Hormonal contraceptives refers to birth control methods that work on the endocrine system. Almost all methods consist of steroid hormones, although in India a selective estrogen receptor modulator is marketed as a contraceptive. The original hormonal method - combined oral contraceptive pills - was first marketed as a contraceptive in the 1960s. Over the next decade many other delivery methods have been developed, although oral and injecting methods are by far the most popular. Overall, 18% of the world's contraceptive users rely on hormonal methods. Hormonal contraception is very effective: when taken on a prescribed schedule, steroid hormone user users experience a pregnancy rate of less than 1% per year. Pregnancy rates of perfect use for most hormonal contraceptives are usually about 0.3% or less. Currently available methods can only be used by women; the development of male hormone contraception is an active area of ​​research.
There are two main types of hormonal contraceptive formulations: a combined method containing estrogen and progestin, and a progestogen-only method containing only progesterone or one of its synthetic analogs (progestin). The combined method works by suppressing ovulation and thicken the cervical mucus; whereas the progestogen method alone reduced the frequency of ovulation, much more dependent on changes in cervical mucus. The incidence of certain side effects differs for different formulations: for example, breakthrough bleeding is much more common with progestogen alone. Certain serious complications occasionally caused by estrogen-containing contraceptives are not believed to be caused by progestogen alone: ​​deep vein thrombosis is one such example.
Video Hormonal contraception
Medical use
Hormonal contraceptives are primarily used for the prevention of pregnancy, but are also prescribed for the treatment of polycystic ovary syndrome, menstrual disorders such as dysmenorrhea and menorrhagia, and hirsutism.
Polycystic ovary syndrome
Hormonal treatments, such as hormonal contraceptives, often reduce symptoms associated with polycystic ovary syndrome. Birth control pills are often prescribed to reverse the effects of excessive androgen levels, and decrease ovarian hormone production.
Dysmenorrhea
Hormonal birth control methods such as birth control pills, contraceptive patches, vaginal rings, implant contraceptives, and hormonal IUDs are used to treat cramps and pains associated with primary dysmenorrhea.
Menorrhagia
Oral contraceptives are prescribed in the treatment of menorrhagia to help regulate the menstrual cycle and prevent prolonged periods of menstrual bleeding. Hormonal IUD (Mirena) releases levonorgestrel which dilutes the uterine lining, prevents excessive bleeding and loss of iron.
Hirsutism
Birth control pills are the most commonly prescribed hormonal treatments for hirsutism, because they prevent ovulation and decrease androgen production by the ovaries. In addition, estrogen in the pill stimulates the liver to produce more proteins that bind to androgens and reduce their activity.
Effectiveness
Modern contraceptives using steroid hormones have perfect use or methods failure rates of less than 1% per year. The lowest failure rate is seen with Jadelle and Implanon implants, at 0.05% per year. According to Contraception Technology , none of these methods have a failure rate greater than 0.3% per year. SERM ormeloxifene is less effective than steroid hormone methods; research has found a perfect rate of failure to approach close to 2% per year.
Long working methods such as implants and IUSs are user-free methods. For user-free methods, the typical failure rate or actual-usage is the same as the failure rate of the method. Methods requiring routine user action - such as taking a pill every day - have a typically higher failure rate than a perfect failure rate. Contraceptive Technology reports a typical 3% annual failure rate for Depo-Provera injection, and 8% per year for most other dependent-dependent hormonal methods. Although no major research is undertaken, it is expected that newer methods that require less frequent actions (such as patches) will result in higher user compliance and therefore lower typical failure rates.
Combined vs. progestogen alone
While unexpected breakthrough bleeding is a possible side effect for all hormonal contraceptives, it is more common with progestogen alone formulations alone. Most COCPs, NuvaRing, and contraceptive patching regimens incorporate a placebo or weekly rest that causes regular withdrawal bleeding. While women who use combined injectable contraceptives may have amenorrhea (less menstruation), they usually have predictable bleeding comparable to women using COCPs.
Although high-quality research is lacking, it is believed that estrogen-containing contraceptives significantly decrease the quantity of milk in lactating women. Progestogen contraceptives alone are not believed to have this effect. In addition, while overall progestogen-only pills are less effective than other hormonal contraceptives, the additional contraceptive effects of breastfeeding make them highly effective in breastfeeding women.
While combined contraceptives increase the risk for deep venous thrombosis (DVT - blood clotting), progestogen contraceptives alone are not believed to affect DVT formation.
Maps Hormonal contraception
Side effects
Cancer
There is a combined effect of combined hormonal contraceptives at various cancer levels, with the International Agency for Research on Cancer (IARC) states: "It is concluded that, if the associations reported are causal, the excess risk for breast cancer is related to the general pattern of use the combination of current oral contraceptives is very small. "and also says that" there is also convincing evidence that this agent has a protective effect against ovarian and endometrial cancer ":Cardiovascular Disease
Combined oral contraceptives may increase the risk of certain types of cardiovascular disease in women with pre-existing conditions or an increased risk of cardiovascular disease. Smoking (for women over 35 years), metabolic conditions such as diabetes, obesity and family history of heart disease are all risk factors that may be exacerbated by the use of certain hormonal contraceptives.
