2 popular ec products pc4 schering postinor-2 gedeon richter
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2 Popular EC Products
PC4Schering
Postinor-2Gedeon Richter
Progestin-alone EC has Better Effectiveness Pregnancy rates (per episode)
Levonorgestrel (LNG) 1.1%
Yuzpe (Combined
Formulation) 3.2%
Progestin (LNg)-Alone EC has Fewer Side Effects
Vomiting Nausea
LNg 5.6% 23.1%
Yuzpe 18.8% 50.5%
Source: WHO 1998
The Necklace
Standard Days Method
Efficacy of SDM
Correct use (w/abstinence)
Correct use (abstinence + other method)
Correct + non-compliance
4.4
5.6
11.9
Pregnancy rate over 13 cycles
• “Generally regarded as safe (GRAS)” reclassify as active pharmaceutical ingredient
• Inexpensive, widely available, stable at several temperatures
• Sulphated polymer – high molecular weight, negatively charged – may block binding of pathogens to target cells
Carraguard - PC-515 (1)
• Population Council’s lead microbicide
• Derived from seaweed (carrageenan)
• Carrageenans used widely in food, pharmaceuticals & cosmetics as excipient
Microbicides in clinical trials Sept. 2002
0
2
4
6
8
10
Phase 1 Phase 2 Phase2/3 Phase 3
2002
When will we actually see a microbicide product for use in
programs?
Not for at least several years.
Female Condom
Inner ringOuter ring
Plastic sheathwith ring at both ends
Grasping female condomfor insertion
Reality and Reddy Female Condoms
Auto-Disable (AD) Syringes
• Automatic inactivation after single use
• Difficult / impossible to re-use
• Slightly more expensive
• Successful experience in immunization
• Starting to be shipped by USAID for Depo-Provera
What country in ANE/E&E has already had Depo shipped with
AD Syringes?
Jordan!
What ANE/E&E countires are Scheduled for AD Syringes in
2002-3?
• Afganistan, Bangldesh, Jordan, Nepal, Philippines, Egypt, WB Gaza
• Albania, Romania
CBD Workers….A. Can provide condoms
B. Can provide condoms and pills
C. Can provide condoms, pills and injectables
D. Can provide condoms, pills and injectables but certain quality components (e.g. side effect counseling, clean needle) key
N-9 Spermicides..A. Very effective for preventing pregnancy and
HIV.B. Very effective for preventing pregnancy but
not HIV.C. Effective against HIV but not pregnancy.D. Mediocre against pregnancy and not
effective against HIV.
Non-Menstruating FP Clients
A. Are only a small part of potential FP users.B. Should be told to go away and return when
they are menstruatingC. Should be given condoms and told to return
when they are menstruating. D. Can be given hormonal methods if
pregnancy is ruled out e.g. by the “Pregnancy Checklist.”
Syndromic Management of STIs
A. Not a sound approach to SITsB. Not a sound approach for cervical STI’s in
women such as gonorrhea and chlamydia, but effective for urethritis, and often for genital ulcers. May be sensible approach to vaginitis
C. Good for all STI syndromesD. A good approach for social marketing antibiotics
for urethritis.
According to WHO, how many pill packs should be given at initial visits?
A. 1 PackB. 3 PacksC. 6 PacksD. Up to 13 Packs (1 year)E. As many as client wants
IUDs
A. Can be safely provided to nulliparous women with proper screening
B. Require a follow-up only at about one month unless the client has problems
C. May be appropriate for HIV+ womenD. Do not increase the risk of infertility in well-
screened clients.
Nonfatal VenousThromboembolism May be More
Common with Third Generation Pills
Situation
Source: Vessey MP. BJOG 1997; 104:516.
No COC
Rate(per 100,000
women/years)
5 - 11
COC with Desogestrel or Gestodene (3rd generation)
COC with Norethisterone or Levonorgestrel
Pregnant and postpartum women
15
60
30
Types of MonthlyCombined Injectables
Cyclofem(Cyclo-Provera):
25 mg DMPA5 mg estradiol cypionate
Mesigyna(Norigynon):50 mg NET-EN
5 mg estradiol valerate
Comparative Characteristics of DMPA and NET-EN
Effectiveness
Bleeding
Needle/pain
Reinjection window
Duration
Cost
DMPA NET-EN
(no significant difference)
More amenorrhea
Smaller/less
2 - 4 weeks early or late
3 months
Less expensive
More irregular
Larger/more
1 - 2 weeks early or late
2 months
More expensive
54 mm
4 mm(1/8 in)
(2 inches)
EC:The Sooner the BetterWHO Pooled Data (Yuzpe and LNg)
0.5%
1.5%1.8%
2.6%3.1%
4.1%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
0-12 13-24 25-36 37-48 49-60 61-72
Pregnancy Rate
Source: Piaggio, von Hertzen, Grimes and Van Look 1999
p<.01
Actual Return of Menses Compared with Expected Return
0%
10%
20%
30%
40%
50%
60%
70%
<-3 -3 to +3 +4 to +7 >+7
WHOPop Council
Source: WHO 1998; Ellertson et al. 2001
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