Raiyyan Tahsan

Raiyyan Tahsan
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Gynecology Case No.13 OCP

OCP গুলিকে ২ ভাগে ভাগ করা যায়,

1.. শুধু প্রোজেস্টেরন ( progesterone Only pill))

Ex: Tablet 1.Minicon (21 + 7 iron pill) (AS A Norgestrel AS A Oral Contraceptive preparations.)

Indications of Tablet:-Minicon (21 + 7 iron pill) (AS A Norgestrel AS A Oral Contraceptive preparations.):-

In recent times, millions of women are taking oral contraceptive pill for birth control Worldwide, because

  • Oral contraceptive pill is a modern, tolerable and effective birth control system.
  • It is temporary and easily changeable. Any couple can use this pill on a regular basis until they want to have a baby. They can have a baby when they stop using the pill.
  • It has some other healthy advantages besides ensuring birth control.

Description of Tablet:-Minicon (21 + 7 iron pill) (AS A Norgestrel AS A Oral Contraceptive preparations.):-

Normally there two types of birth control pills are available. Among them one is combined oral pill in which there are two types of hormone named estrogen and progesterone. Another one is Minicon which contains lower amount of progesterone than combined oral contraceptive pill.

For whom Minicon is suitable?

  • Minicon is comparatively better birth control pill for breast feeding mother.
  • The women sensitive to estrogen can take Minicon.
  • Comparatively aged women especially who have high blood pressure, weight gain tendency, history of varicose veins, Minicon is advantageous for them.

Advantages of Minicon:

  • The women who are breast feeding their baby after delivery can use Minicon thoughtlessly. Minicon does not do any change in the quality and quantity of breast milk.
  • Minicon can be taken after 6 weeks of delivery.
  • As there is no estrogen, so the side effects related to estrogen such as- nausea, headache, acne or weight gain etc. are rarely observed in case of Minicon. Besides, the women sensitive to estrogen can take Minicon.

Disadvantages related to Minicon:

  • Normal menstruation can be slightly changed due to Minicon such as: spotting or irregular menstruation etc. Besides this, some women may experience mild headache or tenderness of breast. But these are not harmful for health.

Pharmacology of Tablet:-Minicon (21 + 7 iron pill) (AS A Norgestrel AS A Oral Contraceptive preparations.):-

How Norgestrel helps in birth control?

  • Norgestrel thickens the cervical secretion of uterus so that sperm cannot enter into the uterus.
  • Norgestrel inhibits the emission of ovum from ovary.

Dosage & Administration of Tablet:-Minicon (21 + 7 iron pill) (AS A Norgestrel AS A Oral Contraceptive preparations.):-

One pill should be taken regularly at a particular time.

When Norgestrel can be started?

  • A breast feeding woman can start Norgestrel after 6 weeks of delivery.
  • Non breast feeding women can start Norgestrel followed by delivery.
  • In case of other women, Norgestrel should be started within the first 5 days of menstruation.

Direction to take Norgestrel:

  • Special concern should be taken in case of using Norgestrel as there is only one hormone, especially for partially breast feeding or non-breast feeding mother.
  • One pill should be taken in a particular time regularly.
  • New pill should be started in the very next day after finishing the all the pills of the existing packet. There should be no gap between using two packets.

In case of missed dose:

  • Use a back-up method of birth control or condom for 2 days if you are more than 3 hours late taking this medicine. Take the next dose at your regular time.
  • Risks of getting conceive is increased if 2 consecutive doses are missed. In this case, condom or any other non-hormonal back-up method should be taken instead of taking pill. Norgestrel should be started from the first day of the next menstruation cycle. If menstruation does not occur after 4-6 weeks of stopping pill, then consult with a doctor.

After how many days combined pill can be started?

  • Norgestrel is highly effective during the period of breast feeding. But, when the baby can take other foods along with breast milk after completion of 6 months, other low dose pilletter than Norgestrel in that case. Any combined pill can be taken in this case. In this situation, combined pill can control regular menstruation cycle very effectively.

Period এর প্রথম দিন থেকে শুরু করবে, ২১ দিন খাবে, পরে ৭ দিন আয়রন খাবে।।

Tablet 2. Norpil 1 1.5mg AS A(levonorgestrel)  (AS A Emergency Contraceptive Pill, Oral Contraceptive preparations )ইমার্জেন্সি pill 2.. Combined oestrogen and progesterone..

Indications of Tablet 2. Norpil 1 1.5mg AS A(levonorgestrel)  (AS A Emergency Contraceptive Pill, Oral Contraceptive preparations:-

Emergency contraception is a rescue method that is aimed to prevent fertilization in case of unprotected intercourse.

