Hormonal Contraception

1. Oral contraception

Mode of action Contraindication Advantages Disadvantage

1. COCP i. Suppress ovulation i. high efficacy i. VTE, MI,
(Combined Oral by preventing ii. reversible stroke, raised BP
Contraceptive ovarian follicular iii. Not related to ii. Breast cancer
Pills) maturation & LH intercourse iii. Cholestasis
surge iv. Reduced iv. Gallstone
ii. Thicken cervical menstrual blood
mucus thereby flow (reduced
reducing sperm IDA)
penetrability V. Less
iii. Alteration of dysmenorrhea
endometrium
thereby reducing
likelihood of
implantation

2. Progestogen- i. Thicken cervical - not for i. readily i. Require strict

only pill mucus pregnancy, liver reversible adherence to
adenoma, severe ii. reduce the rules of pill
arterial disease, problems in taking
undiagnosed diagnosing ii. Unpredictable
vaginal bleeding menopause on pattern of
hormonal bleeding
contraception iii. ↑ i/o ovarian
(bcs does not follicular cysts
affect ↑ FSH and ↑ risk of
and estradiol ectopic
level) pregnancy
iii. low failure compared to
rate COCP

3. Emergency i. Inhibit ovulation if - not for i.

contraception still early part of suspected nausea/vomiting
cycle pregnancy,
ii. Decrease tubal abnormal
motility vaginal bleeding
iii. Possibly interrupt
implantation

1
2. Injectible contraception

Mode of action Indication Advantage Disadvantage

1. DMPA : i. Inhibit i. Women who i. No risk of i. Menstrual
depo-provera ovulation forget to take ovarian and disturbances –
ii. pills, particularly endometrial irregular vaginal
(deep IM traveller cancer bleeding,
injection every 3 ii. Wish for secret ii. No a/w stroke, amenorrhea
months =/- 2 or ‘private’ MI or VTE ii. Weight gain
weeks) method ii. reduce HDL iii. Delay in
iii. In whom level in 15% return in to
estrogen is users normal fertility
contraindicated iv. Headache,
(HPT, DM, dizzy, breast
age>35& tenderness &
smoking) mood changes
v. Osteoporosis

3. Implants

Mode of action Advantage Disadvantage

1. Implanon i. Inhibit i. Very low i. Menstrual
ovulation by failure rate disturbances
- license for 3 preventing LH ii. Rapid return to ii. alopecia,
years surge fertility (90% of emotional
- can be ii. Thicken women ovulate lability,
administered up cervical mucus within 30 days) depressive
to day 5 of and endometrium iii. Independence symptoms,
menses iii. of user dysmenorrhea
compliance iii. headache,
acne, breast pain

4. Intrauterine devices (IUD)

Mode of action Advantage Disadvantage

1. LNG-IUS : i. Profound i. Long-acting, i. Difficulty
MIRENA endometrial rapidly inserting
atrophy and reversible especially
Licensed for foreign body nulliparous
contraception for effect render ii. Management woman
5 years endometrium of menorrhagia ii. Irregular
unresponsive to (reduce menstrual bleeding (3
oestrogen blood loss up to months after
ii. Change in the 97%) endometrial
cervical mucus atrophy)
which prevent the iii. Cost-effective
ascent of compared to iii. Amenorrhea
spermatozoa hysterectomy

2
 Non-hormonal contraception
1. Barrier methods
Male Female
- male condom - Female condom
- spermicide - Diaphragm
- Cervical cap
- Sponge

Mode of action Advantage Disadvantage

1. Male condom i. lack of
sensitivity around
glans of penis
2. Spermicide Kills sperm

Mode of action Advantage Disadvantage

1. Female i. expensive
condom

2. Diaphragm

3. Cervical cap

4. Contraceptive
patch - nausea vomiting
- transdermal
patch

5. Contraceptive i. Convenient and

ring (NUVA ensure privacy
ring) ii. Lower
oestrogen
exposure than
COCP or
contraceptive
patch
iii.

2. Coitus interruptus

3
3. Periodic abstinence (Natural family planning)
= method of contraception keyed to observation of naturally occurring signs and symptoms of the
fertile phase of the menstrual cycle and avoiding sex during that time

4
4. Sterilization
Male Female
- vasectomy - Mini laparotomy
- Laparoscopic
- Hysteroscopic
Female Mode of action Advantage Disadvantage
1. Bilateral tubal i. 99% effective in i. difficult to
ligation the first year reverse (meant to
following procedure be
ii. Various approach PERMANENT)
ii. 33% chance of
ectopic
pregnancy if
pregnancy does
occur
iii. Exposed to
surgical
complication
iv. Costly