Drugs are available that decrease fertility by

prevention ovulation impairing gametogenesis or gamet maturation

interfering with gestation

The most common pharmacologic intervention:

Interference with ovulation

Two types of preparations are used for oral contraception: (1) combinations of estrogens and progestins (2) continuous progestin therapy only The combination agents are further divided into

Monophasic forms Biphasic or triphasic forms SC Implant

Norgestrel/etonogestrel IM Injection Large doses of medroxyprogesterone

Progestin implant

Postcoital contracea ption

Progestin pill
Combina tion pill

Combinations of estrogens and progestins

selective inhibition of pituitary function that results in inhibition of ovulation

produce a change in the cervical mucus, uterine endometrium, motility and secretion in the uterine tubes

The continuous use of progestins alone:

does not always inhibit ovulation

decrease the likelihood of conception and implantation.

 Nausea, mastalgia, breakthrough bleeding, and edema Changes in serum proteins and endocrine function Headache is mild and often transient Withdrawal bleeding

Breakthrough bleeding Weight gain Increased skin pigment. Acne Hirsutism Ureteral dilation Vaginal infections Amenorrhea

Thromboembolism MCI CVD Gastrointestinal Disorders (cholestatic jaundice) Endometrial and ovarian cancer

The progestin implant are extremely effective, and last for 56 years (Norplant) or 24 years (Implanon). The low levels of hormone have little effect on lipoprotein and carbohydrate metabolism or blood pressure. The disadvantages include the need for surgical insertion and removal of capsules and some irregular bleeding rather than predictable menses. An association of intracranial HT. Patients experiencing headache or visual disturbances should be checked for papilledema.

Contraception with progestins is useful in patients with hepatic disease, hypertension, psychosis or mental retardation, or prior thromboembolism.
The side effects include headache, dizziness, bloating and weight gain of 12 kg, and a reversible reduction of glucose tolerance.