Spotters in "Family Planning: Hormonal Contraceptive Methods" for CFM & MPH students
A. Oral pills:
1. Combined pill:
(a) Mala-N:
Important points:
- Type of contraceptive: Combined OCP
- Composition: Ethinyl estradiol-0.03 mg (30 mcg) & Norgestrel-0.15 mg (150 mg)
- Status in RCH: Provided free of cost through all PHCs & urban family welfare centers
- Mechanism of action: Prevents the release of ovum from the ovary by blocking the pituitary secretion of gonadotropin that is necessary for ovulation
- Adverse effects: Cardiovascular-MI,cerebral & venous thrombosis, hypertension; Carcinogenesis- increased of cervical cancer & breast cancer; Metabolic effects- elevated BP, altered lipid profile, blood clotting & hyperglycemia; Hepatocellular adenoma; Gallbladder disease; Cholestatic jaundice, monolial vaginitis; Decline in milk volume during lactation; Depression; General effects-Breast tenderness; Weight gain, Headache/migraine; Bleeding disturbances
- Beneficial effects: In Benign breast & ovarian disorders, PID, Ectopic pregnancy, Iron deficiency anemia, ovarian & endometrial cancer, PCOS, endometriosis, adenomyosis, dysmenorrhea, acne, DUB, irregular menstrual cycle.
- Contraindications: Absolute- Breast cancer, Genital cancer, Liver disease, H/o thromboembolism, cardiac abnormalities, Congenital hyperlipidemia, undiagnosed abnormal uterine bleeding, pregnancy; Relative- Age > 40 years, Smoking & age >35 years, Mild Hypertension, CKD, Epilepsy, Migraine, Nursing mothers (0-6 months),DM, Gall bladder disease, Amenorrhoea, H/o infrequent bleeding.
(b) Mala-D:
Important points:
- Type of contraceptive: Combined OCP
- Composition: Ethinyl estradiol-0.03 mg (30 mcg) & Desogestrel-0.15 mg (150 mg)
- Status in RCH: Provided at subsidized cost (Rs 3/- per packet) through all PHCs & urban family welfare centers
- Mechanism of action: Prevents the release of ovum from the ovary by blocking the pituitary secretion of gonadotropin that is necessary for ovulation
- Adverse effects: Cardiovascular-MI,cerebral & venous thrombosis, hypertension; Carcinogenesis- increased of cervical cancer & breast cancer; Metabolic effects- elevated BP, altered lipid profile, blood clotting & hyperglycemia; Hepatocellular adenoma; Gallbladder disease; Cholestatic jaundice, monolial vaginitis; Decline in milk volume during lactation; Depression; General effects-Breast tenderness; Weight gain, Headache/migraine; Bleeding disturbances
- Beneficial effects: In Benign breast & ovarian disorders, PID, Ectopic pregnancy, Iron deficiency anemia, ovarian & endometrial cancer, PCOS, endometriosis, adenomyosis, dysmenorrhea, acne, DUB, irregular menstrual cycle.
- Contraindications: Absolute- Breast cancer, Genital cancer, Liver disease, H/o thromboembolism, cardiac abnormalities, Congenital hyperlipidemia, undiagnosed abnormal uterine bleeding, pregnancy; Relative- Age > 40 years, Smoking & age >35 years, Mild Hypertension, CKD, Epilepsy, Migraine, Nursing mothers (0-6 months),DM, Gall bladder disease, Amenorrhoea, H/o infrequent bleeding.
