Note on Hormonal Method

  • Note
  • Things to remember


  1. Combined Oral Contraceptive

Image result for combined oral contraceptive

Combined oral contraceptive are considered to be a very reliable method of contraception. All COCs contain the hormone estrogen and progesterone. Estrogen in the pills usually prevents realizes of an ovum from the ovary and progesterone causes thick and scanty cervical mucus to prevent sperm traveling into the uterus.


In Nepal, ovulation: The most common COcs are low dose pills in 28 days package. Name of pills available in Nepal are:

  1. Lo- femenal
  2. Gulaf
  3. Nikocan
  4. Sequential estrogen
  5. Micro pills


Mechanism of action

1, In ovulation: As the hormonal level ie estrogen and progesterone increase in blood, the pituitary gonadotrophin is not produced thus the ovaries do not produce ovum.

2, Alteration of the character of the cervical mucus so as to prevent sperm penetration.

3, Thining of the endometrium: there are stromal edema and decidual reaction because thinning of endometrium cause favors condition for implantation in the uterus.


COCs are 99.9% effective when used correctly. They are more effective than IUCD and condoms.


  1. Has irregular menstrual cycles.
  2. Has severe menstrual cramping.
  3. Has anemia from heavy menstrual bleeding
  4. Symptoms of midcycle ovarian pain, premenstrual syndrome.


  1. Venous or arterial thrombosis
  2. Severe hypertension
  3. Valvular heart disease
  4. Focal migraine
  5. Acute liver disease
  6. Liver cancer



  1. Highly effective: 99.9% effectiveness if correctly used.
  2. Few method related health risks.
  3. Do not interfere with intercourse.
  4. Easy to use and simple.
  5. Make menstrual cycle regular and dysmenorrhoea.
  6. Prevent anemia by decreasing the blood loss and providing ferrous sulfate.



  1. User dependent:

- Must be taken daily

- Forgetfulness increase failure

  1. Some drugs interaction may occur (rifampicin, phenytoin).
  2. No protection against STD/HIV,AIDS,HBV.
  3. Minor sick effect may be seen as

_ Nausea

_ Amenorrhoea

_ Breast tenderness

_ Spotting between periods, breakthrough bleeding

_ Headaches

_ Weight loss

_ Mood change

_ Dizziness

  1. DMPA/Depo-Provera

Injectable contraceptive contains only the hormone progestin and was developed in the 1950's. They were 1st used to treat endometriosis and endometrial cancer as well as dysmenorrhea and bleeding disorders.

By the 1960's they came to be used as a contraceptive. This long acting progestin has the effect of suppressing ovulation; that is, they prevent the release of mature eggs from the ovary. They create thick cervical mucus which prevents sperm from penetrating the cervix. The brand name of depo Provera commonly called depo and or sangini.

Related image

Mechanism of action

  1. Inhibition of ovulation: by suppressing the mid-cycle LH peak.
  2. Cervical mucous become thick and viscid thereby prevents sperm penetration.


Depo-Provera is one of the most effective temporary family planning methods. DMPA has been extremely effective, even more than COCs, with a failure rate of less than 1%.


  1. Healthy women
  2. Wants long term spacing
  3. Cannot use Contraceptive that contains estrogen
  4. A breastfeeding women and needs a contraceptive
  5. Wants hormonal method but cannot use COCs because she is heavy smoker or presence of HTN



  1. Pregnancy or suspected pregnancy
  2. Cancer of breast
  3. Cervical cancer, ovarian cancer
  4. Jaundice, liver disease
  5. Uterine bleeding


_ highly effective (99%)

_ rapidly effective

_ very popular and easy to use

_ can provide long-term protection

_ pelvic examination is not required to begin

_ does not interfere with intercourse

_ unobtrusive

_ weight gain for some woman

_ effectiveness continues even if the client is up to 2 weeks late for her return visit.


_ injection available only at clinics

_ health personnel are needed to inject

_ causes menstrual changes in most user

  • amenorrhea in 50-80% of the user
  • irregular bleeding including spotting

_ possibility delay in return of fertility after discontinuation.

  1. Norplant Implant

The subdermal implant is a new generation of long acting contraceptive. They are the registered trademark of the population council for contraceptive subdermal implants. Norplant is highly effective, a reversible contraceptive method of women.

 Image result for Norplant Implant

Norplant implants are usually placed under the skin on the inside of women's upper arm in a fan-shaped configuration using a simple tractor. Each of the 6 stick capsules is 34mm long with a diameter of 2.4mm. Each capsule contains 36mg levonorgestrel, which is released slowly at the rate of about 85 mcg per day during the first week decreasing to about 50mcg per day by 9 months. The hormone release gradually declines to about 35 mcg per day at 18 months followed by a further decline to a steady level of 30mcg per day till the remaining time.


Mechanism of action

  1. Ovulation inhibition.
  2. Thickening of the cervical mucus inhibiting sperm penetration into the uterus.
  3. Effect on the endometrium reducing the likelihood of implantation and depressed progesterone during the luteal phase.



_ healthy women

_ want long term spacing i.e 7 years

_ require immediate postabortal use

_ cannot use a contraceptive that contains estrogen

_ are not ideal for IUCD

_ are breastfeeding and need a contraceptive



_ known or suspected pregnancy

_ acute liver disease

_ unexplained vaginal bleeding

_ sickle cell anemia

_ high blood pressure

_ thrombophlebitis



_ highly effective

_ long term protection up to 7 years

_ immediate return of fertility upon removal

_ pelvic exam not required

_ does not interfere with intercourse

_ comfortable and unobtrusive

_ may be used by post-abortion client

_ can be removed at any time for any reason

_ offers continuous protection



_ does not protect against most STDs including HIV/AIDS

_ Causes menstrual change in most users :

  • irregular bleeding including spotting
  • prolonged or heavy vaginal bleeding
  • amenorrhea in 20% of user

_ requires minor surgical procedure for insertion and removal

_ weight gain or loss may occur.


Reference › ... › Conditions

  • All COCs contain the hormone estrogen and progesterone.
  • COCs are 99.9% effective when used correctly. They are more effective than IUCD and condoms.
  • The brand name of depo Provera commonly called depo and or sangini.

  • Norplant implants are usually placed under the skin on the inside of women's upper arm in a fan-shaped configuration using a simple tractor.

Very Short Questions



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