Contraception

Technology Update
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KONTRASEPSI TERKINI

Dr. dr. Eka Rusdianto SpOG ( K )

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Life is short
Number of germ cells in human ovaries:

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Pola Perencanaan Keluarga

Fase Fase Fase

Menunda Menjarangkan Tidak Hamil

Kehamilan Kehamilan lagi

2-4

20 35

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 Contraceptive Methods Rationale Choice

Phase Phase Phase

DIFFERING SPACING COMPLETING

2-4

- Pill - IUD - IUD - Steril

- IUD - Inject. - Inject. - IUD
- Conventional - Pill - Pill - Pill
20 35 - Implant
- Inject. - Implant - Implant
- Implant - Conventional - Conventional - Inject.
- Steril - Conventional
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World wide use of methods
Fem. Sterilisation
29%
Male Sterilisation
9%

Injectables
IUD
4% 21%

Condoms
9%

Trad. Methods Pill

14% 14%
6 WHO, 1990
 Contraceptive Users

METHODS USERS %

INJECTABLES 9,743,550 35.2

PILLs 7,796,474 28.1
IUDs 5,218,196 18.8
IMPLANTABLES 3,156,705 11.4
STERILIZATION 1,515,406 5.5
OTHERS 278,473 1.0
TOTAL 27,708,804 100.0

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Source: BKKBN, 2007
Current Contraceptive Users
METHODS USERS %

Users 20,714835 61.9

Modern 19,376,235 57.9
Injectables 10,675,335 31.9
Pills 4,551,240 13.6
IUDs 1,305,135 3.9
Implantables 1,104,345 3.3
Sterilization 1,070,880 3.2
Others 669,300 2.0
Traditional 1,338,600 4.0
Non-users 12,750,165 38.1
TOTAL 33,465,000 100.0
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Source: SDKI, 2012
New CONTRACEPTIVE CHOICES

1. PILLS
2. PATCHES
3. INJECTABLES
4. HORMONE-RELEASING IUDs
5. VAGINAL RINGS
6. IMPLANTABLES

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 {
ORAL CONTRACEPTIVE PILLS

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Why do we need a new pill?

1. Improve patient compliance

2. Reduce unwanted side effects

3. Provide additional benefits

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Pharmacokinetic Profile of Different
Contraception

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 PIL KB

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 Pack berisi 91 Pil
 84 Pil aktif (Pink)
 7 Inaktif Pil (Putih)
 Dosis kombinasi rendah:
 EE 30 μg
 LNG 150 μg

Seasonale ®
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Reason why the lady stops their pills,
not even to start using it………

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  Estrogen:
 Ethinyl estradiol (EE)
 Mestranol

 Progestogen/Gestogen/Progestin:
 17 alpha-hydroxyprogesterone

derivatives
 19 nortestosterone derivatives

 17 alpha-spironolactone derivatives

Composition of OCP
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 Progestin
Classification of Progestins

Progesterone 19-nortestosterone 17α-spirolactone

Pregnanes Gonanes

Norgestrel
Medroxy- Drospirenone
progesterone Levonorgestrel
acetate Norgestimate
Cyproterone Desogestrel
acetate Gestodene
Chlormadinone
acetate

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 0.03 mg ethynilestradiol
0.15 mg levonorgestrel

0.03 mg ethynilestradiol + 0.05 mg levonorgestrel for 6

days 0.04 mg
ethynilestradiol + 0.075 mg levonorgestrel for 5 days
21 0.03 mg
ethynilestradiol + 0.125 mg levonorgestrel for 10 days
 Mempercantik diri dengan ber-KB

0.03 mg ethynilestradiol
0.075 mg gestodene

0.03 mg ethynilestradiol
3.00 mg drospirenone

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 Epidemiologi Gejala dan
Keluhan Premenstruasi

Semua Wanita dengan 50–80%

mengalami gejala 13– 3–8%
siklus menstruasi PMDD 3–14
premenstruasi 1–4 26%
PMS 3,5,6

1. de la Gandara Martin and de Diego Herrero 1996; 2. Ramcharan et al. 1992; 3. Wittchen et al. 2002;
4. Woods et al. 1982; 5. Angst et al. 2001; 6. Halbreich et al. 2003; 7. Campbell et al. 1997; 8. Chawla et al. 2002; 9.
Cohen et al. 2002; 10. Deuster et al. 1999; 11. Gehlert and Hartlage 1997; 12. Johnson et al. 1988;
13. Rivera-Tovar and Frank, 1990; 14. Sveindóttir and Bäckström 2000
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PMS: A common disorder affecting
millions of women worldwide

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 Modern contraception trends

Efficacy, Reliability, Safety

New
Formula
1960 2010

efit s , ifes t yle

n L
ea lth Be norrhea,
dd e d H e, Ame
A
v e nienc
Con

Reduction / elimination of EE 20 microgram

New progestines with additional benefits

Changes in intake regimen

24/4 regimen
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 New
Formula

mengandung
ethinyl estradiol (EE) 20 g
drospirenone (drsp) 3 mg

Diminum setiap hari selama 24 hari

kemudian dilanjutkandengan interval
bebas hormon selama 4 hari (regimen
24/4)

