Estrogen and progesterone ( advanced pharmacology)

Role of Estrogen and Progesterone in Contraception Affiliation Administration of estrogen and progesterone by means of oral, transdermal or depot injection methods inhibits ovulation by the process of negative feedback inhibition. These hormones exert their action by inhibiting the secretion of gonadotrophins like lueteinizing hormone (LH) and follicle stimulating hormome (FSH) in the luteal phase. The augmentation of FSH is required to trigger the development of follicle and LH increase is critical to initiate ovulation. As a result ovulation is suppressed. This is the mechanism of inhibition underlying the oral hormonal contraceptives to prevent conception. Pills containing progesterone also act by secreting thick cervical mucus which blocks the movement of the sperm beyond the cervix. There are many different types of progesterones like synthetic or oral progesterone, crinone, injectible progesterone and progesterone suppositories. Before recommending an oral contraceptive pill which is usually a combined oral contraceptive pill (COCP) to the client, a detailed clinical history must be taken. The history should cover information like the previous and current medications taken by the client, herbal and over the counter remedies and drug usage. In case of women above 35 years and women with a history of cardiovascular disease, diabetes, migraines, gall bladder disease and pulmonary hypertension, COCP recommendation should be avoided (Petitti, 2003).
The oral contraceptive may either be a combination birth control pill or a minipill. The combination birth control pill contains both progestin and estrogen and different combinations of active and inactive pills which may be conventional or continuous dosing type. Progestin is the only constituent of the minipill. The combination birth control pills may be monophasic or triphasic. In case of a monophasic birth control pill, every active pill comprises of the same quantity of progestin and estrogen, whereas the triphasic combination birth control pill contains three different types of pills that contain different hormones taken for a period of 3 weeks. Other than oral contraceptives, there are also novel approaches available to prevent conception. Ortho evra is a trans-dermal patch that is worn on any region of the body like abdomen, buttocks, upper arm or upper torso except the breasts that delivers progestin and estrogen in an uninterrupted manner into the blood stream through the skin. Contraception is also achieved through depot specific injections. For instance, Depo provera is medroxyprogesterone acetate which could protect against conception for a period of 14 weeks when injected into the arms or buttocks. Intravaginal ring device is another method of non-formulatory contraception. Nuva ring is a flexible ring, small enough to be inserted vaginally once in three weeks and has demonstrated high efficacy in preventing conception. Clients using Depo provera and Nuva ring should be educated on the possible side effects like depression, nervousness, headache, acne etc and are contraindicated in women with liver disease, breast cancer etc (Marchbanks et al., 2002). Further, Depo provera does not provide protection against sexually transmitted diseases (STDs)
Petitti, D. B. (2003) Combination Estrogen-Progestin Oral Contraceptives. New England Journal of Medicine, 349, 1443-50
Marchbanks, P. A., McDonald, J. A., Wilson, H. G., Folger, S. G., Mandel, M. G., Daling, J. R., Bernstein, L…. & Weiss, L. K. (2002). Oral Contraceptives and the Risk of Breast Cancer. New England Journal of Medicine, 346, 2025-32