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KONTRASEPSI HORMONAL

DAN NON HORMONAL

Dr. FRANCISCA DIANA A, M.Sc


Outline
Introduction
Dosage form
Mechanism of action
Indication
Side effect
Advantage and disadvantage
Prescription
Types of contraceptives

Hormonal
IUD
Barrier
Methods based on
information
Permanent sterilization
IDEAL CONTRACEPTIVE
Inexpensive
Easy and simple to use
Minimum side effects
Rapidly reversible
Readily available
Highly effective?
Can be administered by non-healthcare
personnel?
Hormonal contraception

The most effective method of


controlling fertility and preventing
pregnancy.
The effects of hormonal
contraceptives fully reversible
Sometimes used to treat heavy
periods and endometriosis and to
relieve severe premenstrual
symptoms.
Dosage form
Pill (COC pill)
Patches
Injections
Implants
Intra-uterine system
(IUS)
progestogen-only pill
(mini-pill).
Mechanism OF action
Estrogen negative feedback on the anterior .
pituitary greatly decreases release of FSH
inhibits follicular development and helps prevent ovulation
Combined Estrogen-
progestogen
Combined hormonal
prevent ovulation by
suppressing the release
of gonadotropins. They
inhibit follicular
development and prevent
ovulation as their primary
mechanism of action
Prevent implantation
Thickens cervical mucus
Contraceptive Pills

Combination Oral
Contraceptive
Pills can be taken to prevent
pregnancy
Pills are safe and effective
when taken properly
How to Use the contraceptive
Pill
How does a woman take the
pill?
She takes a pill by mouth
around the same time
every day. There are 21
hormone pills and 7
hormone free pills in this
package.
She will have her period
while the 7 hormone free
pills are taken.
Taking the Pill
Once a day at the same time
everyday
Suggest : Use condoms for first
month
Use condoms when on antibiotics
Use condoms for 1 week if you
miss a pill or take one late
The pill offers no protection from
STDs
Positive Benefits of contraceptive Pills

Prevents Decreases incidence


pregnancy of ovarian cysts
Eases menstrual Prevents ovarian and
cramps uterine cancer
Decreases acne ???
Shortens period
Regulates period
Side-effects
Breast tenderness
Nausea
Increase in headaches
Moodiness
Weight change
Spotting
CONTRAINDICATIONS
Absolutes :
Histoy of vascular disease (thromboembolism)
Systemic diseases (affect vascular system) SLE
, DM with retinopathy or nephropathy
Undiagnosed uterine bleeding
Increase serum TGs
Smoking in female more than 35y
Relatives:
Migraine headache
Undiagnosed amenorrhea and depression
Smoking in female less than 35 y
Monophasic pills
Monophasic pills have a constant dose of both estrogen
(ethinyl estradiol) and progestin (levonorgestrel) in each of
the hormonally active pills throughout the entire cycle (21
days of ingesting active pills)
Side effects:
such as mood changes, including breakthrough bleeding,
spotting and amenorrhea that can result from fluctuating
hormone levels in the body.
Microgestin, Modicon, Necon, Nelova, Nordette, Norinyl,
Ortho-Cept, Ortho-Cyclen, Ortho-Novum, Ovcon, Ovral,
Yasmin
Low dose of estrogen (20 mcg)
Regular dose 3035
High dose 50 mcg
BIPHASIC PILLS

7 tablet:40 mcg etinil change the level of


estradiol,25 mcg desogestrel
hormones once during
15 tablet:30 mcg etinil
the menstrual cycle. The
estradiol,125 mcg desogestrel
same amount of estrogen
each day but level the
progesterone dose is
increased about halfway
through the cycle.
Examples of biphasic pills
include Clymen 28,
Jenest, Mircette, Necon
10/11, Nelova 10/11,
Ortho-Novum 10/11.
TRIPHASIC PILLS
contain three different doses of hormones in the active
pills (changing every seven days during the first three
weeks of pills). Triphasic pills gradually increase the dose
of estrogen and some pills also increase the progesterone
dose.
Triphasic pills include Cyclessa, Ortho-Novum 7/7/7,
Ortho Tri-Cyclen, Triphasil, Tri-Levlen, Trivora, Tri-
Norinyl.
6 tablet: 30 mcg etinil estradiol,50 mcg
levonorgestrel
5 tablet: 40 mcg etinil estradiol,75 mcg
levonorgestrel
10 tablet: 30 mcg etinil estradiol,125
mcg levonorgestrel
Kontrasepsi Oral Tunggal
(minipil).
Kontrasepsi yang bentuknya tablet
dalam ukuran mini.
Pil mini hanya berisi derivat
Progestin, Norentindron, atau ,
Norgesterel
Cara kerja :
- menekan ovulasi
- mempengaruhi siklus haid
- meningkatkan viskositas mucus
serviks
Keuntungan:
- Angka kejadian yang berhubungan dengan
estrogen (misalnya tromboemboli) minimal
- Penurunan dismenorrhea.
- Penurunan premenstrual syndrome symptoms
- Fertilitas dengan cepat kembali seperti semula
setelah penggunaan dihentikan.

