FUTURE OPTIONS OF BIRTHCONTROL

CONTRACEPTION-FUTURE OPTIONS

There are several options of contraceptives studied in order to minimize the size of the dosages, frequency of the dosages, and the side effects. The major purpose of the future options also includes increasing the maximal benefits with a minimal dose or dosage frequencies, and the side effects.

Accordingly, the researches invent a synthetic hormone replicating the brain hormone Luteinizing Hormone-Releasing Hormone which 144 times more powerful than the natural parent compound. Even though in micro dosages this drug is found as a curative for infertility yet this hormone is under research in the suitably modified dose for birth control.

The hormone is acting on the luteal phase of the menstrual cycle and shortening it, and the follicular phase is elongated and the ovulation delayed. Before ovulation happened these hormones act on the uterus to develop the endometrium and other preparation to receive the ovum which actually not present at the tube. When ovulation happened the luteal phase comes to an endpoint so that the endometrium degenerate, and the uterus becomes hostile to the coming ovum, the implantation disturbed, and the menses starts.

The powerful hormone needs a micro dosage and effects will last for longer periods. Yet the disadvantage is its side effects.

Another option researched by Alabama University Researchers Norethindrone, a progestin enclosed in microcapsules for injection which can timely release the medicines from the tiny capsules. Still, it is under consideration.

The abortive drug mifepristone is also on the line of consideration as in modified dosage it is found that it can delay ovulation.

MALE CONTRACEPTION VASECTOMY

VASECTOMY

Vasectomy is an invasive method of male contraception.In his method by using a surgical operation a small incision is made at the two vasa deferentia which carries the sperm from the two epididymis of the testicles to he ejaculatory duct in anticipation to the act of ejaculation.Afer the incision the ends of the vas ducts are tied firmly to closure so that they cannot transport sperm to ejaculatory tubes.

The above picture shows the two vas ducts indicated by the two arrows from either epididymis of the testes.

In vasectomy operations the surgeon cut the tubes by incision and tie off or clamped or sealed off the tubes so that they cannot carry sperm from the testes.The operation is simple and sure.

It causes no change in hormone production and sex desires unless if he feels and depressed psychologically that he is castrated.

After vasectomy the man can carry on his usual sexual activities with his partner satisfactorily with proper erection clmax and ejaculation.But his ejaculation contains only semen the secretions of seminal vesicles and prostate without a single sperm.But this may take several months after the vasectomy because there are already produced and transported sperms are stored in the seminal vesicles which can be ejaculated with the semen and they can still make the female partner to become pregnant.Hence even after the vasectomy one should use condoms or other means of birth control until a test of ejaculate does not contains a single sperm.

The Procedure :-

 

1.Before the procedure started the area is shaved and cleaned

2.A sedative will be given orally so that the patient can sleep inorder to relieve from the trauma

3.A local anesthetic will be injected into the scrotum 

4.Each vas deferens can be located by touch.

5.Doctor will make two small incision at the areas on the scrotum.

6.Through the openings the two vasa deferentia are pulled out sufficiently and cut by scissors and sealed or stretched together of by heat applied by electrocution.The scars formed by the heat helps firm sealing.

7.After this the two ducts will be inserted back into the scrotum and the mouth of the incision would be stretched off.

The whole procedure would take hardly 20 to 45 minutes.

Even after the vasectomy the testes can able to produce sperm but all will be absorbed by the body.

Until recently it is beleived that vasectomy is an irreversible method of contraception and a man who underwent vasectomy is sterile for life.

But modern technologies are improved so that vasectomy can be reversed by surgical methods as the above video illustrates

The following videos also shows the vasectomy reversals

 

 

 

CONTRACEPTION-BARRIER METHODS

BARRIER CONTRACEPTIVE METHODS

In this post we will deal with various barrier contracepive methods such as condoms for males,cervical caps,and diaphragm for females.

