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group_5_presentation_1_-_birth_control_-_contraception [2020/01/31 23:50] gus10 |
group_5_presentation_1_-_birth_control_-_contraception [2020/02/13 14:51] (current) hanj35 |
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| - | == Sterilization for Males == | + | === Sterilization for Males === |
| The sterilization technique for males, vasectomy, prevents pregnancy by cutting and sealing up the vas deferens to block the release of spermatocytes from the testes. Males who have undergone vasectomy still produce spermatocytes, but instead of reaching the seminal vesicle to blend in with semen, the cells are trapped within the testes and epididymis, eventually degenerating and being absorbed by the body (WebMD, 2019). | The sterilization technique for males, vasectomy, prevents pregnancy by cutting and sealing up the vas deferens to block the release of spermatocytes from the testes. Males who have undergone vasectomy still produce spermatocytes, but instead of reaching the seminal vesicle to blend in with semen, the cells are trapped within the testes and epididymis, eventually degenerating and being absorbed by the body (WebMD, 2019). | ||
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| By the early 20th century, the US became the first country in the world to legalize male sterilization for eugenic purposes, or in other words, for producing better "quality" offspring by selective reproduction (FPA, 2010). In 1954, India became the first to approve vasectomy as a contraceptive program on a national scale. Chinese surgeons further refined the technique by introducing non-scalpel vasectomy in 1974, which enabled surgeons to reach the vas deferens through a tiny puncture rather than an incision (Beatty, 2019). Further improvements continue to be made, with reversible inhibition through the implantation of an intra-vas device being currently explored as an option (FPA, 2010). | By the early 20th century, the US became the first country in the world to legalize male sterilization for eugenic purposes, or in other words, for producing better "quality" offspring by selective reproduction (FPA, 2010). In 1954, India became the first to approve vasectomy as a contraceptive program on a national scale. Chinese surgeons further refined the technique by introducing non-scalpel vasectomy in 1974, which enabled surgeons to reach the vas deferens through a tiny puncture rather than an incision (Beatty, 2019). Further improvements continue to be made, with reversible inhibition through the implantation of an intra-vas device being currently explored as an option (FPA, 2010). | ||
| - | == Sterilization for Females == | + | === Sterilization for Females === |
| Sterilization for females is achieved by cutting and cauterizing the fallopian tubes to obstruct the release of oocytes from the ovaries (Mayo Clinic, 2019). Compared to vasectomy in males, tubal ligation often entails a series of safety concerns as it involves abdominal surgery and requires at least days of hospitalization for recovery (Leuking, 2013). | Sterilization for females is achieved by cutting and cauterizing the fallopian tubes to obstruct the release of oocytes from the ovaries (Mayo Clinic, 2019). Compared to vasectomy in males, tubal ligation often entails a series of safety concerns as it involves abdominal surgery and requires at least days of hospitalization for recovery (Leuking, 2013). | ||
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| The female sterilization technique was first proposed by British physician James Blundell in 1834; however, it was not put into practice until US surgeon Samuel Lungren performed the first procedure ever to be published in 1880 (Leuking, 2013). Multiple incisions were required at the time to reach the fallopian tubes, making the procedure rather invasive and difficult to recover from. In 1934, Dr Albert Decker was the first person to apply culdoscopy to the procedure (FPA, 2010). Instead of relying on abdominal incisions to locate the fallopian tubes, culdoscopy only requires a minor incision to be made on the posterior vaginal wall, through which a culdoscope, or specialized endoscope, is inserted into the peritoneal cavity to reach the surgical target (EngenderHealth, 2002). This was a remarkable development as it transformed tubal ligation from a risky surgical operation to a minimally invasive sterilization technique. | The female sterilization technique was first proposed by British physician James Blundell in 1834; however, it was not put into practice until US surgeon Samuel Lungren performed the first procedure ever to be published in 1880 (Leuking, 2013). Multiple incisions were required at the time to reach the fallopian tubes, making the procedure rather invasive and difficult to recover from. In 1934, Dr Albert Decker was the first person to apply culdoscopy to the procedure (FPA, 2010). Instead of relying on abdominal incisions to locate the fallopian tubes, culdoscopy only requires a minor incision to be made on the posterior vaginal wall, through which a culdoscope, or specialized endoscope, is inserted into the peritoneal cavity to reach the surgical target (EngenderHealth, 2002). This was a remarkable development as it transformed tubal ligation from a risky surgical operation to a minimally invasive sterilization technique. | ||
