Hormonal contraceptives intrauterine

Rivera R, Yacobson I, Grimes D. The mechanism of action of hormonal contraceptives and intrauterine contraceptive devices. Am J Obstet Gynecol. 

Women receiving anticonvulsants for a seizure disorder require special attention with regard to hormonal contraception. Giving a hormonal contraceptive concomitantly with phenobarbital, carba-mazepine, or phenytoin reduces the contraceptive s efficacy, and many anticonvulsants (e.g., phenytoin) are known teratogens. The use of condoms in conjunction with high-estrogen OCs, injectable progestin-only contraceptives, or intrauterine devices may be considered for these women. ... 

Ectopic as well as intrauterine pregnancy may occur in contraceptive failures. Lactation Hormonal contraceptives may interfere with lactation, decreasing both the quantity and the quality of breast milk. A small amount of OC steroids is excreted in breast milk. A few adverse effects on the nursing infant have been reported, including jaundice and breast enlargement. 

There are numerous choices of contraception for women, and the efficacy and costs of each must be balanced when giving advice, both to the individual and to the community at large. Hormonal contraception is still the most effective method of fertility control, and in this section only hormonal contraception will be considered. However the relative merits of other methods such as intrauterine contraceptive devices (lUCDs), condoms, and vaginal or cervical caps should be kept in mind as alternatives. Condoms in particular have important advantages in limiting spread of sexually transmitted disease. 

Only one implantable contraceptive preparation is available at present in the USA. Etonogestrel, also used in some oral contraceptives, is available in the subcutaneous implant form listed in Table 40-3. Several hormonal contraceptives are available as vaginal rings or intrauterine devices. Intramuscular injection of large doses of medroxyprogesterone also provides contraception of long duration. 

French RS, Cowan FM, Mansour DJ, Morris S, Procter T, Hughes D, Robinson A, Guillebaud J. Implantable contraceptives (subdermal implants and hormonally impregnated intrauterine systems) versus other forms of reversible contraceptives two systematic reviews to assess relative effectiveness, acceptability, tolerability and cost-effectiveness. Health Technol Assess 2000 4(7) 1-107. 

A non-hormonal approach to emergency contraception is insertion of an intrauterine contraceptive device up to 7 days after ovulation in a cycle during which unprotected intercourse has occurred (13). 

In another study of the LNG-IUS in 200 young nulli-parous women, half of whom received the intrauterine system and the remainder an oral contraceptive for 1 year, 20% of those in the LNG-IUS group withdrew, one-third because of pain the adverse effects in the oral group, in which 28% withdrew, were hormonal (53). 

Wildemeersch D, Schacht E, Wildemeersch P. Performance and acceptability of intrauterine release of levonorgestrel with a miniature delivery system for hormonal substitution therapy, contraception and treatment in peri- and postmenopausal women. Maturitas 2003 44 237 15. 

Kaunitz AM. Beyond the pill new data and options in hormonal and intrauterine contraception. Am J Obstet Gynecol. 2005 192 998-1004. 

Use of spermicides in the vagina (They are used in combination with barrier methods. This is strictly chemical rather than hormonal contraception as also are intrauterine devices that contain copper, which is gametocidal). 

Spermicidal condoms emd intrauterine devices (lUDs) contmning copper or a hormone are medicines, whereas non-spermicidal condoms and other barrier-type contraceptives (e.g., diaphragms) cire medical devices. 

An innovative progesterone-containing device (Progestasert) has been made available as a long-lasting intrauterine contraceptive. It contains 38 mg of the drug in a silicone oil solution, which on proper insertion releases 63 jig of progesterone per 24 hours for periods up to 1 year. The contraceptive effects of the device itself (an intrauterine device, IUD) is believed to be enhanced by the hormone s local effect on the endometrium. 

The oral contraceptives are of two main types the combined hormonal contraceptives containing both an oestrogen and a progestogen (monophasic, biphasie, triphasie, or sequential), available as tablets or a patch, and the progestogen-only contraceptives, which are available as tablets (sometimes ealled mini pills), parenteral preparations (implants, depot injections) and intrauterine devices. 

The most well known commercial reservoir controlled release systems deliver hormones for contraception from hydrophobic polymers. The Norplant subcutaneous device controls the release of levonorgestrel with silicone rubber, and the Progestasert intrauterine device (lUD) releases progesterone from reservoir devices of ethylene vinyl acetate. In the field of insecticides, reservoir dispensers called BioLure were developed to provide zero-order release ofinsect pheromones to disrupt mating (Smith et al, 1983). The dispenser consists of a slab configuration with a rate-controlling membrane, with constant release described by Eq. 1. 

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