(c) Femilon/ Elogen:
Important points:
- Type of contraceptive: Combined OCP
- Composition: Ethinyl estradiol-0.02 mg (20 mcg) & Desogestrel-0.15 mg (150 mg)
- Mechanism of action: Prevents the release of ovum from the ovary by blocking the pituitary secretion of gonadotropin that is necessary for ovulation
- Adverse effects: Cardiovascular-MI,cerebral & venous thrombosis, hypertension; Carcinogenesis- increased of cervical cancer & breast cancer; Metabolic effects- elevated BP, altered lipid profile, blood clotting & hyperglycemia; Hepatocellular adenoma; Gallbladder disease; Cholestatic jaundice, monolial vaginitis; Decline in milk volume during lactation; Depression; General effects-Breast tenderness; Weight gain, Headache/migraine; Bleeding disturbances
- Beneficial effects: In Benign breast & ovarian disorders, PID, Ectopic pregnancy, Iron deficiency anemia, ovarian & endometrial cancer, PCOS, endometriosis, adenomyosis, dysmenorrhea, acne, DUB, irregular menstrual cycle.
- Contraindications: Absolute- Breast cancer, Genital cancer, Liver disease, H/o thromboembolism, cardiac abnormalities, Congenital hyperlipidemia, undiagnosed abnormal uterine bleeding, pregnancy; Relative- Age > 40 years, Smoking & age >35 years, Mild Hypertension, CKD, Epilepsy, Migraine, Nursing mothers (0-6 months),DM, Gall bladder disease, Amenorrhoea, H/o infrequent bleeding.
2. Progesterone only pill/ Mini pill/ Micropill:
Important points:
- Type of contraceptive: Progesterone only OCP
- Composition: Low dose progesterone mainly Norethisterone & Levonorgestrel (Norgestrel 0.075 mg)
- Mechanism of action: It causes thickening of cervical mucus & endometrial atrophy
- Adverse effects: Irregular, unexpected bleeding, ordinary headaches, mood changes & breast tenderness. It may lower high density lipoproteins
- Beneficial effects: Can be safely used among lactating women as they do not affect quality and quality of milk, can be given to older women for whom combined OCPs are C/I as in CVD, Hypertension, DM, obesity, epilepsy, thromboembolic disorders & also in younger women who has risk of neoplasia
- Contraindications: Breast cancer, Genital cancer, Liver disease, undiagnosed abnormal uterine bleeding, previous ectopic pregnancy, porphyria, ovarian cyst
3. Post-capital pill/Emergency contraception/ Morning after pill:
Important points:
- Type of contraceptive: Emergency contraceptive pill
- Composition: 1.5 mg of Levonorgestrel
- Status: Free supply under National Family planning Program
- Indication: Unprotected sexual intercourse, rupture of condom during the act, sexual assaul/rape, cervical cap dislodge or missed pill
- Doses: One tablet of 1.5 mg taken within 72 hours of unprotected intercourse
4. Once a week pill/ Non-hormonal pill:
Important points:
- Type of contraceptive: Non-steroidal, non-carcinogenic, non-teratogenic pill
- Composition: Ormeloxifene/ Centchroman
- Status : Free supply under National Family planning Program
- Developed by: Central drug research institute (CDRI), Lucknow, India
- Mechanism of action: A selective estrogen receptor modulator which acts by increasing movement of fertilized ovum through the fallopian tube. Also increases rate of maturation of ovum & delays the development of chorionic villi
- Doses & Frequency: 1 tablet (30 mg) twice a week for 3 months, then 1 tablet per week
- Adverse effects: Not known to cause any side effects except prolongation of menstrual cycle in few women.