Norpill 1 must be used as soon as possible, preferably within 12 hours and no later than 72 hours (3 days) after the unprotected sexual intercourse, particularly;

  • if you have had sexual intercourse whereas either yourself or your partner did not use a contraceptive method;
  • if you have forgotten to take consecutive 3 contraceptive pills;
  • if your partner’s condom has broken, slipped, or been improperly removed, or if he has forgotten to use it;
  • if you fear that your intrauterine device has been expelled;
  • if your vaginal diaphragm or your contraceptive cap has moved or if you have removed it too early;
  • if you are afraid that the method of coitus interruptus has failed or if you have had sexual intercourse during the period when you are supposed to be fertile while using the rhythm method;
  • in the event of rape.

Composition of Tablet 2. Norpil 1 1.5mg AS A(levonorgestrel)  (AS A Emergency Contraceptive Pill, Oral Contraceptive preparations:-

 

1.5 mg: Each tablet contains 1.5 mg levonorgestrel. Levonorgestrel belongs to a group of medicines called progestogen. Each pack contains 1 round white tablet.
0.75 mg: Each tablet contains 0.75 mg of levonorgestrel. Levonorgestrel belongs to a group of medicines called progestogen. Each pack contains 2 round white tablets.

Description of Tablet 2. Norpil 1 1.5mg AS A(levonorgestrel)  (AS A Emergency Contraceptive Pill, Oral Contraceptive preparations:-

Norpill 1 is an emergency contraceptive for women. This should be used within 72 hours of unprotected intercourse. It should not be taken as a regular birth control pill. This medicine is also known as Post Coital Pill and Morning After Pill. The active substance in this medicine is Norpill 1.

Some information about the menstrual cycle and contraception:

The menstrual cycle is the time elapsed between two menstrual periods. Normally, the cycle lasts for 28 days but its length can vary noticeably from one woman to another.

Menstrual periods occur when a woman is not pregnant. At the middle of the cycle, an ovum is expelled by one of the 2 ovaries (this moment is called “ovulation”). Usually, ovulation takes place in the middle of the cycle, but it can occur at any moment during the cycle.

If sperms are near the ovum, fertilization (i.e. the merge between the ovum and a sperm cell in order to create an embryo) can take place. After a few days, the fertilized ovum implants in the womb and the pregnancy starts.

Contraceptive methods are aimed to prevent:

  • either the ovulation: this is the case for the contraceptive pill,
  • either the fertilization (merge of the sperm with the ovum): this is the case for condoms,
  • or the implantation of a fertilized ovum: this is the case for intrauterine devices.

Emergency contraception aims to block ovulation or prevent implantation if the sexual intercourse has taken place in the hours or days preceding ovulation, i.e. at a time when the likelihood of fertilization is the highest. It could also prevent implantation. It becomes inefficient as soon as implantation has started.

Without a contraceptive method, a woman cannot exclude the possibility of becoming pregnant after sexual intercourse.

If you have taken this medicine and that you do not use regular contraception, it is highly recommended to visit your doctor in order to obtain advice on a method of contraception suitable to you.

The advice in case of risk of transmission of sexually transmitted disease:

If you fear a pregnancy, this can mean that you have not used a condom (or that you have used it improperly) during sexual intercourse. You may therefore have contracted a sexually transmitted disease or the AIDS virus, if you are not aware of your partner’s health status, or if you have several partners. You should ask for advice from your doctor as soon as possible for early detection and, if necessary, early treatment. During your next sexual intercourse, it is recommended to take the appropriate measures in order to prevent unwanted pregnancy and/or a sexually transmitted disease and to avoid AIDS contamination. If you need further information about Norpill 1, ask your doctor, or a family planning center.

Pharmacology of Tablet 2. Norpil 1 1.5mg AS A(levonorgestrel)  (AS A Emergency Contraceptive Pill, Oral Contraceptive preparations:-

Oral contraceptives containing levonorgestrel suppress gonadotropins, inhibiting ovulation. Specifically, levonorgestrel binds to progesterone and androgen receptors and slows the release of gonadotropin-releasing hormone (GnRH) from the hypothalamus. This process results in the suppression of the normal physiological luteinizing hormone (LH) surge that precedes ovulation. It inhibits the rupture of follicles and viable egg release from the ovaries. Levonorgestrel has been proven to be more effective when administered before ovulation.

Dosage of Tablet 2. Norpil 1 1.5mg AS A(levonorgestrel)  (AS A Emergency Contraceptive Pill, Oral Contraceptive preparations:-

1.5 mg Tablet: The treatment necessitates the intake of one tablet. The Levonorgestrel tablet must be taken as soon as possible, preferably within 12 hours, after the unprotected intercourse, and no longer than within 72 hours (3 days) after the intercourse. Levonorgestrel can be taken at any moment during the menstrual cycle.