| - | In 1971, laparoscopic sterilization was first performed postpartum, with the use of multiple rings and clips to effectively occlude the fallopian tubes (Leuking, 2013). Hysteroscopic sterilization, a non-scalpel technique that utilizes tiny intra-tubal devices, became available in 2002 (FPA, 2010). The intra-tubal devices are designed to be placed at the point of connection between the uterus and fallopian tubes, after being carefully inserted through the vagina and cervix. In spite of its minimally invasive nature, hysteroscopic sterilization is shown to be less effective than other variations to the procedure and thus has not been made widely available (FPA, 2010). | + | In 1971, laparoscopic sterilization was first performed postpartum, with the use of multiple rings and clips to effectively occlude the fallopian tubes (Leuking, 2013). Hysteroscopic sterilization, a non-scalpel technique that utilizes tiny intra-tubal devices, became available in 2002. The intra-tubal devices are designed to be placed at the point of connection between the uterus and fallopian tubes, after being carefully inserted through the vagina and cervix. In spite of its minimally invasive nature, hysteroscopic sterilization is shown to be less effective than other variations to the procedure and thus has not been made widely available (FPA, 2010). |
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| A vasectomy is a very safe procedure with minimal side effects. However, possible side effects include: swelling and bruising of the scrotum, discomfort or pain, inflammation or infection (Vasectomy Procedure: Effectiveness, Recovery, Side Effects, Pros & Cons, n.d.). | A vasectomy is a very safe procedure with minimal side effects. However, possible side effects include: swelling and bruising of the scrotum, discomfort or pain, inflammation or infection (Vasectomy Procedure: Effectiveness, Recovery, Side Effects, Pros & Cons, n.d.). | ||
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| === Tubal Ligation === | === Tubal Ligation === | ||
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| Possible side effects include: discomfort at the incision site, abdominal pain or cramping, fatigue, dizziness, shoulder pain, gassiness and bloating (Tubal ligation—Mayo Clinic, n.d.). | Possible side effects include: discomfort at the incision site, abdominal pain or cramping, fatigue, dizziness, shoulder pain, gassiness and bloating (Tubal ligation—Mayo Clinic, n.d.). | ||
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| === Copper IUD === | === Copper IUD === | ||
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| ==== Patch ==== | ==== Patch ==== | ||
| - | The first contraception patch (transdermal delivery system) developed in the 1980s was a scopolamine patch. Since then, medications that have been developed in a transdermal form include nicotine, estradiol for hormone therapy, fentanyl, clonidine, nitroglycerin, among others. For successful delivery of medication through a transdermal system, the molecule must be small and lipophilic to permeate through the skin. Estradiol and ethinylestradiol (EE) are ideal molecules as therapeutic levels can be delivered easily, whereas progesterone and progestins require higher therapeutic levels. | + | The first contraception patch (transdermal delivery system) was developed in the 1980s. It was a scopolamine patch. As medications have been improved over the years, more transdermal forms were developed. For example, the patch contains nicotine, estradiol for hormone therapy, fentanyl, clonidine, nitroglycerin, among others. For successful delivery of medication through the transdermal system, research had discovered that the molecule/hormone must be small and lipophilic to permeate through the skin. Estradiol and ethinylestradiol (EE) are ideal molecules as therapeutic levels can be delivered easily. (Galzote, Rafie, Teal, & Mody, 2017) |
| + | |||
| + | Some benefits of a transdermal patch in comparison to the oral contraceptive pill are less fluctuation in plasma concentrations of estrogen, decrease estrogen-related side effects, and nausea. Also, the users only have to change the patch once every week, as opposed to taking pill daily, which could improve the patient’s adherence. The patch perfect use ranging from 88% to 91% which is higher than the oral perfect use ranged from 68% to 85%. (Galzote, Rafie, Teal, & Mody, 2017) | ||