- Beneficial effects: Causes prompt return of fertility, can be given to women of all age groups, as a treatment of DUB
- Failure rate: 1-2 per 100 women years
- Contraindications: PCOD, Cervical hyperplasia, recent h/o jaundice, severe allergy
5. Male pill/ Gossypol:
Important points:
- Type of contraceptive: A male contraceptive pill
- Composition: A derivative of cotton seed oil
- Mechanism of action: Interferes with spermatogenesis
- Adverse effects: Produces azoospermia or severe oligospermia, it can be toxic also
B. Depot (slow release) formulations:
1. Injectable Contraceptive/ DMPA/NET-EN:
Important points:
- Type of contraceptive: Progesterone only injectable contraceptive
- Composition: (Depot formulation) Medroxyprogesterone acetate
- Dose: 150 mg IM/SC every three months-DMPA, 200 mg IM/SC every 2 months- NET-EN
- Status: Under Antara program given free of cost under National family planning program
- Mechanism of action:
- Adverse effects: Disruption of normal menstrual cycle, amenorrhoea
- Beneficial effects: Highly effective, long lasting & reversible, does not affect lactation
2. Subcutaneous implants/ Norplant:
Important points:
- Type of contraceptive: Subdermal implant contraceptive
- Composition: 6 silastic capsules containing 35 mg LNG each, Norplant R2 contains 2 capsules of 75 mg LNG each
- Effective contraception: for 5 years
- Mechanism of action: Capsules or rods are inserted beneath skin of forearm, prevents ovulation
- Adverse effects: Irregularities of menstrual cycle, surgical procedures required for the insertion & removal
3. Vaginal ring/ Nuvaring:
Important points:
- Type of contraceptive: A hormonal contraceptive
- Composition: Contains Levonorgestrel
- Mechanism of action: The hormone is slowly absorbed through vaginal mucosa, permitting most of it to bypass the digestive system & liver & allowing potentially lower dose
- Dose & frequency: Ring is worn for 3 weeks in the vagina & removed for the fourth week
- Beneficial effects: High efficacy, comfortable to insert & remove
- Disadvantages: Leucorrhea or increased vaginal discharge, Irregular bleeding or no monthly bleeding, Headache, Nausea.,Inflammation and irritation of the vagina.
References:
- Park, K. (2019). Park's textbook of preventive and social medicine. 25th. Jabalpur, India: M/S Banarsidas Bhanot.
- Kadri AM. (2019). IAPSM's Textbook of Community Medicine. 1st. New Delhi, India: Jaypee Brothers Medical Publishers (P) Ltd.
- https://humdo.nhp.gov.in/choice_for_planning/mala-n/ photo credit
- https://www.fitbynet.com/shop/uncategorized/mala-d-tablet_deys-medical/ photo credit
- https://www.buy-pharma.md/Desogestrel-Ethinyl-Estradiol-p-1579.html photo credit
- https://www.indiamart.com/proddetail/femilon-tablet-16385457548.html photo credit
- https://www.simpleonlinepharmacy.co.uk/online-doctor/doctor/cerazette/ photo credit
- https://humdo.nhp.gov.in/choice_for_planning/ezy-pill/ photo credit
- https://www.indiamart.com/proddetail/saheli-centchroman-tablet-22359066933.html photo credit
- https://humdo.nhp.gov.in/choice_for_planning/chhaya/ photo credit
- https://www.theguardian.com/society/2016/jul/23/what-happened-to-the-male-contraceptive-pill photo credit
- https://humdo.nhp.gov.in/choice_for_planning/antra/ photo credit
- https://georgecourides.com/index.php/portfolio-item/norplant/ photo credit
- https://collection.sciencemuseumgroup.org.uk/objects/co96805/packet-of-norplant-contraceptive-implants-middlesex-england-1993-contraceptive-implant photo credit
- https://www.nhs.uk/conditions/contraception/vaginal-ring/ photo credit
- Park, K. (2019). Park's textbook of preventive and social medicine. 25th. Jabalpur, India: M/S Banarsidas Bhanot.
- Kadri AM. (2019). IAPSM's Textbook of Community Medicine. 1st. New Delhi, India: Jaypee Brothers Medical Publishers (P) Ltd.
