Contraception

2,268 views
2,176 views

Published on

Ob-Gyne Course

0 Comments
5 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
2,268
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
229
Comments
0
Likes
5
Embeds 0
No embeds

No notes for slide

Contraception

  1. 1. CONTRACEPTION <br />Dr. Mona A. Almushait<br />Dean, Girl’s Centre<br />Associate Professor, Medical College<br />Consultant, Obstetrics & Gynaecology<br />King Khalid University<br />Abha, Saudi Arabia<br />
  2. 2. Methods of Contraception<br />
  3. 3. I.Combined Hormonal Products <br />and <br />Progestin–Only Injection and Pills<br />
  4. 4. Combined Estrogen and Progesterone Contraceptives <br />4Different delivery systems are used to supply estrogen and progestin to provide contraception:<br /><ul><li>Oral contraceptive pills
  5. 5. Monthly injections
  6. 6. Transdermal patches
  7. 7. Vaginal rings </li></li></ul><li>Pills<br />
  8. 8. Mode of action: <br />  Combination of hormonal methods utilizes 2 main mechanisms of contraceptive action:<br /><ul><li>Suppression of the LH surge (to prevent ovulation) ->to inhibit ovulation
  9. 9. Thickening of the cervical mucus (to prevent sperm entering the upper genital tract)
  10. 10. Other mechanisms:</li></ul>-> slowing of tubal transport <br />-> atrophy of the endometrium <br /> <br />
  11. 11. Complications of Estrogen–Containing Contraceptives:<br /><ul><li>Thromboembolism
  12. 12. Post pill amenorrhea
  13. 13. Cerebrovascular accidents
  14. 14. Increased in Cholelithiasis (cholestatic jaundice)
  15. 15. HTN
  16. 16. Benign hepatic tumors (Hepatoma)
  17. 17. Headache in the week off </li></li></ul><li> Contraindications to the Use of Estrogen–Containing Contraceptives<br />ABSOLUTE<br /><ul><li>Arterial thrombosis
  18. 18. Venous thrombus (Thromboembolism)
  19. 19. Pulmonary embolism
  20. 20. Coronary vascular disease, IHD -> cardiomyopathy, vascular heart disease
  21. 21. Past cerebrovascular accident
  22. 22. Pulmonary HTN
  23. 23. Current pregnancy
  24. 24. Breast cancer within the last 5 years (Oestrogen–dependent Cancer)</li></li></ul><li>ABSOLUTE<br /><ul><li>Endometrial cancer
  25. 25. Hepatic tumor or abnormal liver function, Dubin–Johnson or Rotor syndrome, known gallstones
  26. 26. Unexplained abnormal uterine bleeding
  27. 27. Age >35 and cigarette smoking
  28. 28. Uncontrolled hypertension
  29. 29. History of melanoma
  30. 30. Hyperlipidaemia, focal and crescendo migraine
  31. 31. Trophoblastic disease</li></li></ul><li>RELATIVE<br /><ul><li>Risk factor for arterial disease
  32. 32. Complicated prolonged Diabetes -> F.H. of DM
  33. 33. Estrogen–dependent neoplasm
  34. 34. Depression, Hyperprolactinemia
  35. 35. Severe varicose veins
  36. 36. Hypertriglyceridemia
  37. 37. increasing age, smoking, obesity, migraine</li></li></ul><li>Progestin–Only Hormonal Methods of Contraception<br /><ul><li>The Progesterone only Pill (PoP) is also known as the Mini–Pill.
  38. 38. The Progestin–only methods provide the greatest pregnancy protection of all reversible methods of contraception.</li></li></ul><li>Mode of action: <br /><ul><li>PoPs thicken the cervical mucus to inhibit sperm entry through the cervical canal.
  39. 39. Few women inhibit ovulation
  40. 40. Twining the endometrium</li></ul>How to use?<br /><ul><li>PoPs are taken as a continuous preparation, in 28 day packs, with no break between packs.
  41. 41. Taken at the same time each day
  42. 42. Irregular bleeding in the first few months
