Hormonal

Contraception:
mechanism & delivery
Ruswana Anwar, dr.SpOG, KFER, MKes
Outline
Hormonal Contraception
How does it work?
Menstrual Cycle
Combined vs. Progestin Only
Delivery Methods 6 Options
Examples
Pharmacokinetics

Questions
The Menstrual Cycle
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Sperm
Sertoli cells
FSH
Testosterone
Leydig cells
LH
Male
Follicular growth and dev
FSH
Growth of primary follicles
LH
Female
Gonadotropes in anterior pituitary
GnRH from hypothalamus
Estrogenic Effects
Inhibits ovulation by
suppressing FSH & LH

Alters endometrial secretions
and cellular structures

Alters local hormones
(prostaglandins) which
contribute to degeneration of
corpus luteum

Progestational Effects
Inhibits ovulation by
suppressing FSH & LH

Thickens cervical mucus

Reduces activity of cilia

Promotes atrophic
endometrium

Inhibits sperm capacitation

Pharmacologic Actions on Endometrium
Pakarinen PI, et al. Fertil Steril. 1997;68(1):59-64
Silverberg SG, et al. Int J Gynecol Pathol. 1986;5(3):235-241
Days of cycle
Ovulation
Normal Menstrual Cycle
Resting State with LNG-IUS (Mirena)
Days of cycle
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Delivery Methods
Oral - E+P, P

Trans-dermal - E+P

Intramuscular - P

Vaginal - E+P

Intra-uterine - P

Implants - P
Clinical Pharmacokinetics
Adapted from: Alexander NJ, et al. Fertility & Sterility. 2004 Jul;82(1):1-12.
Clinical Pharmacokinetics

Nilsson CG, et al. Acta Endocrinol. 1980;93:380-384
Diaz S, et al. Contraception. 1987;35:551-567
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Combination OCs
Mini-pill
Implant
Mirena