Male and Female Hormonal Contraception

Male and Female Hormonal Contraception.

Introduction. Many elements need to be considered by women, men, or couples at any given point in their lifetimes when choosing the most appropriate contraceptive method. These elements include safety, effectiveness, availability and acceptability. Voluntary informed choice of contraceptive methods is an essential principle, and contraceptive counseling, when applicable, might be an important contributor to the successful use of contraceptive methods. IN choosing a method of contraception, dual protection from the simultaneous risk for HIV and other STDs also should be considered. Although hormonal contraceptives are highly effective at preventing pregnancy, they do not protect against STDs, including HIV. Consistent and correct use of the male latex condom reduces the risk for HIV infection and other STDs, including chlamydial infection, gonococcal infection, and trichomoniasis..

Female hormonal contraception. The hormones used to prevent conception include estrogen and progestins (drugs similar to the hormone progesterone). Hormonal methods prevent pregnancy mainly by stopping the ovaries from releasing eggs or by keeping mucus in the cervix thick so that sperm cannot pass through the cervix into the uterus. Thus, hormonal methods prevent the egg from being fertilized. All hormonal methods can have similar side effects and restrictions on use..

Contraceptive hormones can be:. Taken by mouth (oral contraceptives) Inserted into the vagina (vaginal rings or barrier contraceptives) Applied to the skin (patch) Implanted under the skin Injected into muscle.

First oral contraceptive:. Combination tablets: that contain both estrogen and progestin are typically taken once a day for 21 to 24 days, not taken for 4 to 7 days (allowing the menstrual period to occur), then started again. Inactive (placebo) tablets are usually taken for the days when combination tablets are not taken to establish a routine of taking one tablet a day. They are classified as monophasic, biphasic, triphasic, Quadra phasic pills. The classification depends on the progestin dose. Monophasic pills have the same dose of estrogen and progestin in all active pills. The others have different concentrations of estrogen and progestin varying throughout the pack. Patients sensitive to changes in hormone levels (suffer from headaches, acne, premenstrual dysphoric disorder) should be treated with a monophasic regimen. Progestin-Only Pills: are taken every day of the month at the same time of day. They often cause irregular bleeding. Pregnancy rates with these tablets and with combination tablets are similar. Progestin-only tablets are usually prescribed only when taking estrogen may be harmful. If more than 27 hours go by between tablets, women should use a backup contraceptive method for the next 7 days in addition to taking the progestin-only contraceptive each day..

The contraceptive patch : is a small sticky patch that releases hormones into body through skin to prevent pregnancy. The patch releases a daily dose of hormones through the skin into the bloodstream to prevent pregnancy. It contains the same hormones as estrogen and progestogen that works in the same way by preventing ovulation. It makes the cervical mucus thick, as it more difficult for sperm to move through the cervix and thins the womb lining so a fertilized egg is less likely to be able to implant itself. It’s applied for 7 days then changed in day 8 , every week for 3 weeks, and a patch-free week. Though this week woman may get a withdrawal bleed, like a period but it’s not always happened. After patch-free week new patch is applied and start the cycle again. It’s directly stock onto the skin onto most areas of body, as long as the skin is clean, dry and not very hairy. Contraceptive injection : . A progestin called medroxyprogesterone acetate is injected by a health care practitioner once every 3 months. Its injection may be given immediately after a miscarriage, an abortion, or delivery of a baby. If the interval between injections is more than 4 months, a pregnancy test is done to rule out pregnancy before the injection is given. If women do not get the first injection within 5 to 7 days after their period starts, they must use a backup method of contraception for 7 days after they get the injection There are two types of contraceptive injections available. One is injected into a muscle of the arm or buttock and the other is injected under the skin. Each type is very effective. If women get the injections as instructed, only about 0.2% of them become pregnant during the first year of use. With typical use the way most people use with delays between injections about 6%become pregnant..

