk
no change
OCP
Cardiovascular Risk
• No increase in risk in healthy, non-smoking
women
• () risk with smoking and hypertension
• Risk of thromboembolism among OCP users is
3-4 times greater than the risk in women not
using OCP but is far less than that associated
with pregnancy
WHO Medical Eligibility
Criteria for OCP
(First edition-1996, Second edition-2000)
No restriction
Benefits > risks (generally use
the method)
Risks > benefits (not usually
recommended)
Use unacceptable
Review for Contraindications:
Coagulation System Abnormalities
Ask about family history of: Factor V
Leiden Mutation (Resistance to Protein C)
Protein C
 Protein S
 Antithrombin III
Hx of DVT (4)
Hx of superficial thrombophlebitis (2)
Review for Contraindications:
Breast Disease
•Breast cancer (4)
•Benign breast disease (1)
•Family history of breast disease (1)
Review for Contraindications:
Liver Disease
•Liver tumors (benign/malignant) (4)
•Acute liver disease (4)
Review for Contraindications:
Hypertension
•Hypertension
(4)
•Adequately controlled
hypertension
(3)
•History of high blood pressure
during pregnancy (2)
Review for Contraindications:
Headaches
•Migraines without focal
neurologic symptoms (2)
•Migraines with focal
neurologic symptoms (4)
Review for Contraindications:
Chronic Disease / Diabetes
•No vascular complications - 2
•Nephropathy - 3/4
•Retinopathy - 3/4
•Neuropathy - 3/4
Oral Contraceptive Pills (OCP)
•21-pill pack versus 28-pill pack
(Be specific when you write a prescription)
•Mini pills (progestin only) versus combined
(estrogen/progestin) pills
•Monophasic (constant amount) versus
multiphasic (amount varies)
•Estrogen/progestin components
Oral Contraceptive Pills:
Estrogen Component
•Ethinyl estradiol: 20-50 micrograms
•Mestranol: 50 micrograms (less used,
must undergo O-demethylation
in the liver)
Oral Contraceptive Pills:
Progestin Component
•Various progestins
•Various amounts
•Various metabolites
OCP- Progestin Role
To help in blocking ovulation
To counteract some of the
estrogenic effects
Oral Contraceptive Pills:
Progestin Potency
•Affinity for progesterone receptors
•Affinity for androgen receptors
•Effect on sex hormone binding
globulin (SHBG)
Tailoring OCP
Girls with no problems
Low Dose OCP
Monophasic
Triphasic
Tailoring OCP
Prescribe OCP with a potent progestin
(such as norgestrel or levonorgestrel)
to:
Girls with
heavy menstrual bleeding
severe dysmenorrhea
signs of fluid retention (bloating)
breast tenderness
Tailoring OCP
Prescribe OCP with a less androgenic
progestin (such as norgestimate, desogestrel,
or drospirenone) to:
Girls with
acne
hirsutism
PCO
overweight
OCP-Counseling
•Address safety issues, perceived health risks
•Emphasize benefits of OCP (regular periods,
relief of dysmenorrhea, improved acne)
•Review side effects (breakthrough bleeding
and nausea are common during the
first 3 cycles)
•Advise patient to take the pill at bed time after
brushing teeth
OCP-Counseling (continued)
•Emphasize the need for consistent
use of condoms
•Open-door, open-telephone policy
(encourage patient to contact you with
any concern, if she has missed more
than 2 pills, or before discontinuing
OCP for any reason)
OCP-Counseling
•Follow-up 1-2 months after initiation,
every 3-4 months thereafter
•Discuss strategies to obtain refills if
follow-up is less frequent (patient
should have an extra dispenser at
any time)
OCP
Approaches Undergoing Investigation
"Quick Start"
-For patients who have not had sex within the
past 10 days
-Negative pregnancy test
-Patient initiates OCP in the clinic
without waiting for her menstrual
period
Extended use of OCP to a 91-day cycle
(Seasonale)
Extended Cycle OCP
Medical indications for continued use
>21 days of active hormones
• S/P Dysfunctional uterine bleeding (DUB)-until
HGB >10.0 g/dl
• When platelet count is very low
• Treatment of endometriosis
• Women on OCP who continue to experience
menstrual symptoms or exacerbation of a
medical condition (asthma, arthritis, seizures)
during the active pill-free interval
Extended cycle regimen
(allowing menses every 3 or more
months)
Studies in adult women
• Easier to follow
• Well tolerated
• Efficacious in reducing menstrual-related
symptoms
OCP and the Menstrual Cycle
Tricycle regimen (Seasonale)
Spring
Winter
Summer
Autumn
Tricycle regimen (Seasonale)
•A pill (30 mcg ethinyl estradiol/150 mcg
levonorgestrel) taken daily for 84 days followed
by 7 days of placebo
•Estrogen/progestin similar to that found in the
OCP Nordette-28
Reduction of menstruation frequency
extending the duration of active oral
contraceptive pills (>21 days)
Concerns
• Decreased endometrial stability during
prolonged continues OCP taking?