Male Condoms are meant for male contraception and is more safe and convenience.Unlike invasive surgical operations like vasectomy or contraceptive drugs they are not disturbing our body health or our systemic blood circulations.They are user friendly.They cause reversible contraception.

Most importantly they give more protection from infections such as venereal diseases like syphilis,gonorrhea,and AIDS while other methods are not.

Condoms are usually made out of special latex rubber silicon which are very thin and user friendly.Latex condoms are having a natural antiviral actions against AIDS viruses and hence they give 100% protection against AIDS when compared with condoms made out of other materials.This guarantee can be given to those who use the condoms regularly but not intermittently.

Laex condoms also can give protection against herpes virus;genital ulcers,STDs such as gonorrhea,syphilis;hepatitis-B and Chlamydia.

If the male is regularly using latex condoms it is greatly reducing the chances of PIDs(Pelvic Inflammatory Disease) and Pelvic Infections (PI) by their female partners.

If used in a correct manner the condoms are giving a good record of birth control and that means if used properly condoms give pregnancy about 3 to 36% only.

Latex allergy and some other medical conditions are the restrictions for the use of latex condoms.To these patients condoms made out of natural membrane like polyurethane the one branded as Avanthi are available to protect from pregnancy but not from infections. 

Female Condoms are available such as Reality condoms. diaphragm and cervical caps for those partners among whom the male partner does not want to use male condoms.

Female condoms are made of a polyurethane sheath with flexible rings at each end.It can be inserted into either the vagina like a diaphragm or into the anus to line or cover the uterus or rectum respectively.The anal insertion is mostly ment for the homosexual male partners.When inserted it provides a barrier against semen and microbes such as HIV.If used perfectly it give approximately a 95% protection from pregnancy.But an improper use may result in a 26% increased chance of pregnancy.Another drawback is it is not so  economical.In U.S a piece of the condom costs about US$ 5 to US$ 6 or may be more.It is available in US in the brand name of Reality.

The Diaphragm

Diaphragms are the common method of female contraception.As in the above picture it is looking like a small cap or dome with an outer ring like spring at the rim.It is made out of silicon latex or natural rubber.Silicon diaphragms are more convenient and last for 10 years for re use where as rubber diaphragms are lasting for 4 to 5 years.The spring forms a seal against the wall of the vagina.During the usage after the insertion the diaphragm should be left atleast 8 hours in the vagina after the last ejaculation of the male partner during the intercourse.

The above video is embedded here purely for illustrative purposes how to use a diaphragm and cervical cap.
Cervical Cap this is also a female condom similar to diaphragm and are unlike Reality these are economical.If used properly they prevent pregnancy 82% to 94%.

The following video illustrates how to insert cervical cap

As look in the above picture these are cap like female condoms to be inserted into the vagina to cover the cervix and block sperm to enter into the uterus. 

WOMEN GYNACOLOGY-PART-X-INTRA UTERINE DEVICES

OTHER METHODS OF BIRTH CONTROL

INTRA UTERINE DEVICE or IUD is a fashioned historical method to prevent pregnancy by inserting a device into the vigina and make to to stay there to produce longer effects of contraception.

Historically it was rumored that some Arab pagans inorder to prevent the births of several calfs as a burden to their female camels they inserted small stones into their uteruses through their vagina to prevent conception.

This historical basics has been used to develop devices with higher technology.

There are two types of IUDs,the hormonal and non hormonal.The hormonal IUDs contains usually a progestin such as a slow release levonorgestrel.The other nonhormal IUDs contains a copper spring.Both the IUDs are yielding a reversible contraception.The effects of copper IUDs are longer than the hormonal IUDs.The hormonal IUDs like Mirena is found to be effective upto 5 years while as the copper IUDs can give the effects upto 7 years.

The insertion should be done by an experienced physician.

 As seen in the above figure the IUD should be correctly positioned by the help of a speculum a medical device used for inserting a device through any small opening or orifice like vagina.

