Medicamentos atuantes no sistema reprodutivo feminino - Anticoncepcionais

1. Medicamentos atuantes no sistema reprodutivo feminino - Anticoncepcionais Gilberto De Nucci denucci@gilbertodenucci.com http://gilbertodenucci.com

2. Dúvidas denucci@gilbertodenucci.com Arquivo Medicamentos atuantes no sistema reprodutivo feminino - Anticoncepcionais Link http://www.gilbertodenucci.com/medicamentos_contraceptivos.ppt

3. In the United Statesaccording to a study published in 2011 In 2006, 49% of pregnancies were unintended—a slight increase from 48% in 2001. Among women aged 19 years and younger, more than 4 out of 5 pregnancies were unintended. The proportion of pregnancies that were unintended was highest among teens younger than age 15 years, at 98%.

4. The anatomy of the female internal genitalia and accessory sex organs Walter F. Boron/ Emile L. Boulpaep – Medical Physiology – Fig 54-1

5. The anatomy of the female internal genitalia and accessory sex organs Walter F. Boron/ Emile L. Boulpaep – Medical Physiology – Fig 54-1

6. Ovarian cycle Rupture of mature follice and release of ovum (ovulatory phase) Corpus luteum formation (luteal phase) Growth and development of the follice (follicular phase) Corpus luteum degeneration Foyes Principles of Medicinal Chemistry – Fig. 29.2

7. In this illustration, the menstrual cycle is divided into four stages. • an egg matures inside the ovary, • which then releases the egg , • allowing it to travel through the fallopian tube, where it rests awaiting fertilization • If the egg is not fertilized, it is flushed out with the menstrual flow www.healthofchildren.com/images/gech_0001_000...

8. Approximate plasma concentrations of the gonadotropins and ovarian hormones during the normal female sexual cycle 800 600 400 200 0 Progesterone 8 6 4 2 0 Ovulation Estradiol Menstruation Progesterone (ng/ml) Estradiol (pg/ml) 800 600 400 200 0 LH Ovulation FSH and LH (ng/ml) FSH 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 Days of female sexual cycle Guyton & Hall – Textbook of Medical Physiology – fig 81.3

15. Mechanism of Action of Estrogen/Progestin Contraceptives • Inhibition of ovulation by suppression of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) • Alteration of cervical mucus to inhibit sperm transport • Interference with ovum transport • Inhibition of implantation by suppression of normal endometrial development Essential of Reproductive Medicine – Tab. 26.1

16. Fertilization process www.jillstanek.com

17. Estrogen secretion throughout the sexual life of the female human being 400 300 200 100 0 Puberty Menopause Estrogens excreted in urine (µg/24 hr) 0-----12 13------40 50 60 Age (yr) Guyton & Hall – Textbook of Medical Physiology – fig 81.10

18. MÉTODOS ANTICONCEPCIONAIS • Tabela – Natural • Barreira – impede o encontro • - Diafragma • - Preservativo • - DIU normal • Medicamentoso • DIU – cobre ou progestogênico • Skin patch • Anel vaginal • Implante • Pílula

19. A clinical guide for contraception – fifth Ed – pg 191

20. CONTRACEPTIVOS HORMONAIS Forma eficaz, segura e reversível. - Puros: somente progestágeno - Combinados: associação de estrogênio e progestágeno

21. Historical Landmarks • Animal experiments in the late 1930s demonstrated that high-dose progesterone could arrest ovulation • Carl Djerassi synthetized progestin from an extract of Mexican wild yam root in late 1940 • First pill marketed for cycle control (1960) - Enovid 10 – 9.85 mg norethynodrel + 150 microg mestranol • Not legal to discuss contraception or prescribe the pill for the indication of contraception until 1969 • Pope Paul VI Humanae Vitae (1968) – pill sinful Essential of Reproductive Medicine – Tab. 26.1

22. ESTROGÊNIO Década de 60 - Pró-Hormônio – Mestranol 150 mcg Etinil Estradiol - Alta dose (> ou = 50 mcg) - Baixa dose (35, 30, 20, 15 mcg) - Tendência – Ultrabaixa (sem consenso)

23. Mestranol (pró-droga) A clinical Guide For Contraception - Fifth edition - pag 36

24. Ethinyl estradiol A clinical Guide For Contraception - Fifth edition - pag 36

25. Estradiol Valerate a

26. Low – Dose Oral Contraceptives Products containing less than 50 mcg of ethinylestradiol

27. Classification of oral contraceptives Into generation according to the type of progestogens associated with estrogen Combined (estrogen + progestin) or progesting only

28. First-Generation Oral Contraceptives Products containing either norethisterone acetate, lynestrenol, ethynodiol acetate or norethynodrel.

29. Ethisterone Testosterone A clinical Guide For Contraception - Fifth edition - pag 37

30. Progestagional derivatives of testosterone Ethisterone Norethindrone A clinical Guide For Contraception - Fifth edition - pag 37

31. A clinical Guide For Contraception - Fifth edition - pag 38

32. A clinical Guide For Contraception - Fifth edition - pag 38

33. Second-Generation Oral Contraceptives Products containing levonorgestrel or norgestimate

34. A clinical Guide For Contraception - Fifth edition - pag 38

35. A clinical Guide For Contraception - Fifth edition - pag 41

36. Dienogest A clinical Guide For Contraception - Fifth edition - pag 42

37. Third-generation Oral Contraceptives Products containing desogestrel, norgestimate or gestodene

38. A clinical Guide For Contraception - Fifth edition - pag 39

39. Fourth-Generation Oral Contraceptives Products containing drospirenone, dienogest or nomegestrol acetate

40. Drospirenone A clinical Guide For Contraception - Fifth edition - pag 42

41. Nomegestrel s

42. Dienogest s

45. Change in adjusted mean number of lesions (papules, pustules, open and closed comedones) from baseline to end point (full analysis set). DRSP, drospirenone; EE, ethinyl estradiol; COC, indicates combined oral contraceptive; Hormonal Contraceptives for Acne Management – CUTANEOUS MEDICINE FOR THE PRACTITIONER - VOL. 81 NO. 1S JANUARY 2008

46. Oral Contraceptives With Acne Benefits Pharmacology of Hormonal Contraceptives and Acne – CUTANEOUS MEDICINE FOR THE PRACTITIONER - VOL. 81 NO. 1S JANUARY 2008

47. Progestin only Low daily doses of progestin (norethindrone, levonorgestrel or desogestrel) Injectable 3-month contraceptives (depot medroxyprogesterone acetate) IM Levenorgestrel implant or etonogestrel single-rod implant – 3 years Intrauterine device containing levonorgestrel – 5 years

48. Contraceptive use in the United States, 1995. Percentage of Women Ages 15-50 30 25 20 15 10 5 0 26% 24% 19% 7% 6% 3% 1% 1% 1% Pill Sterilization Condom Withdrawa/ Rhythm Hysterectomy/ Menopause Injectable Spermicide IUD Implants Method Essential of Reproductive Medicine – Fig. 26.2

49. A clinical Guide For Contraception - Fifth edition - pag 63

50. A clinical Guide For Contraception - Fifth edition - pag 66