0.75 mg Tablet: The first Levonorgestrel tablet must be taken within 72 hours of the intercourse and the second tablet should be taken after 12 hours of the intake of the first tablet. Levonorgestrel must be taken within 48 hours of unprotected intercourse and in no way after 72 hours because the effectiveness of the medicine starts reducing after 48 hours of intercourse. Levonorgestrel can be taken at any moment during the menstrual cycle.

After using emergency contraception, it is recommended to use a local contraceptive mean (condom, spermicide, and cervical cap) until the next menstrual period resumes. The use of Levonorgestrel does not contraindicate the continuation of regular hormonal contraception. If you have used this medicine while you were using oral contraception (contraceptive pill), you should carry on taking the usual tablets until the end of the treatment. In case no menstrual period occurs in the next pill-free period following the use of Levonorgestrel a pregnancy test should be performed to rule out a pregnanc

যে সব নামে পাওয়া যায়…

sukhi pill, famicon, Marvelon, desolon… Rosen 28.

সব গুলি কমবাইন্ড pill.

এই গুলিও ২১ দিন করে খাবে।

Progesterone only pill কিভাবে কাজ করে?

এইটা cervical mucous কে thick করে দেয়, Thus prevent entry of sperm….

2… Combined oral contraceptive pill কিভাবে কাজ করে?

এইটা সরাসরি Ovulation টা প্রিভেন্ট করে দেয়…

কাকে Combined দেওয়া যাবেনা??

বয়স ৩৫ এর বেশি কিংবা chain smoker, কিংবা Breast feeding baby আছে, কিংবা IHD/ stroke এর হিস্ট্রি আছে কিংবা VTE এর হিস্ট্রি থাকলে,৷ uncontrolled HTN, ও Migraine with aura থাকলে combined দেওয়া যাবেনা,

এইসব ক্ষেত্রে progesterone only pill দিতে হবে…

Combined OCP + Rifampicin খেলে Contraception failure হতে পারে,৷ Rifampicin OCP rapidly metabolized করে দেয়।।

ব্রেস্ট ফিডিং এ কোন contraceptive দিবেন?

Minicon /mygest (progesterone only pill)

uncontrolled HTN থাকলে? Progesterone only pill diben.

Capsule3:- Mygest 200mg (AS A Progesterone Micronized AS A Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations.)

Indications of Capsule:- Mygest 200mg (AS A Progesterone Micronized AS A Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations.)

Mygest softgel capsule is indicated in-

  • Maintenance of Pregnancy in cases of Threatened / Recurrent abortion.
  • Luteal support during IUI and ART procedures IVF-ET.
  • Luteal support in cases of proven luteal phase insufficiency.
  • Along with estrogen in post-menopausal hormone replacement therapy (HRT) either in sequential or in continuous regimen.
  • To prevent endometrial hyperplasia where endogenous estrogen is present.
  • As progesterone challenge test in secondary amenorrhoea.
  • For cycle control along with estrogen therapy.
  • Dysfunctional uterine bleeding (DUB)
  • Premenstrual tension.
  • Endometriosis.
  • Oocyte donation programme.
  • Benign mastopathy.

Pharmacology of Capsule:- Mygest 200mg (AS A Progesterone Micronized AS A Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations.)

 

Progesterone Micronized softgel capsule contains micronised progesterone, which is structurally and biologically identical to natural endogenous progesterone. Micronisation increases the bioavailability of progesterone. When micronised progesterone is administered after meals, maximal serum progesterone levels are significantly increased. Progesterone concentrations in the endometrial and breast tissue attain high level. Progesterone is approximately 96%-99% bound to serum proteins, primarily to serum albumin (50%-54%). Progesterone is metabolized to pregnanediols and pregnanolones in the liver. The glucuronide and sulfate conjugates of pregnanediol and pregnanolone are excreted in the bile and urine. Progesterone metabolites, which are excreted in bile, may undergo enterohepatic circulation.

Dosage & Administration of Capsule:- Mygest 200mg (AS A Progesterone Micronized AS A Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations.)

 

The usual recommended dose: Progesterone 100 mg/200 mg 2 to 3 soft gel capsules daily by the oral or vaginal routes in divided doses. Flexible dosage regimen can be followed depending on the indication and requirements of patients.

Maintenance of Pregnancy in cases of Threatened / Recurrent abortion: Progesterone 200 to 400 mg per day in divided doses.

In-vitro fertilization and embryo transfer: Progesterone 200 mg thrice a day from the day of embryo transfer till pregnancy is confirmed. If pregnant, it is continued till 12th week of pregnancy.

HRT: In sequential regimen: Progesterone 200mg daily for 12 days in last 2 weeks of each therapeutic cycle. In continuous regimen: Progesterone 100 mg daily throughout the month along with estrogen.