Before insertion the pelvic portion should be thoroughly examined for any inflammation,injury or infection like chlamydia and gonorrhea.The position and shape of the uterus should be confirmed through the pelvic exam.

During the insertion the vagina is held open by a speculum.The cervix should be grasped by a grasping instrument.The leangth of the uterus must be measured for proper insertion.Now the IUD must be carefully inserted through the cervix by using a narrow tube into the uterus.A short narrow monofilament plastic/nylon string attached to the device should be come and hang out through the vagina for the convenience of the patient to check the IUD position later on at times.

 The above video gives an explanation of the inserting methods.

Mechanisms of Actions

1.Make uterus hostile to the fertilized ovum

2.The endometrium becomes thin and not hospitable to the ovum

3.The cervix become thick and sperm cannot penetrate it.

4.Unimportantly sometimes ovulation is retarded

Advantages:-

1.Longer effects

2.No need to take any systamic medications like pills and injections

3.Most of the released hormone from the hormonal IUDs are absorbed and stay within the uterus by leaving a negligible minute quantity into the system.

4.Reversible contraception

5.Inexpensive as they are made out of plastics.

6.The copper IUDs are totally harmless during breast feeding.But there are no known guarentee for hormonal IUDs.

7.No prior care or preparations needed before sex,but the patient has to check the string at times to ensure the device is staying in proper place.

Disadvantages:-

1.Risks of ectopic pregnancy,the pregnancy happened outside the uterus usually at the tube.

2.Irregular heavier periods and spotting

3.Menstrual cramping and back pain. 

4.Painful intercourse experienced by some women.

5.Rare but serious perforation of uterus.

6.Pelvic pain and inflammation leads to serious infections.

Conraindications:-

1.Patients who take blood hinners like aspirin,warfarin and clopidrogel

2.Those who use copper IUD must avoid exposure to microwaves or any short waves such as ultra violet radiations.

3. Teen agers and women who gave several births are commonly experiencing displacement or expulsion of the device and hence should be careful in their movements.

4.Pelvic infections

WOMEN GYNECOLOGY-PART IX-ANTI PROGESTINS

ANTIPROGESTINS-DRUGS FOR ABORTION

As we have already seen that progestins such as progesterone are the agents aiding and maintaining pregnancy.Any drug which opposes or block the actions of progesterone will result in the termination of pregnancy or abortion.

Although anti estrogens have been available since the late 1950s the first report of an antiprogestin appear only after 1981.In that year a drug which is a glucocorticoid antagonist was reported by the name RU-38486 or simply RU-486 was having some anti gestagenic properties also.Later the drug was named as mifepristone.

Although mifepristone's main use is as a terminator of early pregnancy these anti progestins also are tried for the uses as contraceptives,anti cancer drugs,and agents to induce labour.

Chemistry Structurally mifepristone is related to progesterone as a seroidal compound.It is a derivative of norethindrone (a progestin with a methyl group at the 19 th position of its steroidal structure) with a dimethyl-aminophenyl substituent at the 11-b position.

Mechanism The mechanism of action of mifepristone is that because of its similarity in chemical structure to progesterone it competitively inhibit its receptors and block the pregnancy protecting effect of progesterone  at the sensitive tissues like uterus, and thereby causes early contraction of the uterus and terminate the pregnancy.

But mifepristone when present alone in the absence of progesterone it will act as a weak progestin by acting as a partial agonist.

Mifepristone also act on the progesterone sensitive tissues of ovary.If given for a short period in the later follicular phase of the menstrual cycle,it delays ovulation by depressing LH surge.If it has been given frequently or continuously it can prevent ovulation but not in all cases.

If administered for several days in mid or late luteal phase mifepristone disturb the development of the secretory endometrium and causes menses.