SUBDERMAL PROGESTAGEN IMPLANTS : A subdermal implant is made from a non-biodegradable polymer which contains an active slow release progestogen formulation and is about the size of a matchstick. It is placed subdermally by a special introducer, and will provide contraception for almost 3 years, mainly via inhibition of ovulation. About 20% of women will have amenorrhoea within three months, while up to 50% will have frequent or prolonged cycles. implants are not associated with significant weight changes, mood changes, or loss of libido, but their side effects cannot be easily dealt with owing to their prolonged slow hormone release. Vaginal Contraceptive Ring VCR : The ring is introduced vaginally by the patient by the end of the menstrual period, left for 3 weeks then removed followed by a 7-day ring free period, to allow for menstruation. The mode of action of VCR is similar to that for the COC pills without the need for daily intake owing to its slow hormone release that is readily absorbed from vaginal mucosa, giving an additional benefit of bypassing the first hepatic absorption..

Male hormonal contraception. Despite increases in female contraceptive options, 40–45% of pregnancies across the world are still unplanned. While several effective female contraceptive methods have been developed, contraceptive choices for men are still limited to the male condom with its high failure rates and to vasectomy, which are invasive and not reliably reversible. The availability of male hormonal contraceptives would give men the chance to have control over their own fertility. Among the different approaches to control male fertility, hormonal contraception is the closest to possible clinical application..

Action mechanism of male hormonal contraception. The following diagram illustrates the main mechanism of the male hormonal contraception:.

Hormonal contraceptive injectable regimes using testosterone only: Testosterone enanthate : C linical trials in the 1970s using short-acting testosterone formulations such as testosterone enanthate (TE). These studies demonstrated that intramuscular administration of TE suppresses sperm concentration to very low levels and can induce suppression of spermatogenesis (to azoospermia or severe oligozoospermia) in men. The study demonstrated that azoospermia induced by 200 mg TE injections was able to provide highly effective, sustained, and reversible contraception but some side effects included discomfort at the injection sites, acne, psychological changes, weight gain, polycythemia, and abnormal lipids happened..

Testosterone undecanoate : Long-acting intramuscular testosterone undecanoate (TU) was studied as hormonal male contraceptive agent. In this trial TU was used during the 6-month suppression phase with an initial loading dose of 1000 mg TU, followed by 500 mg TU every month was administered until the achievement of azoospermia or severe oligozoospermia with efficacy rate of 94.8% and 5.2% failure rate but there are some disadvantages that some may discontinued early, and the most frequent complaint was tenderness or discomfort at the injection sites, acne, changes in mood or behavior, and facial swelling or skin rash..

Hormonal contraceptive injectable regimes using testosterone combined with other molecules: Testosterone plus progestin : Testosterone administration demonstrated contraceptive efficacy, but testosterone alone is not as efficient as testosterone plus a progestin in the rate and extension of spermatogenesis suppression. These two steroids have synergic and additive effects on the hypothalamus-pituitary axis resulting in more rapid gonadotropins and sperm suppression compared with each compound administered alone. Adding a progestin also allows the reduction of the testosterone dose therefore reducing possible side effects related to supraphysiological doses of testosterone, therefore improving the safety of the regimen ..

Testosterone plus Gonadotropin Releasing Hormone (GnRH) antagonists: GnRH antagonists act by competitive binding to receptors and reduce both LH and FSH to undetectable levels. GnRH antagonists are very effective in suppressing spermatogenesis. However, GnRH antagonists are expensive and require frequent subcutaneous injections, so until now it does not represent a realistic option for male contraception..

Conclusion. Most women can start most contraceptive methods at any time, and few examinations or tests, if any, are needed before starting a contraceptive method. Routine follow-up for most women includes assessment of her satisfaction with the contraceptive method, concerns about method use, and changes in health status or medications that could affect medical eligibility for continued use of the method. Because changes in bleeding patterns are one of the major reasons for discontinuation of contraception, recommendations are provided for the management of bleeding irregularities with various contraceptive methods. Family Planning is practiced by many couples aiming at spacing pregnancies and choosing the proper time for conception and childbirth. An ideal method for contraception should be cheap,readily available, easy to use, with mini mal side effects and complications, and with maximum efficiency in protection from unwanted pregnancies, Finally the best contraceptive method is one that has no or minimal effects on the future female fertility, once the couple decided planning for a new pregnancy, i.e. reversible contraception .In addition, because women and health-care providers can be confused about the procedures for missed pills and dosing errors with the contraceptive patch and ring, the instructions are streamlined for easier use..