Kerugian :
- Kebutuhan untuk terus menggunakan.
- Diperlukan kontrasepsi lain sebagai backup
dalam waktu 48 jam bila terlambat
mengkonsumsi pil (3jam dari waktu yang
ditentukan).

Nama dagang :Cerazette (Isi: Desogesterol)


Excluton (Isi: Lynestrenol)
What are Progestin Only Pills
(mini pill) ?
take daily to prevent pregnancy.
It contains one hormone Progestin.
Often prescribed to women who are
breastfeeding.
May be prescribed for women who cannot
take the estrogen in combined birth control
pills:
Benefits of the Progestin Only
Pill
Mini pill have no estrogen side effects.
do not decrease breast milk production.
A womans periods may be lighter, shorter
and have less cramping.
Mini pill may be used by women:
Who are breastfeeding
Over 35 years who smoke
Have a history of blood clots in the veins
Have migraine headaches
Have a higher risk of heart attack or stroke
Risks of the Progestin Only Pill
A woman needs to take a pill each day.
The pill must be taken at the same time
each day.
The womans periods may be irregular
with spotting.
Mini pill is less effective if the woman if
taking an anti-seizure (anticonvulsant)
medicine.
Hormonal Methods
Remember: hormonal methods will
prevent pregnancy, but will NOT protect
against sexually transmitted infections
(STI).

ALWAYS USE A CONDOM!!


Missed Contraceptive Pills

COC
7 pill free days are safe
Not for the forgetful!!

Mini pill
Not for the forgetful!!!!!
Missed COC Pill/s
Missed COC pill

Less than 12 hours elapsed More than 12 hours elapsed

Take missed pill and continue regime as Where in pill cycle?


normal. No extra precautions required

1 pill missed from a pack 2 or more pills missed from


in the cycle 2 or more pills missed at any days 15-21
time in the cycle

Continue COC Continue COC to end of pack Continue COC and use
use extra precautions for 7 extra precautions for 7
days days. GO straight on to
next pack without a break
Missed Mini Pill/s

Missed mini pill/s

More than 3 hours late


Less than 3 hours late? (27 hours after last pill)

Cerazette?
Take the missed pill and
continue as normal

NO YES

Less than More than


Take missed pill as soon as 12 hours late? 12 hours late?
possible,
Take rest of packet as normal
And use extra precautions for the
next 2 days
Take missed pill as soon as
Take missed pill as soon possible, take the rest of the
as possible and continue packet as normal.
with packet as normal Use extra precautions until pills
taken for 2 consecutive days
Injeksi
Kontrasepsi hormonal dalam bentuk injeksi
merupakan bentuk sediaan suspensi, dikemas
dalam vial/flacon untuk sekali pakai, yang
diberikan secara suntikan IM.

Contoh :
a. Depomedroxyprogesteron asetat (DPMA)

Cara kerja :
Menghambat ovulasi dengan cara menekan
sekresi hormon FSH dan LH

Dosis :
Dosis tunggal : 150 mg umumnya bertahan selama
minggu.
Konsentrasi ini diulang tiap 3 bulan
KEUNTUNGAN

- DPMA tidak menyebabkan


efek samping yang serius
seperti tromboemboli.
- Risiko untuk menderita
kanker ovarium maupun
endometrium menurun
- Tidak perlu memakan pil KB
tiap hari.
- Memberi perlindungan
selama 3 bulan
KERUGIAN

Terjadi perubahan siklus


menstruasi pada 50 % wanita
pada pemakaian satu tahun
pertama.
Penggunaannya harus dengan
cara disuntik secara
intramuskular.
Tidak ada perlindungan
terhadap penularan penyakit
menular seksual.
Mempengaruhi sistem hormonal
tubuh
Nama dagang :

- Depo Provera atau Depo Ralovera


- Depo Progestin

Pengguna kontrasepsi ini bila menghendaki


kehamilan akan memperoleh kehamilan pada
bulan ke 12 pasca penggunaan terakhir.
Injeksi medroxyprogesteron
asetat dan kombinasi estradiol
Cara kerja :
Menekan ovulasi seperti kontrasepsi oral.