Oocyte donation program: Progesterone 100mg twice daily from the day of transfer till pregnancy is confirmed. This may be increased to a maximum of 600 mg per day and continued till 12th week of pregnancy.

Luteal support: Progesterone 100 mg thrice a day from the 17th day of the cycle for 10 days in induced cycle. If pregnant, it is continued till 12th week of pregnancy.

Luteal phase insufficiency: Progesterone 100 mg thrice daily to be continued up to 12 weeks of pregnancy, increasing the dose by 100 mg/day/week to a maximum of 600 mg/day in divided doses if required.

In secondary amenorrhoea: Progesterone 300mg for 10 days results in withdrawal bleeding in 80% of cases.

Premenstrual syndrome: Progesterone 100-200 mg daily for 10 days from 17th to 26th day of each menstrual cycle.

Benign mastopathy: Progesterone 200-300 mg for 10 days per month, usually from 17th to 26th day of the monthly cycle.

Side Effects of Capsule:- Mygest 200mg (AS A Progesterone Micronized AS A Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations.)

 

Mygest is devoid of estrogenic, androgenic and mineralocorticoid effects. Mild somnolence and other CNS side effects like depression, breast tenderness and bloating are reported. Side effects are less when vaginal route is used.

Precautions & Warnings of Capsule:- Mygest 200mg (AS A Progesterone Micronized AS A Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations.)

  • মেনোপজের পরে হরমোন প্রতিস্থাপন থেরাপি (Post Menopausal Hormonal Replacement Therapy)

এই ঔষধটি মেনোপজ অর্জন করে এমন মহিলাদের মধ্যে এস্ট্রোজেনের সাথে ব্যবহার করা হয়, তবে অস্ত্রোপচার অর্জন করেনি। গর্ত অপসারণ করতে পারে

  • অ্যামেনোরিয়া (Amenorrhoea)

এই ঔষধটি তাদের শরীরের প্রোগেস্টেরনের অভাবের কারণে সন্তান জন্মের সম্ভাব্যতার মাসিকতার অভাবে চিকিৎসার জন্য ব্যবহৃত হয়।

  • অস্বাভাবিক গর্ভাশয় থেকে রক্তপাত (Dysfunctional Uterine Bleeding)

এই ঔষধটি হরমোন মাত্রায় পরিবর্তনের কারণে যোনি থেকে অস্বাভাবিক রক্তপাতের চিকিৎসার জন্যও ব্যবহৃত হয় তবে গর্ভাবস্থা বা গর্ভপাতের কারণে এটি হয় না।

  • এন্ডোমেট্রিয়াল হাইপারপ্লাসিয়া (Endometrial Hyperplasia)

এই ঔষধটি এই অবস্থাকে প্রতিরোধ করার জন্য ব্যবহার করা হয় যেখানে মহিলা যৌন হরমোনগুলি ভারসাম্যহীন এবং ভারী রক্তপাত বা পর্যায়ক্রমে অন্ত্রের রক্তপাত অভিজ্ঞতা হয়।

  • প্রোজেস্টে‌রন কম হওয়া (Progesterone Deficiency)

এই ঔষধটি এমন অবস্থায় চিকিৎসা করার জন্য ব্যবহৃত হয় যেখানে শরীরের প্রজেসেরন স্তর কম থাকে এবং এর ফলে গর্ভপাতের ঝুঁকি খুব বেশী হয়।

মাসিক চক্রের অংশ হিসাবে যৌন হরমোন মাত্রায় পর্যায়ক্রমে পরিবর্তন হওয়ার কারণে অভিজ্ঞতার লক্ষণগুলির জন্য এই ঔষধটি ব্যবহার করা হয়।

  • গর্ভনিরোধ (Contraception)

এই ওষুধটি গর্ভনিরোধক অর্জনের জন্য একটি যোনিযুক্ত সন্নিবেশকৃত ডোজ ফর্ম হিসাবেও ব্যবহার করা যেতে পারে।

 

Severe renal insufficiency, diabetes mellitus, seizures, migraine, headache, heart diseases, depression.

General Queries:-

1.Pop ke lactating mother ke 6 month porjonto Dibo naki 2bosor porjonto debo jotodin baby breastfeeding kore?

Answer is:-

6 month dewa jabe.

2.যেহেতু Progesterone only pill ই সবক্ষেত্রে নিরাপদ, তাহলে কম্বাইন্ড দেওয়ার প্রয়োজন কি?

Answer is:-

side effect beshi…tai combined dewa hoi less side effects hisebe.

Raiyyan Tahsan ❤️Date:-29-12-2024 Sunday Time:3-54-34 pm

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