• Deleterious effects on lipid metabolism
and vascular disease?
• Long-term safety with increased
hormone load?
Oral Contraceptive Pills in
Adolescents
Tendency to stop and restart use depending
on sexual activity
Pregnancy rates from 8% (in girls with
regular intercourse) to 38% (in girls with
sporadic sexual activity) as compared with
only 2% pregnancy rate in adults
Discontinuation rate of 45-66% within
12 months of use
Long Acting Hormonal
Contraceptive Methods
Progestin only
Injection- Depo-Provera (medroxiprogesterone acetate)
effective for 3 months
Subdermal implants- Norplant (levonorgestrel)
effective for 5 years
Intrauterine
system- (IUS) Mirena (levonorgestrel)
effective for 5 years
Levonorgestrel-Releasing Intrauterine
System (Mirena)
• Releases levonorgestrel (LNG) 20
mcg/day into the uterine cavity (low
systemic levels of LNG)
• High efficacy
• Reduces menstrual blood loss
• May be offered to adolescent mothers
• Requires clinician visit for initiation and
discontinuation
Depo-Provera
(medroxyprogesterone acetate)
150 mg i.m. injection
•Esterifying the progestogen alcohol moiety
(6-methyl analog of 17-hydroxyprogesterone) decreases its solubility
and prolongs its effect
•Peak blood levels (2.6-7.8 nmol/L) within hours
•Plateau (2.6-3.9 nmol/L) for 2-3 months,
followed by a gradual decline
Injectable
Long
Acting
Progestin
BRAIN
HYPOTHALAMUS
pulse
frequency
GnRH
mean 12 hrs
unchanged
peak amplitude
frequency
midcycle LH surge
Injectable
Long
Acting
Progestin
PITUITARY
LH
FSH
OVARIES
Progesterone
mean 12 hrs
response to
GnRH
challenge
Inhibin
E2
Alteration of the endometrium
UTERUS Thickening of cervical
mucus
Adolescents' Satisfaction with
Depo-Provera
Most (60-70%) adolescents are very
satisfied with Depo-Provera
Most (96%) would recommend the
method to a friend or relative
About half (51%) of adolescents who
discontinued Depo-Provera stated that
they would like to resume the method in
the future
Depo-Provera in Adolescents
Reasons for Discontinuation
Irregular bleeding
60%
Weight gain
40%
Increased headaches 26%
Mood changes
20%
Fatigue
20%
Breast tenderness
16%
Harel et al,
J. Adolesc Health, 1996
Depo-Provera
Relative estrogen deficiency
Menstrual Irregularity
BMI Increase with Depo-Provera
Serotonin
CRH
Glucocorticoid
Activity
Hypothalamic
Hunger Centers
Insulin Antagonism
Depo-Provera
G.I. Motility and
Satiety factor?