Komposisi :
Medroxyprogesteron acetat 50 mg ,dan
Estradiol cypionat 10 mg/ml/vial

Dosis :
Dosis tunggal untuk jangka 1 bulan ;
satu vial diberikan
dalam setiap 30 hari
Keuntungan:
-Siklus haid menjadi teratur, sekitar 28 hari
persiklus
- - Dismenore dan perdarahan abnormal
berkurang.

Kerugian:
- Terdapat spotting yang irregular.
- Menambah berat badan.
- Penurunan libido.

Nama dagang :
- Cyclofem ( Injeksi MPA + Estradiol cypionate )
- Cyclogeston (Injeksi MPA + Estradiol cypionate )

Pengguna kontrasepsi ini masa subur terjadi


pada bulan 68 setelah penyuntikan terakhir
Implant (Norplant)
Alat kontrasepsi dalam bentuk obat seperti
bacilli/kapsul silastic-silicone yang disusukkan
dibawah kulit. Jumlah kapsul yang disusukkan
adalah 6.

Cara pemakaian :
Kapsul yang panjangnya 34 mm , diameter 2,4 mm
disusukkan dibawah kulit

Nama dagang :
- Implanon
Isi tiap kapsul : Etornogestrel 68 mg
- Indoplant
Isi tiap kapsul : Levonorgestrel 75 mg
Cara kerja :
Menekan lonjakan LH juga menekan
ovulasi.
Perlindungan kontrasepsi mulai saat 24 jam
setelah insersi dimana obat dilepaskan kedalam
darah secara difusi melalui dinding kapsul.
Kapsul diinsersikan secara sub cutan, biasanya
pada lengan atas, sehingga tidak terlihat namun
dapat dipalpasi.

Keuntungan :
- Efektif
- Tidak menggunakan estrogen eksogen
- Reversibel
- Tidak ada efek samping yang berkaitan dengan
produksi ASI.
- Tidak menaikkan tekanan darah.
- Dapat digunakan jangka panjang. (5 tahun)

Kerugian :
- Melalui bedah minor saat insersi
- Kesukaran dalam pengangkatan implant
Efek samping :
- Gangguan siklus haid
- Peningkatan berat badan
- Pusing
- Mual, anoreksia

Indikasi :
- Wanita post partum
- Wanita menyusui.
- Wanita dengan kontra indikasi
penggunaan estrogen
Norplant I vs. Norplant II
Six capsules Two capsules
Five years Three years
Skin Patch

Cara pemakaian : Setiap patch


dipakai terus selama satu minggu.
Total pemakaian tiga minggu,
minggu keempat tidak perlu
memakai.

Penggunaan kontrasepsi ini pada


lengan atas, abdomen bagian
bawah, bokong, atau tubuh bagian
atas tapi tidak pada payudara
Keuntungan :
- Peningkatan kepatuhan.
- Efek samping minimal, seperti
nausea dan muntah.

Kerugian :
- Sama dengan kontrasepsi oral
kombinasi
- Tidak efektif pada wanita dengan
berat badan lebih dari 70 kg.
- Kontrasepsi Skin Patch tidak
beredar di Indonesia
Setiap patch mengandung 1 minggu
suplai hormone yang melepaskan
hormone steroid dosis rendah yang
setara dengan dosis terendah
kontrasepsi oral kombinasi.
Kontrasepsi ini melepaskan etinil
estradiol (hormone estrogen)
20mcg dan norelgertromin
(hormone progestin) 150mcg
setiap hari secara langsung melalui
kulit ke dalam aliran darah
INTRAUTERINE DEVICES (IUD)

T-shaped object placed in the uterus


to prevent pregnancy
Must be on period during insertion
A Natural childbirth required to use
IUD
Extremely effective without using
hormones > 97 %
Copper T vs.. Progestasert

