Unconjugated testosterone is rarely used clinically because its derivatives have a more powerful and prolonged e?ect, and because testosterone itself requires implantation into the subcutaneous fat using a trocar and cannula for maximum therapeutic bene?t. Testosterone propionate is prepared in an oily solution, as it is insoluble in water; it is e?ective for three days and is therefore administered intramuscularly twice weekly. Testosterone phenyl-propionate is a long-acting microcrystalline preparation which, when given by intramuscular or subcutaneous injection, is e?ective for four weeks. Testosterone enantate is another long-acting intramuscular preparation. Mesterolone is an e?ective oral androgen and is less hepatoxic: it does not inhibit pituitary gonadotrophic production and hence spermatogenesis is unimpaired. Testosterone undecanoate is also an e?ective oral form.... androgen
Habitat: Native to Europe and West Asia.
English: Asparagus, Sparrow grass.Ayurvedic: Shataavari, Vari, Shatviryaa, Shatmuuli, Shatpadi, Bhiru, Naaraayani, Bahusutaa, Atirasaa.Unani: Haliyun.Family: Asparagaceae.Habitat: Found wild in tropical and subtropical parts of India, including the Andamans and ascending in the Himalayas to 1,500 m.
English: Indian asparagus.Ayurvedic: Shataavari, Shatmuuli, Atirasaa, Bahusutaa, Shatpadi, Shatviryaa, Bhiru, Indivari, Vari. (Substitute for Medaa, Mahaamedaa.)Unani: Sataavar.Siddha/Tamil: Thanneervittan kizhangu, Sataavari Kizhangu.Action: Used as a galactagogue and for disorders of female genitourinary tract; as a styptic and ulcer-healing agent; as an intestinal disinfectant and astringent in diarrhoea; as a nervine tonic, and in sexual debility for spermatogenesis.
Along with other therapeutic applications, The Ayurvedic Pharmacopoeia of India indicates the use of the tuberous root in gout, puerperal diseases, lactic disorders, haematuria, bleeding disorders and also recommends it for hyperacidity.The plant contains saponins—sha- tavarins I-IV. Shatavarin IV is a glycoside of sarsasapogenin. The saponin in doses of 20-500 mcg/ml produces a special blockade of syntocinon (oxy- tocin)-induced contraction of rat, guinea-pig and rabbit uteri in vitro and in situ. It also blocks the uterine spontaneous motility.The dried root yields sitosterol; 4,6- dihydroxy-2-O-(2' hydroxyisobutyl) benzaldehyde and undecanyl cetano- ate, and contains a large amount of saccharine matter, mucilage and miner- als—Ca (0.172), Cu (0.033), Na (14.60), K (8.32), Mg (0.169), Mn (0.0074), Ni (0.105) and Zn (0.072) mg/g(dry weight).The root was found to reduce gastric emptying time comparable to that of metoclopramide. (J Postgrad Med, 1990, 36(2), 91-94).The root extracts exhibited antiallergic activity in animal studies.The root, when fed orally, acted as immunomodulator against induced sepsis and peritonitis in rats and mice.... asparagus racemosusHabitat: Subalpine and temperate Himalayas, at altitudes of 1,8003,750 m.
English: Bitter Cress, Hedge Mustard, Yellow Rocket, Winter Cress.Folk: Cress.Action: Diuretic, anthelmintic, stomachic, antiscorbutic, (leaves are rich in vitamin C 130 mg/100 g). Pulverised herb is used as an agent for stimulating spermatogenesis.
The roots contain sinigrin; seeds contain a glucoside, glucobarbarin, and myrosin.The protein and phosphorus contents of the plant decrease with the maturity, whereas the calcium contents increase (tender stems are eaten as a salad). The leaves and buds are a rich source of provitamin A (beta- carotene).... barbarea vulgarisHabitat: Native to South Europe, grown as an ornamental.
English: Wall-flower, Gilli Flower.Unani: Tudri (Surkh, Safed, Zard)Action: Flowers—cardioactive, tonic, antispasmodic, purgative, emmenagogue, deobstruent (used in liver diseases and sexual debility). Seeds— stomachic, diuretic, expectorant (in bronchitis and asthma); also goitrogenic. Juice of leaves and seeds—antibacterial.
Flowers contain flavonoids (querce- tin and rhamnetin derivatives); seeds contain high levels of cardiac aglycones (30 cardiac glycosides have been isolated); oil contains cherinine, a glucoside of the digitalis group.In Unani medicine, the drug is used as a tonic to the male reproductive system, but recent findings do not validate its therapeutic use. The flavonoid, kaempferol, isolated from the young plant, inhibits spermatogenesis and alters leydig cell number and diameter, affecting the fertility.... cheiranthus cheiriHabitat: Throughout India.