| - | Some benefits of transdermal patch compared to the oral contraceptive pill are less variability in plasma concentrations of estrogen, decrease estrogen-related side effects that result from high peak estrogen levels, such as nausea. Also the user only changes the patch once weekly, as opposed to taking pill daily, which could result in improved adherence. Patch perfect use ranging from 88% to 91%. Oral perfect use ranged from 68% to 85%. | ||
| == Pharmacology and pharmacodynamics == | == Pharmacology and pharmacodynamics == | ||
| - | Ortho Evra Contraceptive patch is 20cm^2 adhesive that release 35 µg EE and 150 µg norelgestromin (NGMN) per day. NGMN is an active metabolite of norgestimate, the progestin contained in the OCs Ortho-Cyclen® and Ortho Tri-Cyclen. There are three patch sizes, 10, 15, and 20 cm2, were compared in a study of 610 subjects. It was found that the 20 cm2 patch achieved ovulation suppression and cycle control similar to that of Ortho-Cyclen (6.2% 20 cm2 patch, 7.2% Ortho-Cyclen); thus, the only size patch available is the 20 cm | + | Ortho Evra Contraceptive patch is 20cm^2 adhesive patch that releases 35 µg EE and 150 µg norelgestromin (NGMN) per day. NGMN is an active metabolite of norgestimate, the progestin contained in the oral contraceptives Ortho-Cyclen® and Ortho Tri-Cyclen. Three patch sizes are available, 10, 15, and 20 cm2. (Galzote, Rafie, Teal, & Mody, 2017) |
| - | + | ||
| - | Serum levels of NGMN and EE were 20% less if worn on the abdomen compared with the buttock, thigh, or upper arm, though at all sites, the concentration remained within the reference ranges. The mean serum levels of NGMN and EE also remained within the reference range in conditions of heat, humidity, exercise, and cool-water immersion. | + | |
| - | + | ||
| - | The mechanism of action of NGMN and EE involves | + | |
| - | + | ||
| - | 1. thickening the cervical mucus to prevent sperm penetration | + | |
| - | 2. decreasing the endometrial receptivity to reduce likelihood of implantation | + | Serum levels of NGMN and EE in human body were found to be 20% less if worn on the abdomen compared with the buttock, thigh, or upper arm. However, at all sites, the concentration of NGMN and EE remained within the reference ranges. They also remained within the reference range in conditions of heat, humidity, exercise, and cool-water immersion. (Galzote, Rafie, Teal, & Mody, 2017) |
| - | 3. inhibiting ovulation by suppressing gonadotropins, follicle-stimulating hormone (FSH), and luteinizing hormone (LH). | + | The mechanism of action of NGMN and EE involves |
| + | 1. thickening the cervical mucus to block or trap sperm | ||
| + | 2. decreasing the endometrial receptivity to reduce the chance of implantation | ||
| + | 3. inhibiting ovulation by suppressing gonadotropins, FSH and LH. (Galzote, Rafie, Teal, & Mody, 2017) | ||
| - | Steady state concentration is reached within 2 weeks of patch use, though pregnancy prevention is achieved after 1 week. The half-lives of NGMN and EE are 28.4 and 15.2 hours, respectively. Mean FSH, LH, and estradiol values return to baseline levels 6 weeks after discontinuation. | + | Steady state concentration is reached within 2 weeks of patch use and the effect of pregnancy prevention is achieved after 1 week. The half-lives of NGMN and EE inside human body are found to be 28.4 and 15.2 hours, respectively. The mean FSH, LH, and estradiol values return to baseline levels 6 weeks after discontinuation. (Galzote, Rafie, Teal, & Mody, 2017) |
| == Cost of Contraception == | == Cost of Contraception == | ||
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| == Efficacy == | == Efficacy == | ||
| - | In a large epidemiological trial in the UK, patients prescribed Evra™ had an incidence of 0.34 unintended pregnancies per 100 women-years. This was higher than the rate with second-generation COCs of 0.16 and 0.12 for third-generation COCs, but lower than progestin-only pills at 0.43. | + | In a large trial conducted in the UK, patients taking Evra™ had an incidence of 0.34 unintended pregnancies per 100 women-years. The founding was higher than the rate with second-generation oral contraceptives of 0.16 and 0.12 for third-generation oral contraceptives, but lower than progestin-only oral contraceptives pills at 0.43. (Galzote, Rafie, Teal, & Mody, 2017) |
| == Side Effects == | == Side Effects == | ||
| - | Given the overall higher exposure to estrogen with the patch (60% greater AUC) compared to COCs, there was concern that this could translate to an increased risk of thromboembolism events compared to women using pills | + | There is relatively higher estrogen exposure of the patch (60% greater AUC) compared to oral contraceptives. This could translate to an increased risk of VTE events compared to women using pills. (Galzote, Rafie, Teal, & Mody, 2017) |
| - | An overall incidence rate for VTE of 52.8 per 100,000 women-years in patch users and 41.8 per 100,000 women-years in NGM-35 OC users. | + | |