  43. 43. Most women continue to menstruate although some may have lighter periods and a few become amenorrhoeic. </li></li></ul><li>Benefits of Progesterone only Pill:(have little metabolic impact)<br /><ul><li>Safe -> when oestrogen–containing pills cause side effects, or contraindicated
  44. 44. Older women
  45. 45. Smokers, immediately post–partum, breastfeeding, risk of DVT, hypertension, migraine, or diabetes, PMS
  46. 46. Pills most frequently used by breastfeeding women </li></ul>Side effects:<br /><ul><li>↑ functional ovarian cysts
  47. 47. ↑ risk of ectopic pregnancy
  48. 48. Acne, headache, breast tenderness, nausea, irregular bleeding
  49. 49. Weight change
  50. 50. ↑ breast cancer diagnosis</li></li></ul><li>Most common side effects: <br /><ul><li>Menstrual changes (Unpredictable spotting or bleeding)
  51. 51. Amenorrhea, improve dysmenorrhea</li></ul>for mentally retarded woman -> good hygiene<br /><ul><li>Progestin–only Pills require very strict adherence to every 24hr administration.
  52. 52. Failure rates of 3% to 9%
  53. 53. Return to fertility ranges from immediate with pills and implants to slow with DMPA (Depo-Provera).</li></li></ul><li>Depo-Provera<br />
  54. 54. <ul><li>DMPA (Depo–Provera) 150 mg every 3 months, I.M.
  55. 55. Serum level of DMPA is higher than with implants and IUDs
  56. 56. DMPA
  57. 57. Suppresses gonadotropins to inhibit ovulation
  58. 58. Change cervix mucus (thickening)
  59. 59. Twining endometrium
  60. 60. Good for women using anticonvulsants which increased hepatic clearance of sex steroids
  61. 61. The majority of women develop Amenorrhea
  62. 62. Ovarian suppression
  63. 63. Hypoestrogenism (Postmenopausal level)</li></ul>-> dry vagina, low bone mineral density<br /><ul><li>Return to ovulation takes a median time of 10 months</li></li></ul><li>Advantages:<br /><ul><li>High efficacy
  64. 64. No need to remember to take a pill
  65. 65. Use when oestrogen contraindicates
  66. 66. No ↑ed in ovarian cyst or risk of ectopic pregnancy because they inhibit ovulation</li></ul>Disadvantages:<br /><ul><li>Delayed of fertility, weight gain, irregular bleeding
  67. 67. ↑ risk of Osteoporosis due to long term Medroxy progesterone acetate
  68. 68.  </li></li></ul><li>Contraindications:<br /><ul><li>Pregnancy
  69. 69. Severe arterial disease
  70. 70. Undiagnosed vaginal bleeding
  71. 71. Liver disease</li></li></ul><li>Transdermal Patch <br />
  72. 72. <ul><li>It is a beige-colored patch applied once a week to the abdomen, buttock, upper outer arm, or upper torso (excluding breasts).
  73. 73. The patch releases 150 mcg of norelgestromin and 20 mcg of ethinylestradiol to the bloodstream daily to inhibit ovulation.
  74. 74. 3 consecutive 7-day patches (21 days) are applied, followed by 1 patch-free week per cycle. The patch contains 9 days of medication. </li></li></ul><li>Advantages:<br /><ul><li>Very effective
  75. 75. Rapidly reversible
  76. 76. Excellent cycle control by 3 months of use
  77. 77. Easy to use, start, and stop
  78. 78. Extra protection built in; serum hormone levels will remain in the contraceptive range for up to 2 additional days</li></ul>Disadvantages:<br /><ul><li>Requires a prescription
  79. 79. Concern about visibility of patch for some women
  80. 80. Possible skin reactions
  81. 81. Slight increase in risk of VTE compared with COCs
  82. 82. Lack of protection against STIs </li></li></ul><li>Vaginal Ring <br />
  83. 83. <ul><li>Vaginal ring is a thin, transparent, flexible ring that contains oestrogen/progestogen hormones that are absorbed through vaginal mucosa.