Mifepristone is also having effects oncervix,myometrium,ectopic endometrial tissue,breast cancers,and meningiomas

 

WOMEN GYNACOLOGY-PART-VIII-CONTRACEPTIVE PILLS-HEALTH BENEFITS

BIRTH CONTROL PILLS-OTHER BENEFITS

The birth control pills have proved that they have some beneficial effects on the body other than their contraceptive effects.The modern studies have given some useful positive data.

The combination oral contraceptives have been well accepted over a decade for their substantial health benefits unrelated to their birth control uses.These include their beneficial effects on ovarian and endometrial cancers,a number of menstrual disorders,and many other diseases.

Oral contraceptives reduces the risks of ovarian and endometrial cancers within six months of use.The incidences of these diseases have been reduced by 50% after two years of use.More interestingly it is found that these beneficial protective effects of the oral contraceptives are persisting for 15 years after their use is stopped.These agents also beneficial by decreasing the incidences of ovarian cysts and benign fibrocystic breast disease.

Oral contraceptives also give beneficial effects on regulating menstruation,reducing blood losses,reducing the incidences of iron deficiency anemia,dysmenorrhea,and premenstrual tensions.

Also these combination pills reduces pelvic inflammation,ectopic pregnancies(pregnancy outside the uterus),and ameliorating or reducing endometriosis.

Conclusively it is beleived that combination oral contraceptives prevent thousands of deaths,episodes of various diseases and cases of hospitalizations.Hence fertility regulation by oral contraceptives is safer than pregnancy for most women.

WOMEN GYNECOLOGY-PART-VII-BIRTH CONTROL METHODS AND SAFETY

FEMALE CONTRACEPTION-PREVENTION OF PREGNANCY 

Phases of Menstrual Cycle

Normally a total menstrual cycle contains 28 days including the 7 days duration of menses.This may be varied according to some physiological variables such as genetics,obesity,weight,height and the tropical environments.Some pathological conditions also may cause variations in menstrual cycle.

The menstrual cycle depends on the stimulation and secretions of the hypohalamus-anterior pituitary axis,anterior pituitary-ovary  axis,followed by ovarian secretions which control the final and end female parts such as the uterus,the cervix and the vagina.These secretions and effects are generally in a pulsative manner. 

A normal menstrual cycle contains three phases as follows:-

Follicular Phase in which the Graafian follicles by the action of FSH (follicular stimulating hormone) from the anterior pituitary develops and grow and begin to secrete estrogens (estradiol,estriol,and estrone).This phase is composed of approximately 9 days and a slow pulsative decrease of FSH and LH occurs due to a feed back mechanism by estrogens at hypothalamus- anterior pituitary level.

Ovulation Phase which begins on the 10 th day at which a fully developed follicle separates from the ovary and shed into the lumen of the Fallopian tube.In this stage again a pulsative increase of LH occurs and in the empty space from which the ovum detached from the ovary an yellow gland known as Corpus Luteum develops by the action of LH.The duration of this phase is only one day.

Lutinizing Phase Which starts at which the ovulation completed.Lutinizing Hormone helps to develop corpus luteum at the gap left by the detached ovum.This starts almost at the midcycle and last for the rest of the period.At the seventeenth day the peak levels of esrogen and progesterone occur.The FSH level is decreased and LH level increased.
End of the cycle If no fertilization happened the carpus luteum ceased to function,after several days steroid levels drop,and menstruation occurs.The luteal phase is thus controlled by the limited 14 days life time of corpus luteum.The entire sysem then resets and a new menstrual cycle occurs.

Hormonal Conraceptions

Prelude 1.These are the most effective drugs
2.A variey of hormonal derivatives with different combinations,doses and side effects are available.
3.These drugs are mostly used by young and healthy people to prevent pregnancy.
4.In addition to their contraceptive effects these medicines also have substantial health benefits.
5.Because of use of different compounds in different combinations and strengths and in different doses no one can compare or extrapolate the side effects with that of the hormone replacement therapies.