Purpose
•To examine the effects of an early
second injection and prior use of
combined oral contraceptives on side
effects of Depo-Provera during the early
months of use in adolescents
Duration of Bleeding After Depo-Provera
Regular
Early 2nd injection
Prior OCP
Days
25
20
15
10
P=.003
*
P=.02
*
5
0
Interval 1
Interval 2
Interval 3
BRAIN
Prior OCP
Use
HYPOTHALAMUS
Potenial
suppression
of FSH up
to 2-5 months
GnRH
PITUITARY
LH
FSH
OVARIES
Induction of
progesterone
receptors
E2
UTERUS
Vasoactive
&
Growth Factors
BMI Increase with Depo-Provera
Regular
1.4
Early 2nd injection
Prior OCP
P=.0002
*
1.2
1
0.8
0.6
P=.005
*
0.4
0.2
0
After 3 months
After 6 months
Conclusions
•Recent use of combined OCP provides
partial protection against Depo-Provera
induced menstrual irregularities
•Early second injection of Depo-Provera
does not alter menstrual abnormalities,
and is associated with greater early
weight gain
Vitamin B6 and/or Vitamin C in
the Prevention of Depo-Provera
Side Effects in Adolescents
Vitamin B6, a glucocorticoid antagonist and
an important coenzyme in the tryptophan
serotonin pathway, did not have an effect on
weight changes associated with Depo-Provera
Vitamin C, an important factor in uterine
estrogen binding, failed to prevent menstrual
irregularities associated with Depo-Provera
Harel et al,
J. Pediatr Adolesc Gynecol, 2002
Vitamin B6 and/or Vitamin C in
the Prevention of Depo-Provera
Side Effects in Adolescents
All participants were counseled about
the importance of proper nutrition
and regular physical activity during
Depo-Provera use
When data from all study groups were
collapsed, there was no significant
change in BMI after 3 and 6 months of
Depo-Provera use
Vitamin B6 and/or Vitamin C in the
Prevention of Depo-Provera Side
Effects in Adolescents
The unchanged BMI during the
first 6 months of Depo-Provera use
in this study suggests that raising
awareness and close follow-up
may prevent weight gain among
adolescent girls using this contraceptive
method
Prevention of Depo-Provera
Side Effects in Adolescents
Prevention of menstrual
irregularities
(+)Prior OCP use
(immediately before DepoProvera)
(-)Early second injection
(-)Vitamin C
(?)Phytoestrogens
Prevention of
weight gain
(+)Healthy diet
(+)Exercise plan
(-)Vitamin B6
Depo-Provera
Relative estrogen deficiency
Bone loss
(reversible upon D/C in adults,
studies in adolescents still ongoing)
Prevention of Depo-Provera
Side Effects
Prevention of a decrease in bone density
(+)Adequate calcium intake (1300 mg/day)
(+)Regular physical activity
(+)Avoid smoking and alcohol
(?)Periodic add-back estrogen
(?)Phytoestrogens
Beginning a Teen on a Long-Term
Progestin-Only Contraceptive
Candidates
Poor pill compliance
Previous pregnancy
Medical condition
-pregnancy contraindicated
-increased risk of thromboembolic
phenomena
-sickle cell anemia, seizure disorders
Review for Contraindications
Sex hormone dependent tumor
Active liver disease
Beginning a Teen on a Long-Term
Progestin-Only Contraceptive
Counseling about benefits and
potential side effects
Encourage continuation with
OCP (at least a month) until injection
Discuss healthy diet and adequate
calcium intake
Discuss exercise plan and weight
bearing physical activities
Sign consent
Beginning a Teen on Depo Provera

Return during menses
Review benefits and potential side effects
Emphasize safe sex and provide condoms
Urine pregnancy test

Injection
Depo Provera Follow Up
•Schedule a return appointment in 12 weeks
(ask patient whether she needs a reminder
card or a telephone call)
•Open-door, open-telephone policy
(encourage patient to contact you with
any concern, if she has bleeding/spotting
for more than 5 days)
Treatment of Persistent/Heavy
Bleeding During Depo-Provera Use
Rule out STI
Obtain a CBC
Reassurance
Short course (7 days) of estrogen
One cycle of oral contraceptives
Nonsteroidal anti-inflammatory medication
(ibuprofen, 800 mg tid for 5 days)
Long Acting Hormonal
Contraceptive Methods
Combined (estrogen / progestin)
Injection - Lunelle (approved in 2000, but currently N/A)
once a month
Vaginal ring - NuvaRing (since 2001)
once a month
Transdermal - Ortho Evra patch (since 2002)
once a week
Vaginal Ring (Nuva Ring)
Ethinyl estradiol /
Etonogestrel
(active metabolite
of desogestrel)
Ethylene vinyl
Ethylene
vinyl skin
Vaginal Ring (NuvaRing)
Soft, flexible, transparent ring intended for only
one cycle of use
Doesn't require sizing or fitting
Self inserted within 5 days of the onset of menses
for 3 weeks at a time, and then removed for 7 days
to facilitate regular withdrawal bleeding
Intended to be left in place during intercourse
(The ring can be removed for intercourse but
must be replaced within 3 hours)
Refrigerated in the pharmacy. Has a shelf life
of only 4 months at room temperature.
