Contraception .................... Progestin only - TopicsExpress

Contraception .................... Progestin only contraception ......................................... Progestin only oral contraceptives: ................................................. These contraceptive pills contain only progestin and are termend as minipills. Mechanism of action - They primarily prevent conception by causing thick viscid cervical mucus. - Also increase the tubal transport time of gamete, less oppourtunity for fertilization - Can inhibit ovulation but not consistently this leads to a higher failure rate. - They cause atrophic change of the endometrium. In Lactating women: - The prolactin induced ovulation suppression leads to its efficacy. - The another reason for minipill to be an excellent method of birth control in lactation women is that it does not decrease milk volume and has no negative impact on infant growth and development. Efficacy is excellent among older woman (>40yrs) and in lactating woman. Progestin only contraception includes - Progestin only pill (POP) - Depot medroxyprogesterone acetate (DMPA) - Levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena) - Etonogestrel implant. Non contraceptive benefits of progestin only agents, includes amelioration of endometriosis, pain, treatment of specific menstrual disorders such as dysfunctional uterine bleeding and menorrhagia, protection against uterine fibroids and cancer, treatment of anemia, associated with sickle cell disease, and reduction in seizure frequency in patients with epilepsy. Adverse effects include irregular bleeding, weight gain, acne, mood changes, loss of libido, and breast tenderness. The hypoestrogenic state created by long term use of DMPA has been associated with decreased bone mineral density (BMD) in adolescents, especially those who use the method for over two years. The levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena®): The device consists of a plain Nova T device and a Silastic rod, impregnated with 52 mg levonorgestrel. The release rate of levonorgestrel is 20 mcg/24 h and the effective life span is at least 5 years. Ref: Contraception edited by Donna Shoupe, 2011, page 166.

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