Family Planning

There are several methods of contraception that used in family planning. This section will review about hormonal contraceptive.

Hormonal contraceptive provides women with a reliable method of regulating their fertility. Hormonal contraceptive are available as oral preparations, subcutaneous implantation, and intramuscular injection.

Oral preparations include a combined oral contraceptive which contains combination of hormones (estrogen and progestogen), contraceptive which only contains one hormone (progestogen), and postcoital contraception which consists of high-dose estrogen alone or combined with a progestogen.

Combined oral contraceptive agents are effective and safe method of contraception. It inhibits ovulation and induces changes in cervical mucus and the endometrium that make sperm transport and implantation of the embryo, respectively, unlikely. The drug is taken daily for 21 days, followed by 7 days without treatment.

Oral contraceptive containing only progestogen also inhibits ovulation and makes cervical mucus hostile to the transport of sperm, but less effective than combined oral contraceptives in preventing pregnancy. This estrogen-free method of contraception is taken daily and its use is often restricted to women whose fertility is already reduced, such as older or lactating women in whom a combination oral contraceptive is contraindicated.

Contraceptive containing only progestogens also can be given intramuscularly or implanted subcutaneous. The implant consists of non-biodegradable silicone-rubber capsules and is designed to be replaced at certain period of time.

Post coital contraception reduces the risk of pregnancy after unprotected intercourse but must be taken within 72 hours after intercourse.

The risk of cardiovascular disease associated with the use of combined oral contraceptives in premenopausal women probably results from thrombogenesis. The risk of which is related to many variables, not only serum lipoprotein concentration but also changes in procoagulants and platelet aggregation. These changes are probably important only in women who smoke, since smoking also increases the risk of thrombogenesis. The combined oral contraception is safe in women who do not have preexisting disease of the circulatory system. It is preferable that the women do not smoke.

Combined oral contraceptives cause hypertension in about 4-5% of normotensive women and increase blood pressure in 9-16% of women with preexisting hypertension. The risk is related to race, family history, obesity, diet, smoking, and the duration of the use of the drug. The effect is almost always reversible. Monitoring blood pressure during the first three months of use can help to identify affected women.

Contraception with progestogen alone have fewer systemic side effects but associated with disturbances in menstruation, particularly irregular bleeding.

Overall, the current methods of hormonal contraception have been in clinical use for decades and have proved to be highly reliable and acceptable to millions of women. The health benefits of these methods outweigh their side effects and risks.