Vaginal Ring (NuvaRing)
Advantages
Vaginal administration allows a lower dose of
estrogen to be administered than with oral forms
(Daily release of ethinyl estradiol 15 mcg and
etonogestrel 120 mcg)
Highly effective (98.8%) when used correctly
Easy insertion and removal by the user herself
Good cycle control
A rapid return to normal cycling and
fertility after removal
Vaginal Ring (NuvaRing)
Side Effects
Prolonged withdrawal bleeding - 20-27%
Headache - 7%
Leukorrhea - 5%
Vaginitis - 5%
Device related events (foreign body sensation,
coital problems, expulsion) - 4% (But the
most common reason for discontinuation)
Vaginal Ring (NuvaRing)
Concerns about the use in adolescents
Some adolescents have not yet developed optimal
comfort with their body
NuvaRing can be accidentally expelled (when it has
not been inserted property, while moving the
bowels, straining, or with severe constipation)
Some adolescents may be aware of the ring
at random or during intercourse.
Sexual partners may feel NuvaRing during
intercourse
The week four ring-free interval may lead to
confusion
4.5 cm
Three layers-The matrix system
1. Outer protective
beige layer of polyester
2. Medicated adhesive
middle layer
3. Polyester clear liner which
is removed before patch
application
Transdermal Contraception:
The Contraceptive Patch Ortho Evra
Contains Ethyinyl Estradiol 750 micrograms
and Norelgestromin (primary active
metabolite of norgestimate) 6 miligrams
Releases Ethyinyl Estradiol 20 micrograms
and Norelgestromin 150 micrograms into the
bloodstream per 24 hours for up to 9 days
The Once-a-Week
Patch Ortho Evra
The Daily OCP
Ortho-Cyclen
(Ethinyl Estradiol 750 mcg
Norelgestromin 6 mg)
(Ethinyl Estradiol 35 mcg
Norgestimate 250 mcg)
Daily release of
Ethinyl Estradiol 20 mcg
Norelgestromin 150 mcg
BLOOD LEVELS
Ethinyl Estradiol 25-75 pg/ml
Norelgestromin 0.6-1.2 ng/ml
Constant
Fluctuate
Transdermal Contraception:
The Contraceptive Patch Ortho Evra
Efficacy
•99% effective in preventing pregnancy
when used correctly
•May be less effective in
women >198 pounds (90 kg)
Transdermal Contraception:
The contraceptive Patch Ortho Evra
Mechanism of action
Ovulation suppression
(ovulation rates <15%)
Thickening of cervical mucus
Alteration of the endometrial
environment
Transdermal Contraception:
The Contraceptive Patch Ortho-Evra
Contraindications
(Similar to contraindications to OCP)
Thromboembolic disorders
Malignancy of the reproductive
organs or breasts
Acute or chronic hepatocelluar disease
Headaches with focal neurological symptoms
Chronic disease with vascular involvement
Skin disorders
Transdermal Contraception:
The Contraceptive Patch Ortho Evra
Application
•Once-a-week for three weeks
•Week four patch free (during which
withdrawal bleeding occurs)
Transdermal Contraception:
The Contraceptive Patch Ortho Evra
Application
•Multiple application sites (lower abdomen, buttock,
upper outer arm, upper torso) excluding the breasts.
New patch can be applied to sites near the area used
for the preceding patch, but not to same site.
•Excellent adhesion (in <5% patches fell off or
partially detached), not affected by humidity,
variable temperature, or physical activity.
Transdermal Contraception:
The Contraceptive Patch Ortho Evra
Side effects
Application site reactions
Breakthrough bleeding
Breast discomfort
Nausea/vomiting
Headache
Emotional Lability
Transdermal Contraception:
The Contraceptive Patch Ortho Evra
Approach to a patient who wants
to start this method
Review of benefits and risks of the patch
Review for contraindications
Sign Consent

Return during menstruation

Approach to a patient who wants
to start the patch
Pregnancy test

Apply the first patch
(established "patch change day")
Review instructions for use
Provide a calendar
Emphasize condom use and provide condoms
Transdermal Contraception:
The Contraceptive Patch Ortho Evra
Features that may make it appealing
to adolescents
Requires attention only once-a-week
compared with the daily attention required
with OCP
Coitus independent
Convenient, easy to use
May seem "cool" and "modern" to some
adolescents
Transdermal Contraception:
The Contraceptive Patch Ortho Evra
Concerns about the use in adolescents
Will adolescents remember to apply a
new patch every week?
