Hormonal Contraceptives 

Hormonal contraceptives are drugs that use synthetic estrogen and/or progestin to prevent pregnancy. They act by suppressing ovulation, altering cervical mucus, and changing the endometrial lining. In Kenya, these agents are available in oral, injectable, implant, and intrauterine forms.

1. Classification of Hormonal Contraceptives

• Combined oral contraceptives (COCs): Estrogen + Progestin

• Progestin-only pills (POPs) – Mini-pills

• Injectable contraceptives – Depo-Provera®, Noristerat®

• Implants – Jadelle®, Implanon®

• Intrauterine systems (IUS) – Mirena®

• Emergency contraceptive pills – Postinor-2®, Levonelle®

2. Mechanism of Action

• Suppress ovulation: Estrogen and progestin inhibit GnRH release → ↓ LH and FSH → no ovulation.
• Cervical mucus thickening: Progestin makes mucus hostile to sperm.
• Endometrial changes: Prevent implantation.
• Tubal motility changes: Reduce sperm/egg transport.

3. Combined Oral Contraceptives (COCs)

Composition: Ethinylestradiol (20–35 µg) + Progestin (Levonorgestrel, Norethisterone, Drospirenone).

Mechanism

Suppress LH/FSH → inhibit ovulation and stabilize endometrium.

Indications

• Contraception
• Menstrual regulation
• Endometriosis and dysmenorrhea
• Acne and hirsutism (antiandrogenic progestins)

Dose and Administration

One tablet daily for 21 days, followed by 7-day pill-free interval or placebo pills.

Common Kenyan Brands

Microgynon®, Marvelon®, Yaz®, Rigevidon®.

Adverse Effects

• Mild: Nausea, breast tenderness, headache, breakthrough bleeding.
• Serious: Venous thromboembolism (VTE), hypertension, migraine exacerbation.
• Long-term: Slightly increased risk of cervical cancer; reduced risk of ovarian and endometrial cancer.

Contraindications

• Smoking in women >35 years
• History of VTE, stroke, or ischemic heart disease
• Migraine with aura
• Breast cancer
• Uncontrolled hypertension

4. Progestin-Only Pills (POPs)

Composition: Levonorgestrel 30 µg or Desogestrel 75 µg per tablet.

Mechanism: Thickens cervical mucus, suppresses ovulation in 50–60% of cycles, and alters endometrium.

Dose: One tablet daily at the same time each day (strict adherence required).

Kenyan Brands: Microlut®, Noriday®, Cerazette®.

Adverse Effects: Irregular bleeding, amenorrhea, headache, breast tenderness.

Clinical Notes: Safe for breastfeeding women and those with estrogen contraindications.

5. Injectable Contraceptives

• Depo-Provera® (Medroxyprogesterone acetate 150 mg IM every 12 weeks)
• Noristerat® (Norethisterone enanthate 200 mg IM every 8 weeks)

Mechanism: Suppresses ovulation, thickens cervical mucus, and thins endometrium.

Advantages: High efficacy, no daily pill.
Disadvantages: Delayed return to fertility (6–12 months), menstrual irregularities.

Adverse Effects: Weight gain, decreased bone mineral density (long-term use), mood changes.

Clinical Notes: Used widely in Kenyan family planning clinics; calcium supplementation recommended for long-term users.

6. Subdermal Implants

• Jadelle® (Levonorgestrel) – effective 5 years.
• Implanon® (Etonogestrel) – effective 3 years.

Mechanism: Continuous progestin release suppresses ovulation and thickens cervical mucus.

Adverse Effects: Irregular bleeding, headache, acne, mood swings.

Clinical Notes: Effective, long-term, reversible. Insertion and removal require trained personnel.

7. Hormonal Intrauterine System (IUS)

• Mirena® – releases levonorgestrel 20 µg/day for 5 years.

Mechanism: Local progestin effect → inhibits endometrial proliferation and thickens cervical mucus.

Advantages: Long-acting, low systemic hormone exposure, reduces menorrhagia.

Adverse Effects: Irregular bleeding initially, pelvic discomfort.

Clinical Notes: Inserted by trained providers; available in major Kenyan referral hospitals.

8. Emergency Contraceptive Pills (ECPs)

• Levonorgestrel 1.5 mg single dose (Postinor-2®, NorLevo®)
• Ulipristal acetate 30 mg (EllaOne® – less common in Kenya)

Mechanism: Delays ovulation and prevents fertilization (does not terminate pregnancy).

Administration: Take within 72 hours of unprotected intercourse (earlier = more effective).

Adverse Effects: Nausea, vomiting, menstrual delay.

Clinical Notes: Widely available in Kenyan pharmacies and clinics.

9. Non-Contraceptive Benefits

• Reduced dysmenorrhea and menstrual blood loss.
• Protection against ovarian and endometrial cancers.
• Improvement of acne and hirsutism.
• Management of polycystic ovarian syndrome (PCOS).

10. Summary Table

11. Kenyan Clinical Notes

• Family planning services are offered free in public hospitals under the Ministry of Health.
• Depo-Provera and Implants (Jadelle®, Implanon®) are the most commonly used hormonal methods.
• National guidelines emphasize counselling before initiation and management of side effects.
• HIV-positive women can safely use hormonal contraception; however, drug interactions with ART should be considered.
• Emergency contraception is available OTC but should not replace regular contraception.