English: Embelia.Ayurvedic: Vidanga, Krmighna, Krmihara, Krmiripu, Chitratandula, Jantughna, Jantunaashana, Vella, Amogha.Unani: Baobarang, Barang Kaabuli.Siddha/Tamil: Vaayuvidangam.Action: Ascaricidal, anthelmintic, carminative, diuretic, astringent, anti-inflammatory, antibacterial, febrifuge. Used in diseases of chest and skin. Active principles are found to be oestrogenic and weakly progestogenic. Root—bechic, antidiarrhoeal. Seed—spermicidal, oxytocic, diuretic. The plant is also used for its blood purifying properties. It is an ingredient in cough syrups, preparations for anaemia, genitourinary tract infections, diarrhoea and diseases of the liver.
Embelin, isolated from the berries, shows significant anti-implantation and post-coital antifertility activity. (Successful trials have been carried out at the National Institute of Immunology, New Delhi on human beings.) It is found to be a potential male antifer- tility agent. Spermatogenesis has been impaired and sperm count reduced to the level of infertility. The antisper- matogenic changes are found to be reversible without any toxic effects.Aqueous and EtOH extract of the fruit—anthelmintic against earthworms. Fruit powder (200 mg/kg), taken with curd on empty stomach, expelled tapeworm within 6-24 h. The treatment was also found effective in giardiasis. EtOH (50%) of the plant was found slightly active against E.coli. Di-salts of embelin—an- thelmintic. Amino salts exhibited less side effects than embelin. The effect of di-isobutyl amino derivatives lasted up to 10 h, also showed anti-inflammatory, hypotensive and antipyretic activities.Berries gave quinones—embelin, ra- panone, homoembelin, homorapnone and vilangin.Dosage: Fruit—5-10 g powder. (API Vol. I.)... embelia ribesHabitat: Native of China; grown in gardens throughout India.
English: Rose-of-China, Shoe- flower, Chinese Hibiscus.Ayurvedic: Japaa, Javaa, Odrapush- pa, Rudrapushpa, Arunaa.Unani: Gul-e-Gurhal.Siddha/Tamil: Semparuthi.Action: Flower—used in impo- tency, bronchial catarrh. Flower and bark—emmenagogue. Leaf— stimulates expulsion of placenta after childbirth; laxative, anodyne. Flower and root—used in menorrhagia.
The plant contains the cyclopro- panoids, methyl sterculate, methyl- 2-hydroxysterculate, 2-hydroxystercu- late, malvalate and beta-sitosterol.The major anthocyanin in the flower is cyanidin 3-sophoroside. The flower nectar is rich in amino acids, mainly aspartic acid and asparagin. During pollination, the amino acid concentration increases substantially.Flower powder exhibited anti-inflammatory activity in male albino rats with carrageenan-induced rat paw oedema. The aqueous extract of the plant showed antitumour activity against sarcoma 180 ascites.An aqueous extract of flowers reduced the duration of oestrus cycle in experimental albino rabbits. The alcoholic extract of flowers showed antiimplantation activity. The benzene extract of flowers, on oral administration, terminated pregnancy in experimental animals.Flower buds are used in the treatment of vaginal and uterine discharges.Oral administration of flower extract to rats affected spermatogenesis and endocrine function of testis.In diabetic patients, a flower bud is given daily up to 10 days or until the level of blood sugar is reduced to tolerable limits.The white-flowered var. of Japan (cultivated all over India in garden) is equated with Hibiscus syriacus Linn. (Rose of Sharon, Shrubby Althaea). The white flower is an oriental drug used as demulcent and antidiarrhoeal. The bud yields mucilage which consists mainly of partially acetylated acidic polysaccharides. The aqueous extract of the petals causes vasorelaxation of the isolated rat arota via both endo- thelium-dependent and -independent mechanisms. The petals contain anthocyanin pigments.The cortex and bark exhibit antifun- gal acitivity.The bark gave canthin-6-one and a fatty acid fraction consisting of lauric, myristic and palmitic acids.Dosage: Flower—10-20 g paste. (CCRAS.)... hibiscus rosa-sinensisBarrier methods These involve a physical barrier which prevents sperm (see SPERMATOZOON) from reaching the cervix (see CERVIX UTERI). Barrier methods reduce the risk of spreading sexually transmitted diseases, and the sheath is the best protection against HIV infection (see AIDS/HIV) for sexually active people. The e?ciency of barrier methods is improved if they are used in conjunction with a spermicidal foam or jelly, but care is needed to ensure that the preparation chosen does not damage the rubber barrier or cause an allergic reaction in the users. CONDOM OR SHEATH This is the most commonly used barrier contraceptive. It consists of a rubber sheath which is placed over the erect penis before intromission and removed after ejaculation. The failure rate, if properly used, is about 4 per cent. DIAPHRAGM OR CAP A rubber dome that is inserted into the vagina before intercourse and ?ts snugly over the cervix. It should be used with an appropriate spermicide and is removed six hours after intercourse. A woman must be measured to ensure that she is supplied with the correct size of diaphragm, and the ?t should be checked annually or after more than about 7 lbs. change in weight. The failure rate, if properly used, is about 2 per cent.