- https://humdo.nhp.gov.in/choice_for_planning/mala-n/ photo credit
- https://www.fitbynet.com/shop/uncategorized/mala-d-tablet_deys-medical/ photo credit
- https://www.buy-pharma.md/Desogestrel-Ethinyl-Estradiol-p-1579.html photo credit
- https://www.indiamart.com/proddetail/femilon-tablet-16385457548.html photo credit
- https://www.simpleonlinepharmacy.co.uk/online-doctor/doctor/cerazette/ photo credit
- https://humdo.nhp.gov.in/choice_for_planning/ezy-pill/ photo credit
- https://www.indiamart.com/proddetail/saheli-centchroman-tablet-22359066933.html photo credit
- https://humdo.nhp.gov.in/choice_for_planning/chhaya/ photo credit
- https://www.theguardian.com/society/2016/jul/23/what-happened-to-the-male-contraceptive-pill photo credit
- https://humdo.nhp.gov.in/choice_for_planning/antra/ photo credit
- https://georgecourides.com/index.php/portfolio-item/norplant/ photo credit
- https://collection.sciencemuseumgroup.org.uk/objects/co96805/packet-of-norplant-contraceptive-implants-middlesex-england-1993-contraceptive-implant photo credit
- https://www.nhs.uk/conditions/contraception/vaginal-ring/ photo credit
What are Orlos (Orlistat) Weight Loss Capsules?
ReplyDeleteOrlos is an anti-obesity medication. It works by preventing roughly one-third of the fat in your food from being absorbed in your digestive tract. Orlos binds to digestive enzymes (lipases) and prevents them from breaking down some of the fat you've consumed during your meal. Your body eliminates the undigested fat since it can't be stored. Orlos is used to treat obesity when used in conjunction with a low-calorie diet.
How to take Orlos (Orlistat) Weight Loss Capsules?
Choose your start date
Plan ahead of time when you'll begin taking the pills. Begin your low-calorie, low-fat diet before starting the capsules, and give your body a few days to acclimate to your new eating habits. Keep a food journal to keep track of what you consume. Food diaries work because they make you aware of what you're eating, how much you're consuming, and provide a foundation for making changes.
Decide on your weight loss goal
Consider how much weight you want to lose and then create a goal for yourself. A reasonable target is to shed between 5% and 10% of your starting weight. Week to week, the amount of weight you lose may fluctuate. You should try to shed roughly 0.5 kg (1 lb) per week in a moderate, steady manner.
Set your calorie and fat targets
Set two daily goals, one for calories and one for fat, to assist you to attain your weight-loss objective.
Adults 18 and over:
Three times a day, take one capsule.
Take Orlos 30 minutes before, during, or one hour after a meal. This normally entails taking one capsule at each meal, including breakfast, lunch, and dinner. Make sure all three of your main meals are well-balanced, low-calorie, and low-fat.
Do not take a capsule if you miss a meal or if your meal is low in fat. Orlos do not work unless the meal has some fat.
With water, swallow the capsule whole.
Take no more than 3 capsules each day.
I'm not sure how long I should take Orlos.
Orlos should only be used for six months at a time.
If you haven't lost weight after 12 weeks of Orlos, consult your doctor or pharmacist. It's possible that you'll have to quit taking Orlos.
It's not enough to eat differently for a brief period of time before reverting to your old habits to lose weight. People who lose weight and keep it off adopt lifestyle adjustments, such as changing their eating habits and increasing their physical activity.
What are the ingredients in Orlos (Orlistat) Weight Loss Capsules?
Orlistat is the active ingredient. Orlistat is 60 milligrams in each hard capsule.
The following are the remaining ingredients:
The capsule filler is made up of microcrystalline cellulose (E460), sodium starch glycolate, povidone (E1201), sodium laurilsulfate, and talc.
Black ink (shellac, iron oxide black (E172), propylene glycol), indigo carmine (E132), titanium dioxide (E171), sodium laurilsulfate, sorbitan monolaurate Gelatin, indigo carmine (E132), titanium dioxide (E171), sodium; capsule shell: gelatin, sorbitan monolaurate, indigo carmine (E132), titanium dioxide (E171), sodium laurilsulfate
Gelatin, polysorbate 80, and indigo carmine make up the capsule band (E132).
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