Types

1.Combination Oral Contraceptives

These compounds mostly contains an estrogen with a progestin.These combination have the benefit of reducing the side effects of both estrogens and progestins to a minimum and giving about of 99.9% increase in benefits.

The estrogens used are commonly ethynyl estradiol and mestranol. Among this ethynylestradiol is the most frequently used.

The progestins used are mostly 19 nor progestins(nor,means methyl)

The side effects of the progestins are depending on their androgenic.estrogenic and their anti-estrogenic activities.

Desogestrel and Norgesimate are the most recently developed progestins and have less side effects than the other 19 nor compounds.

These compounds are available as three phasic preparations as :- 1)Monophasic acting on any one of the three phases of the cycle.Comes in 21 days packings.

Contains equal quatities of esrogens and progestins are presnt in each pill which is taken 1 tablet daily for 21 days with a 7 days pill free period.Excempted by some packings which contains 28 pills with the 7 day pills contains no active ingredients.

Examples of Monophasics

1.Ethynylestradiol /Norethindrone combinations contains ethynylestradiol ranges from 0.020 to 0.050mg;   norethindrone acetate as progestin in various amounts ranges from 0.4 to 1.5 mg according to the brands

2.Ethynylestradiol /Levonorgestrel combination contains levonorgestrel 0.15 mg

3.Ethynylestradiol / Norgestrel contains norgestrel 0.3 and 0.5 in different brands

4.EthynylestrEthynylestradiolne diacetate combination contains the ethynodione diacetate 1 mg

5.Mestranol /Norethindrone combinations contains norethindrone 1 mg.

6.Ethynylestradiol / Desogesrel combinations contains desogesrel 0.15 mg.

7.Ethynylestradiol / Norgestimate combinations contains norgestimate 0.25 and 0.5 mg

2.Biphasics are acting on any two of the menstrua phases.They provide two different pills contains variying amount of active ingredients to be taken at different times during he 21 day cycle.This reduces the total amount steroids administered and thereby reduces their side effects.The amount variations of the steroids closely approximate the variations of steroids secreted in phases.For example generally the ratio of estrogen to progeserone higher in luteal phase and hence the amount of progestins can be reduced conveniently.These methods are developed in late 1980.

Examples of Biphasics

1.Ethynylestradiol / Norethindrone combinations contains 0.035 mg/5 mg in 10 tablets and 0.035 mg/1mg in 11 tablets in the brand NELOVA 10/11 and 0.035mg/0.5mg in 7tablets and 0.35mg/1mg in 14 tablets.in the brand JENSET-28

Triphasic these preparetions are acting on all three phases similar to biphasic their formula provides the amount of steroids according to the occuring during the phases.

Examples of the Triphasics

1.Ethynylestradiol/Norethindrone combination contains in all preparations the ratio of  ethynylestradiol  is 0.035mg  to the ratio of the norethindrone ranges from 0.5,0.75 and 1 mg in 7,7,7 tablets in one pack respectively according to the three phases to be taken as in ORTHONOVUM 7,7,7 

2.Ethynylestradiol/Norgestimate combination contains the amount of esradiol is 0.035mg to the ratio to norgestimate 0.18,0.215,0.25mg in 7,7,7 tablets per pack as in ORTHO-TRYCYCLIN
Remember that any pills which contains >50 microgram of estrogen is known as high dosed and if it contains <50 microgram is considered as low dosed.The lower limit is =20mic.gm.

2.Progestin Only Conraceptives

These combination has been deviced for particularly to whom estrogens are contra indicated like heart patients with high blood pressure and thrombo embolic diseases and breast cancer  etc.

Eventhough they are less efficacious they are widely used.

These agents block ovulations but less consistantly than combination tablets,suggesting that the they have some other additional mechanisms.

Preparation include the minipill  or the oral preparations of low dose progestins.These has to be taken daily without interrution;subdermal implants of 216 norgestrel as in NORPLANT is available for slow release and for a prolonged duration (for 5 years)

An Intra Uterine Device (Progestasert) that releases low amount of progestin locally is available to be used on yearly basis.