Copper T Progestasert
5 years 1 year
99.2 % effective 98% effective
Copper on IUD acts as T shaped plastic that
spermicide, IUD blocks releases hormones over
a one year time frame
egg from implanting
Thickens mucus, blocking
Must check string before egg
sex and after shedding of Check string before sex &
uterine lining. after shedding of uterine
lining.
IUD
Copper T
Nuva T (+ Progesterone)
Emergency Contraception

Emergency contraception
pills can reduce the chance
of a pregnancy by 75% if
taken max within 72 hours
of unprotected sex!
EMERGENCY
CONTRACEPTION (ECP)
After intercourse and before implantation
Indication: failure of condoms
Unprotected intercourse
Max Within 24 - 72 hours after unprotected
intercourse
Levonorgestrel or Combined Prescription
(high dose)
Single dose, the earlier the better
Prevented 75% of unplanned pregnancies
Must be prescribed by doctor
ECP Mechanism
Floods the ovaries with high
amount of hormone and prevents
ovulation
Alters the environment of the uterus,
making it disruptive to the egg and
sperm
Two sets of pills taken exactly 12
hours apart
Non hormonal
contraceptives
Barrier methods of
contraception
Two types :

1.Physical barrier methods condoms,


diaphragm, and cervical caps, that prevent
pregnancy by blocking the entry of sperm
into the upper genital tract;
2.Chemical barrier methods
(spermicides) that kill or inactivate sperm
on contact. ( less effective , used in
combination , no STDs protection )
BARRIER METHODS

Spermicides
Male Condom
Female Condom
Diaphragm
Cervical Cap
1. SPERMICIDES
Chemicals kill sperm in the vagina
Different forms:
-Jelly -Film
-Foam -Suppository
Some work instantly, others require
pre-insertion
Only 76% effective (used alone),
should be used in combination with
another method i.e., condoms
Spermicides

Failure rate is about 26% within the 1st


year of use.
Advantages : ease of application ,
inexpensive and it augments the
contraceptive efficacy of the cervical
cap and diaphragm .
Disadvantages : minimal protection
against STDs , risk of vaginal irritation
and allergic reaction.
2. MALE CONDOM

Most common and effective barrier


method when used properly
Latex and Polyurethane should only be
used in the prevention of pregnancy and
spread of STIs (including HIV)
Latex and polyurethane condoms are
available
Combining condoms with spermicides
raises effectiveness levels to 99%
3. FEMALE CONDOM
Made as an alternative to male
condoms
Physically inserted in the vagina
Woman can use female
condom if partner refuses
Female condoms
- Mechanism of action :
Prevents passage of sperm
and infections into the vagina
( protection against STDs )

Can be inserted up to 8 hours


prior to intercourse; can remain in
place up to 8 hours
4. VAGINAL RING
Steroids absorbed though vaginal epithelium
directly into circulation
Contain ethniyl estradiol and
etonogestreland
Place in vagina for 21 days and remove 7 days
to allow withdrawal bleedings
5. Cervical cap
a cup-shaped latex device that fits over the
base of the cervix.
The cap must be filled one third full with
spermicide prior to insertion
Inserted 8 hours before coitus and can be left in
place for as long as 48 hours.
DIAPRAGHMA
Latex barrier placed inside vagina during
intercourse
Spermicidal jelly before insertion
Inserted up to 18 hours before intercourse
and can be left in for a total of 24 hours
METHODS BASED ON
INFORMATION
METHODS BASED ON
INFORMATION
1. Withdrawal
2. Natural Family Planning &
Fertility Awareness Method
3. Abstinence
4. Natural method
1. WITHDRAWAL
Removal of penis from the vagina
before ejaculation occurs
NOT a sufficient method of birth
control by itself
Effectiveness rate is 80% (very
unpredictable in teens, wide
variation)
1 of 5 women practicing withdrawal
become pregnant
Very difficult for a male to control
2. Natural Family Planning &
Fertility Awareness Method

Women take a class on the


menstrual cycle to calculate more
fertile times
Requires special equipment and
cannot be self-taught
3. Abstinence
Only 100% method of birth control
Abstinence is when partners do not
engage in sexual intercourse
Communication between partners is
important for those practicing abstinence
to be successful
Periodic Abstinence
calendar method
4. Natural methods
Lactational amenorrhea
Definition
Efficacy
Advantages
Disadvantages
STERILIZATION
Procedure performed on a man or a
woman permanently sterilizes
Female = Tubal Ligation
Male = Vasectomy
Thank you