  84. 84. The ring is 92% to 99% effective for pregnancy prevention (typical to perfect use).
  85. 85. It stops ovulation and thickens the cervical mucus.
  86. 86. Worn continuously for three weeks followed by a week off, each vaginal ring provides one month of birth control.</li></li></ul><li>Advantages:<br /><ul><li>Easy to use
  87. 87. Can be worn for three weeks
  88. 88. Effects fertility one month at a time</li></ul>Disadvantages:<br /><ul><li>Does not protect against sexually transmitted infections, including HIV/ AIDS
  89. 89. Spotting
  90. 90. Increased vaginal discharge
  91. 91. Nausea </li></li></ul><li>II. Barrier and Behavioral Methods<br />
  92. 92. <ul><li>The advantage of these contraceptives is that they need to be used only at the time of intercourse.
  93. 93. Most profoundly decreases their utilization and increases their failure rates in typical use.</li></li></ul><li>Male Condom<br />
  94. 94. Advantages:<br /><ul><li>The condom is the best method for reducing the risk of STIs.
  95. 95. ↓transmission of STD, HIV, Chlamydia and Gonorrhea
  96. 96. Can be easily obtained.</li></ul>Disadvantages:<br /><ul><li>Some people are allergic to latex. Polyurethane condoms can be used as an alternative.
  97. 97. Loss of sensation or pleasure
  98. 98. Slippage/breakage</li></li></ul><li>Female barrier method<br />Diaphragm and Cap<br />
  99. 99. <ul><li>Diaphragms and Capsmust be fitted initially and prescribed by clinicians trained in their use.
  100. 100. They must be filled and coated with spermicide and inserted before intercourse.
  101. 101. 84% to 94% effective for pregnancy prevention.
  102. 102. Must be left in place for at least six hours. </li></li></ul><li>Advantages:<br /><ul><li>Easy use
  103. 103. Protection from sexually transmitted infections
  104. 104. Can be put into the vagina at any time before intercourse</li></ul>Disadvantages:<br /><ul><li>Cystitis
  105. 105. Skin irritation
  106. 106. Increased risk of bladder infection (diaphragm only)
  107. 107. They do not prevent HIV transmission </li></li></ul><li>Female barrier method<br />Female Condom<br />
  108. 108. <ul><li>A lubricated polyurethane pouch that is inserted inside the vagina during intercourse.</li></ul>Advantages:<br /><ul><li>Prevents the transmission of HIV and other STDs
  109. 109. No hormonal side effects
  110. 110. Can be used by people with latex sensitivities
  111. 111. Does not affect future fertility</li></ul>Disadvantages: <br /><ul><li>Sometimes difficult to insert or use
  112. 112. Friction/noise during intercourse
  113. 113. Loss of sensation
  114. 114. Can break or leak</li></li></ul><li>Jelly<br />
  115. 115. <ul><li>Contraceptive jelly is another form of concentrated spermicide (which is a chemical that kills sperm).
  116. 116. Jellies come in tubes and are usually used with a diaphragm or cervical cap.
  117. 117. It allows for immediate protection, which lasts for about 1 hour. </li></li></ul><li>Vaginal Contraceptive Sponge<br />
  118. 118. <ul><li>The contraceptive sponge is a small, donut-shaped foam sponge that contains a spermicide called Nonoxynol-9.
  119. 119. It is a non hormonal vaginal barrier method of birth control that is fairly easy to insert.</li></li></ul><li>Vaginal Contraceptive Foam <br />
  120. 120. <ul><li>Foam is placed into the woman’s vagina using an applicator (similar to tampon insertion).
  121. 121. It has two effects:
  122. 122. It kills or destroys sperm which is why it is called spermicidal.