Blood Clots
Hormonal contraceptive methods are consistently associated with the risk of developing blood clots. However, the risks vary depending on the type of hormone or birth control method used.
Depression
There is a growing body of research evidence that investigates the relationship between hormonal contraception, and the potential adverse effects on women's psychological health. Findings from a large Danish study of one million women (followed up from 2000-2013) were published in 2016, and reported that the use of hormonal contraceptives was associated with a statistically significant increase in the risk of depression, especially among adolescents. In this study, women who only took progestogen-only pills, 34% were more likely to be given a first depression diagnosis or to take anti-depressants, compared to those who did not use hormonal contraceptives. Similarly, in 2018, another large cohort study in Sweden with women aged 12-30 (n = 815.662) found an association between hormonal contraception and the use of psychotropic drugs, especially among adolescents (ages 12-19). These studies highlight the need for further research into the relationship between hormonal contraception, and adverse effects on the psychological health of women.
Type
There are two major classes of hormonal contraceptives: combined contraceptives contain estrogen (usually ethinylestradiol) and progestin. The only progestogen contraceptive contains only progesterone or synthetic analogs (progestin). Also marketed is ormeloxifene; while not a hormone, ormeloxifene acts on the hormonal system to prevent pregnancy.
Combined
The most popular form of hormonal contraception is the oral contraceptive pill known as pill . Taken once a day, most commonly for 21 days followed by a seven day break, although other regimens are also used. For women who do not use ongoing hormonal contraceptives, COCP may be taken after sexual intercourse as emergency contraception: this is known as the Yuzpe regimen. COCPs are available in various formulations.
The contraceptive patch is applied to the skin and worn continuously. A series of three patches are charged for one week each, and then the user takes a week's break. NuvaRing is used in the vagina. A ring is worn for three weeks. Once deleted, the user needs to rest a week before entering a new ring. Like COCP, other regimens may be used with contraceptive or NuvaRing patches to provide long-cycle combination hormonal contraceptives.
Several combined injectable contraceptives can be administered as one injection per month.
Progestogen-only
Progestogen only pill (POP) is taken once per day in the same three-hour window. Several different POP formulations are marketed. Low dosage formulations are known as minipill . Unlike COCP, progestogen-only pills are taken only daily without rest or placebo. For women who do not use ongoing hormonal contraceptives, progestogen-only pills can only be taken after sexual intercourse as emergency contraception. There are a number of special products sold for this purpose.
Intrauterine hormonal contraception is known as intrauterine system (IUS) or Intrauterine Devices (IUD). IUS/IUD should be inserted by health professionals. Copper IUD contains no hormones. While copper-containing IUDs can be used as emergency contraceptives, IUS has not been studied for this purpose.
Depo Provera is an injection that provides three months of contraceptive protection. Noristerat is another shot; it is given every two months.
Contraceptive implants are inserted under the upper arm skin, and contain only progesterone. Jadelle (Norplant 2) consists of two stems that release the low-dose hormone. This is effective for five years. Nexplanon has replaced previous Implanon and is also a single rod that releases etonogestrel (similar to natural body progesterone). The only difference between Implanon and Nexplanon is that Nexplanon is an opaque radio and can be detected with x-rays. This is necessary for the case of implant migration. This is effective for three years and is usually done in the office. This is more than 99% effective. It works in 3 ways: 1. Prevents ovulation - usually eggs are immature 2. thickens the cervical mucus so as to prevent sperm from reaching the egg 3. If 2 fails, the last one is progesterone causing the lining of the uterus to become too thin for implantation.
Ormeloxifene
Ormeloxifene is a selective estrogen receptor modulator (SERM). Marketed as Centchroman, Centron, or Saheli, it is a pill taken once a week. Ormeloxifene is legally available only in India.
Action mechanism
The effects of hormonal agents on the reproductive system are complex. It is believed that combined hormonal contraceptives work primarily by preventing ovulation and thicken cervical mucus. Progestogen contraceptives alone can prevent ovulation, but rely more on the thickening of cervical mucus. Ormeloxifene does not affect ovulation, and the mechanism of action is poorly understood.
Combined
Combined hormonal contraception was developed to prevent ovulation by suppressing gonadotropin release. They inhibit follicle development and prevent ovulation as the main mechanism of action.
Progestogen negative feedback decreases the frequency of the release of the gonadotropin-releasing hormone (GnRH) by the hypothalamus, which decreases the release of follicle stimulating hormone (FSH) and greatly decreases the release of luteinizing hormone (LH) by the anterior pituitary. A decrease in FSH levels inhibits follicle development, preventing elevated levels of estradiol. Negative feedback of progestogen and lack of estrogen positive feedback on LH release prevents mid-cycle LH spikes. Inhibition of follicular development and the absence of LH waves prevent ovulation.