Non-barrier methods These do not provide a physical barrier between sperm and cervix and so do not protect against sexually transmitted diseases, including HIV. COITUS INTERRUPTUS This involves the man’s withdrawing his penis from the vagina before ejaculation. Because some sperm may leak before full ejaculation, the method is not very reliable. SAFE PERIOD This involves avoiding intercourse around the time when the woman ovulates and is at risk of pregnancy. The safe times can be predicted using temperature charts to identify the rise in temperature before ovulation, or by careful assessment of the quality of the cervical mucus. This method works best if the woman has regular menstrual cycles. If used carefully it can be very e?ective but requires a highly disciplined couple to succeed. It is approved by the Catholic church.
SPERMICIDAL GELS, CREAMS, PESSARIES, ETC.
These are supposed to prevent pregnancy by killing sperm before they reach the cervix, but they are unreliable and should be used only in conjunction with a barrier method.
INTRAUTERINE CONTRACEPTIVE DEVICE (COIL) This is a small metal or plastic shape, placed inside the uterus, which prevents pregnancy by disrupting implantation. Some people regard it as a form of abortion, so it is not acceptable to all religious groups. There is a risk of pelvic infection and eventual infertility in women who have used coils, and in many countries their use has declined substantially. Coils must be inserted by a specially trained health worker, but once in place they permit intercourse at any time with no prior planning. Increased pain and bleeding may be caused during menstruation. If severe, such symptoms may indicate that the coil is incorrectly sited, and that its position should be checked. HORMONAL METHODS Steroid hormones have dominated contraceptive developments during the past 40 years, with more than 200 million women worldwide taking or having taken ‘the pill’. In the past 20 years, new developments have included modifying existing methods and devising more e?ective ways of delivering the drugs, such as implants and hormone-releasing devices in the uterus. Established hormonal contraception includes the combined oestrogen and progesterone and progesterone-only contraceptive pills, as well as longer-acting depot preparations. They modify the woman’s hormonal environment and prevent pregnancy by disrupting various stages of the menstrual cycle, especially ovulation. The combined oestrogen and progesterone pills are very e?ective and are the most popular form of contraception. Biphasic and triphasic pills contain di?erent quantities of oestrogen and progesterone taken in two or three phases of the menstrual cycle. A wide range of preparations is available and the British National Formulary contains details of the commonly used varieties.
The main side-e?ect is an increased risk of cardiovascular disease. The lowest possible dose of oestrogen should be used, and many preparations are phasic, with the dose of oestrogen varying with the time of the cycle. The progesterone-only, or ‘mini’, pill does not contain any oestrogen and must be taken at the same time every day. It is not as e?ective as the combined pill, but failure rates of less than 1-per-100 woman years can be achieved. It has few serious side-effects, but may cause menstrual irregularities. It is suitable for use by mothers who are breast feeding.
Depot preparations include intramuscular injections, subcutaneous implants, and intravaginal rings. They are useful in cases where the woman cannot be relied on to take a pill regularly but needs e?ective contraception. Their main side-e?ect is their prolonged action, which means that users cannot suddenly decide that they would like to become pregnant. Skin patches containing a contraceptive that is absorbed through the skin have recently been launched.
HORMONAL CONTRACEPTION FOR MEN There is a growing demand by men worldwide for hormonal contraception. Development of a ‘male pill’, however, has been slow because of the potentially dangerous side-effects of using high doses of TESTOSTERONE (the male hormone) to suppress spermatogenesis. Progress in research to develop a suitable ANDROGEN-based combination product is promising, including the possibility of long-term STEROID implants. STERILISATION See also STERILISATION – Reproductive sterilisation. The operation is easier and safer to perform on men than on women. Although sterilisation can sometimes be reversed, this cannot be guaranteed and couples should be counselled in advance that the method is irreversible. There is a small but definite failure rate with sterilisation, and this should also be made clear before the operation is performed. POSTCOITAL CONTRACEPTION Also known as emergency contraception or the ‘morning after pill’, postcoital contraception can be e?ected by two di?erent hormonal methods. Levonorgesterol (a synthetic hormone similar to the natural female sex hormone PROGESTERONE) can be used alone, with one pill being taken within 72 hours of unprotected intercourse, but preferably as soon as possible, and a second one 12 hours after the ?rst. Alternatively, a combined preparation comprising ETHINYLESTRADIOL and levonorgesterol can be taken, also within 72 hours of unprotected intercourse. The single constituent pill has fewer side-effects than the combined version. Neither version should be taken by women with severe liver disease or acute PORPHYRIAS, but the ethinylestradiol/levonorgesterol combination is unsuitable for women with a history of THROMBOSIS.
In the UK the law allows women over the age of 16 to buy the morning-after pill ‘over the counter’ from a registered pharmacist.... contraception
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