Examples of Progesin Only Contraceptives

Norethindrone as 0.35 mg is available for oral use as in MICRONOR AND NOR-QD

Norgesrel as 0.075 available as in OVERETTE

Postcoital Contraceptives  

These are available for preventing pregnancy decided on an emergency situation within 72 hours afer an unprotected coitus or intercourse.

1.Ethynylesradiol 100 micro gram combined with 1 mg Norgesrel to be taken twice 12 hour apart but initiated within 72 hours afer intercourse.

2.Ethynylestradiol alone in a dose of 2.5mg twice daily for 5 days initiated within 72 hours of the intercourse.

3.Conjugated estrogens 30 mg daily for 5 days.started within 72 hrs ater coitus.

4.Estrone with a dose of 5 mg three times daily for 5 days initiated within 72 hrs afer the coitus

5.Diethylstilbestrol 25 mg twice daily for 5 days but this regimen is largely reduced because of its side effects.

Among all the above the laest regimen successfully employed is the estradiol- norgestrel combination which is low dosed and more effective and safe provided that the regimen should be initiated within 72 hrs ater the intercourse.

The mechanism is unclear but beleived to be the delay in tubal transportation or development of endometrium hostile to implantation.

These high doses of estrogens frequently causes side effects such as

1.Head aches

2.Dizziness

3.Nausea

4.Vomiting

Because of the frequency and severity the above side effects Post Coital Contraceptives are in appropriate in many situations

Mechanisms of Actions

1.Combination Oral Contraceptives

These are mainly act by preventing ovulation by suppressing FSH and LH.

2.Progestin Only Preparations

Block ovulation similar to combination pills but less efficacious.These are largely acting on hypothalamus-anterior pituitary axis and suppressing Gonadotropin Releasing Hormone pulses.Also thickening of cervix to prevent the entry of sperm,and endometrial alteration to hostile the implantation of the ovum into the uterus are also the action of these preparations to avoid pregnancy.3
In general the women if she take the pill without forgot daily the she had the contraceptive protection well . 

Toxicities of Oral Hormonal Contraceptives

1.Formations of Blood Clots

2.Increased risks of Breast Cancer but this is questionable as convincing reports are suggesting that these compounds are reducing the incidences of endometrial and breast cancers especially by combination oral preparations.

3.Breast tenderness.

4.Headache

5.Gallstones

6.Acne

7.Weight gain.

8.Irregular,unpredictable breakthrough bleeding which leads to amenorrhea after 1 year use.(Typical to progestin alone contraceptives)
9.Visual problems
10.Non cancerous liver tumor

Contraindications

1.Pregnancy

2.History of Thrombo embolism 

3.Coronary Artery Disease like Angina,and MI

4.Central vascular disease

5.Congenital Hyperlipidemia
6.Breast or endometrial cancer
Drug Interactions
1.Contraceptive pills and smoking are disasterous as nicotine intracts with the hormones so seriouly.
2.Anti convulsants such as phenytoin (Dilantin),barbiturates and rifampin are all make the pill less potent 
3.Antibiotics such as Penicillins,tetracyclins,doxycyclins,and antifungal griseofulvin also will eliminate the contraceptive hormones very fast from our body and the pills ineffective.
The oralcontraceptives does not give any protections against sexually transmitted infections.

LONG ACTING CONTRACEPTIVE HORMONES

These methods are giving a convenience and no need to rely on daily doses of the pill without forgot

Medroxyprogesterone acetate is available in ijection form  by the trade name Depo-Provera and can give a 4 years contraceptive protection for a woman.The injection site should not be rubbed and massaged to keep the absorption to delay inorder to prolong the effect.
Breast cancer is more common in youngers below 27 years and less common in women above 35 years.
Contraception can easily be reversed after withdrawal of the drug in lean body than a fatty woman