Estrogen was initially included in oral contraceptives for better cycle control (to stabilize the endometrium and thereby reduce the incidence of breakthrough bleeding), but also found to inhibit follicle development and help prevent ovulation. Negative feedback of estrogen in the anterior pituitary greatly decreases the release of FSH, which inhibits follicle development and helps prevent ovulation.
Another major mechanism of action of all progestogen-containing contraceptives is inhibition of sperm penetration through the cervix to the upper genital tract (uterus and fallopian tubes) by reducing the number and increasing the viscosity of cervical mucus.
Estrogens and progestogens in combined hormonal contraceptives have other effects on the reproductive system, but these have not been shown to contribute to the efficacy of their contraceptives:
- Decreased tubal motility and egg transport, which can interfere with fertilization.
- Endometrial atrophy and changes in metalloproteinase content, which may inhibit sperm motility and viability, or theoretically inhibit implantation.
- Endometrial edema, which can affect implantation.
The evidence is not sufficient on whether endometrial changes can actually prevent implantation. The mechanism of action is so effective that the possibility of conception during the use of combined hormonal contraceptives is very small. Since pregnancy occurs despite endometrial changes when the main mechanism of action fails, endometrial changes are unlikely to play an important, if any, role in the observed effectiveness of combined hormonal contraceptives.
Only progestogen
The mechanism of action of progestogen contraceptives depends only on progestogen activity and dosage.
Low single dose progestogen contraceptives include traditional progestogenic pills, Jadelle subdermal implants and Mirena intrauterine systems. This contraception inconsistently inhibits ovulation in ~ 50% cycles and relies primarily on their progestogenic effects thicken cervical mucus and thus reduce sperm viability and penetration.
Single-dose progestogen contraceptives, such as Cerazette's only progestogen-only pills (or subdermal implant implants), allow some follicular development but are much more consistent in inhibiting ovulation in 97-99% cycles. The same cervical mucus changes occur as low-dose progestogens.
High-dose progestogen contraceptives, such as Depo-Provera and Noristerat injections, actually inhibit follicular development and ovulation. The same cervical mucus changes occur with very low doses and medium dose progestogens.
In anovulatory cycles use only progestogen contraceptives, thin endometrium and atrophy. If the endometrium is also thin and atrophy during the ovulatory cycle, this could theoretically impair the implantation of the blastocyst (embryo).
Ormeloxifene
Ormeloxifene does not affect ovulation. It has been shown to increase the rate of blastocyst development and to increase the rate at which the blastocyst is removed from the fallopian tube to the uterus. Ormeloxifene also suppresses proliferation and decidualization of the endometrium (endometrial transformation in preparation for possible embryonic implantation). While they are believed to prevent implantation rather than fertilization, exactly how these effects operate to prevent pregnancy are not understood.
Frequency of use
Pills - combination and progestogen alone - are the most common forms of hormonal contraception. Worldwide, they account for 12% of contraceptive use. 21% of reversible contrast tool users choose COCP or POPs. Pills are very popular in more advanced countries, where they account for 25% of contraceptive use.
Injectable hormonal contraception is also used by most - about 6% - of contraceptive users in the world. Other hormonal contraceptives are less common, accounting for less than 1% of contraceptive use.
History
In 1921, Ludwig Haberlandt demonstrated a temporary hormonal contraceptive in a female rabbit by grafting the ovaries of a second pregnant animal. In the 1930s, scientists have isolated and determined the structure of steroid hormones and found that high-dose androgen, estrogen, or progesterone inhibits ovulation. A number of economic, technological and social barriers must be addressed before the development of the first hormonal contraceptive, combined oral contraceptive pill (COCP). In 1957 Enovid, the first COCP, was approved in the United States for the treatment of menstrual disorders. In 1960, the US Food and Drug Administration approved an application that enabled Enovid to be marketed as a contraceptive.
The first progestogen contraceptive was introduced in 1969: Depo-Provera, a high-dose progestin injection. During the next one and a half decades, other types of progestogen-only contraceptives were developed: low-dose progestogen (1973) pills; Progestasert, the first hormone replacement tool (1976); and Norplant, the first contraceptive implant (1983).
Combined contraception has also been available in various forms. In 1960 several contrast injectable contraceptives were introduced, mainly Injectable Number 1 in China and Deladroxate in Latin America. The third combined injection, Cyclo-Provera, was redefined in the 1980s by lowering the dose and renamed Cyclofem (also called Lunelle). Cyclofem and Mesigyna, another formulation developed in 1980, was approved by the World Health Organization in 1993. NuvaRing, a contraceptive vaginal ring, was first marketed in 2002. 2002 also saw the launch of Ortho Evra, the first contraceptive patch.
In 1991, ormeloxifene was introduced as a contraceptive in India. While acting on a hormonal system, this selective estrogen receptor modulator is not a hormone.
See also
- Reproductive Health Coalition
- Male hormonal contraception
- Progestogen alone injection contraceptives
- oral contraceptives containing Estradiol
- List of progestogen available in the United States
- List of estrogens available in the United States
Footnote
Source of the article : Wikipedia
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