Combined injectable birth control

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Combined injectable birth control
Background
Type Hormonal
First use About 1980
Failure rates (first year)
Perfect use 0-0.2%[1]
Typical use ?
Usage
Duration effect 1 month
User reminders ?
Advantages and disadvantages
STI protection No
Benefits Especially good if poor pill compliance.

Combined injectable contraceptives (CICs) are a form of hormonal birth control for women. They consist of monthly injections of combined formulations containing an estrogen and a progestin to prevent pregnancy.

Depot medroxyprogesterone acetate (DMPA) is a different injectable contraceptive, containing just a progestin, given every three months. It is a progestogen-only injectable contraceptive.

Hormonal contraception works primarily by preventing ovulation, but it may also thicken the cervical mucus inhibiting sperm penetration.[2][3][4] Hormonal contraceptives also have effects on the endometrium,[5][6] that theoretically could affect implantation,[7][8][9][10]

Medical uses

CIC is administered by intramuscular injection into the deltoid, gluteus maximus, or anterior thigh.[1] It is ideally administered every 28 to 30 days, though it has been demonstrated to be effective up to 33 days.[1]

Available forms

CICs that have been marketed include the following:[11][12][13]

Side effects

The most prominent side effects are menstrual irregularities during the first 3 to 6 months of use.[1]

Pharmacology

Idealized curves of estradiol levels over a period of 30 days after injection of different estradiol esters in women.[13] Four data points were used to generate the curves (day 0, peak day, a third day, and day 30).[13] The measurements from which the points were drawn were taken at 24-hour intervals.[13] The estradiol esters were given mostly as combined injectable contraceptives together with a progestin.[13]

CICs contain an estrogen and a progestin. The estrogen is generally an estradiol ester, which acts as a prodrug of estradiol. The progestin is a progestogen ester, which may or may not act as a prodrug. Steroid esters form a depot and have an extended duration of action when administered by intramuscular or subcutaneous injection.

History

United States

  • October 5, 2000, Pharmacia received FDA approval for Lunelle Monthly Contraceptive Injection.[1]
  • April 2003, Pharmacia acquired by Pfizer (makers of Depo-Provera (DMPA)).
  • October 2003, Lunelle was discontinued in the U.S.

See also

References

  1. ^ a b c d e "FDA Approves Combined Monthly Injectable Contraceptive". Contraception Report. 12 (3). 2001. Archived from the original on September 26, 2006. 
  2. ^ Tamara Callahan MD , Aaron Caughey MD , Blueprints Obstetrics and Gynecology, 2013
  3. ^ KD Tripathi , Essentials of Medical Pharmacology, 2013
  4. ^ Dc Dutta's Textbook of Obstetrics, 2014
  5. ^ K. A. Petrie, A. H. Torgal, C. L. Westhoff, Matched-pairs analysis of ovarian suppressionduring oral vs. vaginal hormonal contraceptive use, „Contraception” 2011, t. 84, p. e2-3
  6. ^ R. L. Birtch, O. A. Olatunbosum, R. A. Pierson, Ovarian follicular dynamics during conventional vs continuous oral contraceptive use, „Contraception” 2006, t. 73, p. 235. p. 239.
  7. ^ K. Bugge, K. S. Richter, J. Bromer, et al., Pregnancy rates following in vitro fertilization are reduced with a thin endometrium, but are unrelated to endometrial thickness above 10 millimeters,„Fertility and Sterility” 2004, t. 82, p. S199.
  8. ^ T. Fiumino, A. Kuwata, A. Teranischi et al., Significance of endometrium thickness to evaluate endometrial receptivity for embryos in natural cycle, „Fertility and Sterility” 2008, t. 90,p. S159.
  9. ^ K. S. Richter, K. R. Bugge, J. G. Bromer, Relationship between endometrial thickness and embryo implantation, based on 1. 294 cycles of in vitro fertilization with transfer of two blastocyst-stage embryos, „Fertility and Sterility” 2007, t. 87, p. 53.
  10. ^ Rivera R, Yacobson I, Grimes D (1999). "The mechanism of action of hormonal contraceptives and intrauterine contraceptive devices". Am J Obstet Gynecol. 181 (5 Pt 1): 1263–9. doi:10.1016/S0002-9378(99)70120-1. PMID 10561657. 
  11. ^ Newton JR, D'arcangues C, Hall PE (1994). "A review of "once-a-month" combined injectable contraceptives". J Obstet Gynaecol (Lahore). 4 Suppl 1: S1–34. doi:10.3109/01443619409027641. PMID 12290848. 
  12. ^ Bagade O, Pawar V, Patel R, Patel B, Awasarkar V, Diwate S (2014). "Increasing use of long-acting reversible contraception: safe, reliable, and cost-effective birth control" (PDF). World J Pharm Pharm Sci. 3 (10): 364–392. ISSN 2278-4357. 
  13. ^ a b c d e Garza-Flores J (April 1994). "Pharmacokinetics of once-a-month injectable contraceptives". Contraception. 49 (4): 347–59. doi:10.1016/0010-7824(94)90032-9. PMID 8013219. 

Further reading

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