The week 4 patch free interval may
lead to confusion.
Visibility may still be an obstacle for use
by some adolescents.
Will the use of the patch decrease condom
use?
Purpose
To examine adolescents’
experience with the
combined estrogen & progestin
transdermal contraceptive
method Ortho Evra
Menstrual Cycle with Ortho Evra
100% - reported regular menstrual periods
while using Ortho Evra
14% - experienced occasional breakthrough
bleeding
50% - reported a shorter duration of
bleeding (4% - longer duration)
36% - reported a lighter flow (7% - heavier flow)
39% - reported decrease in dysmenorrhea
symptoms (11% - () in dysmenorrhea)
Experience with Ortho Evra
No significant BMI changes during use
33% - of the girls who had acne before
initiation reported decrease in facial
acne (17% reported increase)
29% - of the girls who had history of
headaches reported decrease in
headache frequency and severity
while on Ortho Evra (6% reported
increase)
Side Effects of Ortho Evra
Mild temporary application site
reactions - 64%
Some discomfort on patch removal - 32%
Nausea - 18%
Breast tenderness - 18%
Peeling/Detachment During Use
•21% - experienced at least one episode
of complete patch detachment
•32% - reported partial peeling of the
patch corner
Condom Use While On Ortho
Evra
68%
46%
*P=0.03
39%
Before Use
During Ortho Evra
20%
15%
Always
12%
Sometimes Never
Satisfaction with Ortho Evra
68% - were very satisfied
29% - were somewhat satisfied
40% - stated that Ortho Evra was easier
than previous contraceptive methods
they used
93% - stated that they would recommend
the method to a friend/relative
Adolescents' Recommendations
32% - would prefer another patch
color
25% - would like a fourth week placebo
patch
Only 7 % - would like to be able to
write notes on the patch
Conclusions
Ortho Evra provides excellent cycle
control in adolescents
Most adolescents are satisfied with
this method
Intensive efforts should be made to
increase condom use by adolescents on
Ortho Evra
The Vaginal ring NuvaRing and
the Contraceptive Patch Ortho Evra
Issues that have not been explored yet
•Prolonged use of active patches (to control /
prevent bleeding, to treat endometriosis
or severe dysmenorrhea)
•Use as emergency contraception
Postcoital Contraception
•Should be reserved for emergency use
•Must be started within 120 hours after
intercourse
•Efficiency is greater the sooner it is taken
Postcoital Emergency
Hormonal Contraception
Mechanism of Action
• Delays ovulation
• Prevents fertilization
• Inhibits implantation by altering the
endometrium
Postcoital Emergency Hormonal
Contraception
It is very important to counsel the patient
about proper use
Plan for interim/ongoing contraception
Repeat pregnancy test if no menstrual
bleeding occurs within 3-4 weeks
FDA Approved Postcoital Emergency
Hormonal Contraception
1997
Combined OCPs (brands
vary by dose and color)
1998
PREVEN (combined
estrogen/progestin)
Emergency Contraceptive Kit
1999
PLAN B (progestin only)
PREVEN Emergency
Contraceptive Kit
• Pregnancy test
• 2 pills (50 mcg ethinyl estradiol/250 mcg
levonorgestrel each)
-to be taken within 72 hours after
intercourse
• 2 additional pills
-12 hours after first dose
PLAN B Emergency
Contraceptive Pills
One tablet (levonorgestrel 750 mcg)
- to be taken within 120
hours after intercourse
One tablet (levonorgestrel 750 mcg)
-12 hours after first
dose
PLAN B Emergency
Contraceptive Pills
(WHO trial, Lancet 2002)
Two tablets (levonorgestrel 750 mcg each)
- to be taken within 120
hours after intercourse
Emergency Contraception
• Nausea/vomiting are the most
common side effects:
42% / 16%-Preven
23% / 6%-Plan B
• Patient should repeat dose if
vomiting occurs within one hour
• In severe vomiting the pills can be
administered vaginally
"WEST HEMISPHERE
NEWS" January 1, 2099
Teenage
Pregnancy
Conquered
For the first time today, the Bureau of West Hemisphere
Statistics reported zero pregnancy rate, in adolescents
under 21, for the year 2098. When asked about this
phenomenal success, scientists attributed it to: ……….…
………………………………………………………………….