| + | The study showed that the overall incidence rate for VTE of 52.8 per 100,000 women-years in patch users and 41.8 per 100,000 women-years in oral contraceptive users. (Galzote, Rafie, Teal, & Mody, 2017) | ||
| == New Patches == | == New Patches == | ||
| + | (According to the study from Galzote, Rafie, Teal, & Mody, 2017) | ||
| + | |||
| EE/GSD | EE/GSD | ||
| - | * 0.5mg EE, 2.1mg gestodene | + | |
| - | * The dosing of this 11 cm2 patch results in the same amount of hormone exposure as the 0.02 mg EE and 0.06 mg GSD OC | + | * The patch contains 0.5mg EE, 2.1mg gestodene |
| - | * The EE/GSD patch has decreased EE exposure measured by the AUC compared to the EE/NGMN patch | + | * The dosing of this 11 cm2 patch have the same amount of hormone exposure as the 0.02 mg EE and 0.06 mg GSD oral contraceptive |
| - | * The incidence of breast pain was slightly lower in EE/GSD users compared to tradition EE/NGMN patch users, which is expected given the total lower estrogen exposure | + | * It can decrease the EE exposure measured by the AUC compared to the EE/NGMN patch |
| + | * The chances of having breast pain was lower in EE/GSD users compared to the traditional EE/NGMN patch users. | ||
| EE/LNG | EE/LNG | ||
| - | * 2.3mg EE, 2.6mg levonorgestrel | + | * The patch contains 2.3mg EE, 2.6mg levonorgestrel |
| - | * decreased AUC of estrogen and the use of LNG, which has been shown to have lower rates of VTE compared to other progestins. | + | * It can decrease the AUC of estrogen and the use of LNG, which can lower the rates of VTE compared to other progestins. |
| ==== Birth Control Pill/ Oral Contraceptives ==== | ==== Birth Control Pill/ Oral Contraceptives ==== | ||
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| Copper IUD – Planned Parenthood Toronto. (2020). Retrieved 31 January 2020, from http://www.ppt.on.ca/facts/copper-iud/ | Copper IUD – Planned Parenthood Toronto. (2020). Retrieved 31 January 2020, from http://www.ppt.on.ca/facts/copper-iud/ | ||
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| + | Dean, M. (2019, June 28). All Hail Contraceptives! Retrieved January 21, 2020, from https://www.studentpost.org/2017/12/all-hail-contraceptives/ | ||
| EngenderHealth. (2002). Contraceptive Sterilization: Global Issues and Trends. Retrieved January 21, 2020, from https://www.engenderhealth.org/wp-content/uploads/imports/files/pubs/family-planning/factbook_chapter_6.pdf | EngenderHealth. (2002). Contraceptive Sterilization: Global Issues and Trends. Retrieved January 21, 2020, from https://www.engenderhealth.org/wp-content/uploads/imports/files/pubs/family-planning/factbook_chapter_6.pdf | ||
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| FPA. (2010, November 15). Contraception: past, present and future factsheet. Retrieved from http://www.fpa.org.uk/factsheets/contraception-past-present-future | FPA. (2010, November 15). Contraception: past, present and future factsheet. Retrieved from http://www.fpa.org.uk/factsheets/contraception-past-present-future | ||
| - | Glassier, A. (2002, October 1). Contraception: Past and Future. Retrieved January 21, 2020, from https://www.nature.com/fertility/content/full/ncb-nm-fertilitys3.html | + | Galzote, R., Rafie, S., Teal, R., & Mody, S. (2017). Transdermal delivery of combined hormonal contraception: a review of the current literature. International Journal of Womens Health, Volume 9, 315–321. doi: 10.2147/ijwh.s102306 |
| Hormone Imbalance, Menstrual Cycles & Hormone Testing. (n.d.). Retrieved January 27, 2020, from https://womeninbalance.org/about-hormone-imbalance/ | Hormone Imbalance, Menstrual Cycles & Hormone Testing. (n.d.). Retrieved January 27, 2020, from https://womeninbalance.org/about-hormone-imbalance/ | ||
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| + | Glassier, A. (2002, October 1). Contraception: Past and Future. Retrieved January 21, 2020, from https://www.nature.com/fertility/content/full/ncb-nm-fertilitys3.html | ||
| How Do I Get a Tubal Ligation & How Much Will It Cost? (n.d.). Retrieved January 31, 2020, from https://www.plannedparenthood.org/learn/birth-control/sterilization/what-are-benefits-sterilization | How Do I Get a Tubal Ligation & How Much Will It Cost? (n.d.). Retrieved January 31, 2020, from https://www.plannedparenthood.org/learn/birth-control/sterilization/what-are-benefits-sterilization | ||
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| Where Can I Buy a Vasectomy & How Much Will It Cost? (n.d.). Retrieved January 31, 2020, from https://www.plannedparenthood.org/learn/birth-control/vasectomy/how-do-i-get-vasectomy | Where Can I Buy a Vasectomy & How Much Will It Cost? (n.d.). Retrieved January 31, 2020, from https://www.plannedparenthood.org/learn/birth-control/vasectomy/how-do-i-get-vasectomy | ||
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| + | Presentation | ||
| + | {{:4m03_topic_1.pdf|}} | ||