Sehingga memberikan interval bebas

hormon yang lebih pendek
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 Keunikan regimen 24/4
 28 hari DRSP exist

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 { PATCHES

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The Contraceptive Patch Ortho Evra ®

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Composition of EVRA
Backing Film
– Flexible Polyester Film

Middle Layer
– Norelgestromin & Ethinyl
Estradiol
– Polyisobutylene/polybutene
adhesive
– Lauryl lactate
– PVP
– Non-woven polyester fabric

Release Liner
– Clear polyester S-cut film
33 protecting the adhesive
layer
Activities...
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 { INJECTABLES

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 Status Kontrasepsi Suntikan, 2004
Affandi, 2004

Jenis Kurun Yang Tersedia Status

Suntikan bulanan 1. DMPA 25 mg + EC 5 mg Pemasaran
2. Net-En 50 mg – EV 5 mg Pemasaran
3. Net-En 20 mg Fase II
4. DMPA 150 mg + EE 10 mg Pemasaran
5. Lain-lain

Suntikan 2-3 bulanan 1. Net-En 200 mg Pemasaran

2. DMPA 150 mg Pemasaran
3. Net Mikrokapsul 100 mg Fase I - II

Suntikan 6 bulanan 1. DMPA 450 mg Pemasaran

2. Net mikrokapsul 200 mg Fase I – II

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Injectable Contraception
Suntikan KB 1 bulanan

Suntikan KB 3 bulanan – 3 ml Suntikan KB 3 bulanan – 1 ml

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HORMONE-RELEASING IUDs

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  The 1st IUS (Intra Uterine System) is
Progestasert® , 38 mg of progesterone,
with a release rate of 65 µg of
progesterone per day.
 Approved by FDA in 1976, it was

manufactured by ALZA Corporation,

USA.
 Marketing of Progestasert® ended in

the summer of 2001, and it is no longer

available

The Intrauterine System

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  New technic
 Normal (pervaginam) or CS

(perabdominam)
 Post placental insertion (within 10

minute)

Post placental IUD

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VAGINAL RINGS
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The Contraceptive Vaginal Ring:
NuvaRing ®

Flexible, soft,
transparent ring with
outer diameter of 54
mm and cross section
of 4 mm

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IMPLANTABLES
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 Status & Development of
Implantable Contraceptives 2009

TRADE NAME PROGESTIN IMPLANTS DURATION STATUS

Norplant LNG 6 rods 5 years Market

Implanon ENG 1 rod 3 years Market
Jadelle LNG 2 rods 5 years Market
Uniplant NMA 1 caps 1 year Phase III
Nestrone ST1435 1 rod 2 years Phase III
Elcometrine ST1435 1 caps 6 months Market
Indoplant LNG 2 caps 3 years Market
Monoplant LNG 1 caps 3 years Phase II
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MONOPLANT®
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POSTCOITAL CONTRACEPTION
MORNING AFTER PILLS

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EMERGENCY
CONTRACEPTION
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  Emergency contraception (EC)
is any method of contraception
which is used after intercourse
and before the potential time
of implantation

What is emergency
contraception?
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 From fertilization to
implantation about 6 days

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Lumire, Jakarta, 7/9/2013
...not a New Idea...

 “Traditional” methods for post coital contraception

have been used for decades
 High doses of vitamin C, aspirin or chloroquine

 Douches of coca cola, baking soda, urine

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Family Planning Perspectives.1996;22:52-66
  As these methods work prior to
implantation, they are not
abortifacients.
 Emergency contraception is a
backup method for occasional
use, and should not be used as a
regular method of birth control.

IMPORTANT NOTES
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 1. A woman was raped
2. No contraception used
3. Condom slipped, leaked, broke
4. Diaphragm or cervical cap inserted
incorrectly, removed too soon, torn
5. Two consecutive birth control pills
were missed

ECPs can be used when:

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 6. An IUD was partially or totally
expelled
7. A three-month contraceptive
injection was missed by more than
two weeks
8. A one-month contraceptive
injection was missed by more than
three days

ECPs can be used when:

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 There are 2 methods of emergency
contraception:
1. Hormonal methods, which involve the
use of emergency contraceptive pills
(ECPs)
2. The post-coital insertion of a copper
intrauterine device (IUD)

Methods of EC
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 Two hormonal preparations are:
1. One contains only the progestin
levonorgestrel, while the other is a
2. Combined preparation containing
both ethinyl estradiol and
levonorgestrel

Hormonal Method
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Progestin only

 Plan B
 Valenor-2
 Levonelle-2
 Postinor-2
 Contraplan II

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  The regimen consists of 2
doses of 750 µg
levonorgestrel taken orally 12
hours apart

Levonorgestrel-only
method
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  Copper Intrauterine Device
 An IUD (or advice on how to obtain one)
should be offered to all women attending for
EC even if presenting within 72 hours of
UPSI

IUD
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  ECPs are not a good long-term

method of contraception

 Should be used as a bridge to a

regular form of birth control

 ECPs do not protect against STDs

Limitations of ECPs
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 Thank You

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Lumire, Jakarta, 7/9/2013