Harmonal Contraception

Q & A on Hormonal Contraception
By, Diepiriye S. Kuku-Siemons, MPH

1. What is meant by Hormonal Contraception? Which hormonal contraceptives are available in India?
Hormonal contraceptives are made up of single or combination female sex hormones: estrogen and progesterone. Synthetic progesterone is commonly referred to as progestin’. The most popular hormonal contraception is the Combined Oral Contraceptive pill (COC). Other hormonal contraceptives include injectables, subdermal implants that release progestins, transdermal patch, vaginal ring, and emergency contraceptive pill.
2. What is the Pill?
Combined or progestin only pills are taken daily and are an effective way to control fertility. If taken consistently and correctly, annually only one in one hundred women using the Pill would be expected to become pregnant.
For many women, especially non-smokers under 35, the benefits of the Pill outweigh the disadvantages. Modern oral contraceptive pills contain lower doses of hormones than before and have far fewer sideeffects. Since its introduction over 40 years ago, users and researchers have confirmed many non-contraceptive benefits of the pill including improved acne, regulation of heavy menstrual cycles as well as decreased risk of osteoporosis and ovarian, endometrial and colorectal cancers.
3. How does the Pill work?
During a woman’s monthly cycle, the release of hormones triggers the ovaries to release an egg. Around this time, the ovaries release further hormones, including estrogen and progesterone, designed to inhibit further conception. These are responsible for many of the changes in a woman’s body during the menstrual cycle.
The Pill mainly works by:
Preventing the ovaries from releasing an egg
Thickening the mucus at the cervix making it more difficult for sperm to enter the womb
Rendering the lining of the womb unsuitable for a fertilised egg to be implanted
4. What is meant by Combined oral contraceptives (COC)
Combined Oral Contraceptives contain a synthetic version of oestrogen – called ethinylestradiol – plus a synthetic version of progesterone, known as a progestogen. The progestogens in current pills are classed as either “second generation” (e.g. norethisterone, levonorgestrel) or “third generation” (e.g. desogestrel or gestodene).
Some brands of oral contraceptive pills are taken for 21 days, followed by a break of seven days before the next course of 21 days. The dose of the oestrogen can be either of a standard strength – 30-35 micrograms or low strength – 20 micrograms. Some products contain pills with two or three different doses of oestrogen to be taken at different times of the cycle.
For women who cannot take oestrogen-based pills, or for those who wish to avoid oestrogen, the progesterone-only pill may be an alternative. The progestogen-only pill, sometimes called the “mini pill” (inaccurately, as it is no smaller than the combined pill) is slightly less reliable than a COC, an is suitable for lactating mothers.
5. What are injectables?
The most common injectable hormonal contraceptive is Depo Prover a hormonal substance also known as DMPA (depot-medroxyprogesterone acetate) that is injected into the muscle in the upper arm or buttocks. Each injection provides contraceptive protection for up to three months without any daily hassle. Injectable hormones prevent pregnancy by suppressing ovulation (egg formation) and thickening the cervical mucous to make sperm entry difficult. In addition it also thins the endometrial lining. As a natural effect of this action, most women experience harmless menstrual cycles changes that naturally return to normal shortly after cessation of the method. /www.fwhc.org/birth-control/bcdepo.htm”>DMPA carries several non-contraceptive benefits including less anemia with no menstrual bleeding, and increased protection from certain cancers.

Depo Provera is a safe, effective, convenient, private, reversible mid-term spacing method. Professional/Regulatory bodies worldwide endorse the safety and effectiveness ofDMPA.
The WHO conducted trials and approved Depo Provera for usage as Contraceptive method in 1979, the United States FDA in 1992, and the UK FDA in 1996.
Drugs Controller of India approved it for clinical trials and usage in the 1998. The Federation of Obstetrics and Gynecological Societies of India, FOGSI approves of the WHO guidelines and continues to promote greater quality of care by insisting that health care providers inform and counsel users regarding the myriad of contraceptive choices with respect to the individual’s medical history and examination. Injectables have expanded basket of choice and its benefits outweigh the clinically insignificant side effects

6. May breastfeeding mothers use Hormonal Contraception like injectables?
DMPA does not affect the quality or quantity of breast milk and is therefore a reasonable choice for breastfeeding mothers. DMPA can be started as early as 6 weeks after delivery.
It is important to note that fully or nearly fully breastfeeding (at least 85% of the baby’s food is breast milk) before the monthly period resumes usually indicates that a woman is unlikely to become pregnant for up to six months after delivery. This natural form of birth spacing is known as the Lactational Amenorrhea Method of contraception, LAM.
7. What are the other hormonal contraceptive methods Patches and implants?
Patches
Combined hormonal contraceptives are also available as an adhesive skin patch (Evra), which is worn for three weeks out of every four.
Implant
An Implant is a narrow flexible rod about the size of a match (40mm x 2mm) that is inserted under the skin of the upper arm. The rod releases a constant amount of progestogen to give contraception for up to three years. The contraceptive effect is reversed soon after the implant is removed.
8. Should a woman stop using injectables or any other hormonal contraception because she has no menstrual bleeding for a long time (Amenorrhea)?
Menstrual cycle changes should not discourage women from exploring these methods. Amenorrhea is a normal response to injectables as well as several other hormonal contraceptives. There is no medical reason to stop using hormonal contraceptives because of amenorrhea. Moreover, absence of bleeding can make some women healthier because it helps to prevent anemia.
9. Can young women, older women, and women without children use Injectable contraceptives?
You and old women may use DMPA. A health care provider will be able to determine an individual’s eligibility given their specific case history and a current medical examination. The effects of hormonal contraceptives are completely reversible. In fact, a recent World Health Organization statement reaffirms that extended use of Depo Provera does not lead to permanent health changes. DMPA users return to normal fertility an average of 4 months after the last injection.

10. Is it a misconception that use of COC or other hormonal contraceptives run a risk of causing cancer?
Oral contraceptives have not been proved to cause any common cancer. In fact, Oral Contraceptives and DMPA/Depo Provera have been shown to help prevent two common forms of cancer: Cancer of the ovaries and cancer of the endometrium (lining of the womb). DMPA appears to be safe for women of any age. The World Health Organization declares DMPA safe, and concludes that the advantages of the method generally outweigh any theoretical disadvantage. In general, young women can use DMPA.