  123. 123. It blocks the man’s fluids from entering the cervical canal, thus, stopping sperm from reaching the egg. </li></li></ul><li>Advantages:<br /><ul><li>Foam is safe, no hormones are involved, and it is immediately reversible.
  124. 124. Foam adds lubrication and moisture.</li></ul>Disadvantages:<br /><ul><li>Can be irritating to the vagina
  125. 125. It is not protective against HIV</li></li></ul><li>Film <br />
  126. 126. <ul><li>Vaginal contraceptive film is a paper-thin translucent film that contains a spermicide and is used for birth control.
  127. 127. The film is placed in the vagina on or near the cervix where it dissolves in seconds.
  128. 128. It is effective for about one hour.</li></li></ul><li>Nonoxynol–9 Suppositories <br />
  129. 129. <ul><li>Drug name: Nonoxynol-9 suppository
  130. 130. Major components:Nonoxynol–9
  131. 131. Traits: White or milky white torpedo suppository
  132. 132. Indication:Spermicidal products for vaginal contraceptive</li></li></ul><li>Behavioral Methods<br /> <br /><ul><li>Natural family planning
  133. 133. Tracking basal body temperature ↑0.5% (7 days before and 2 days after)
  134. 134. Checking the consistency of cervical mucus</li></ul>-> Moist, sticky, white pre–ovulation, clear, copious and stretchy spinnbarkheit-> The most fertile time<br /><ul><li>Time in cycle</li></ul>->Ovulation occurs every 12–16 days before a period<br />-> Pain from ovulation, breast change -> less<br /><ul><li>Lactational amenorrheafor the first 6 months post partum, its failure rate is 2%
  135. 135. Withdrawal or coitus interruptus</li></li></ul><li>III. Progestin Implants and Intrauterine Devices<br />
  136. 136. Implanon <br />
  137. 137. Implant<br /><ul><li>Norplant contraceptive system, silastic implants placed in the s/c layer of the medical aspect of a woman’s upper arm to release steady amounts of Levenogestrel-> 5 years
  138. 138. Have low circulatory levels of progestin
  139. 139. Constant serum level -> contraceptive effects
  140. 140. Suppress ovulation and change cx mucus
  141. 141. Twining endometrium
  142. 142. Etonogestrel–releasing implants</li></li></ul><li>Disadvantages:<br /><ul><li>Vaginal spotting (most common; may persist for years)
  143. 143. Weight gain
  144. 144. Hair or skin changes
  145. 145. Headaches
  146. 146. Depression
  147. 147. Decreased libido</li></li></ul><li>Intrauterine Contraceptive Devices<br />Mirena<br />
  148. 148. Levenogestrel–Releasing Intrauterine System (LNG–IUS)<br /><ul><li>Contains 52 mg of Levenogestrel
  149. 149. 20 µg of Levenogestrel every 24-hr.
  150. 150. T–shape
  151. 151. Effective for at least 5 years</li></li></ul><li>Mode of action: <br /><ul><li>Thickens the cx mucus
  152. 152. Twins the endometrium->atrophic endometrium
  153. 153. Inhibition of ovulation
  154. 154. Amenorrhea for 2–3 months after irregular bleeding
  155. 155. Fertility returns immediately on removal
  156. 156. ↓ Dysmenorrhea
  157. 157. ↓ PID
  158. 158. ↓ E.P.
  159. 159. Reduction in menstrual blood 70%–90% </li></li></ul><li>Disadvantages:<br /><ul><li>Irregular bleeding for the first 3 months
  160. 160. ↑ functional ovarian cyst
  161. 161. Expulsion and perforation</li></ul>Contraindications:<br /><ul><li>Pregnancy
  162. 162. Active liver disease
  163. 163. Severe arterial disease
  164. 164. Undiagnosed irregular bleeding
  165. 165. Mechanical heart valves
  166. 166. Untreated STD
  167. 167. Hx of ovarian or endometrial carcinoma</li></li></ul><li>Copper T380A I.U.D.<br />
  168. 168. Mode of action of Copper T380A I.U.D.:<br /><ul><li>Copper is spermicidal
  169. 169. Motility is severely compromised and the ability of the sperm to fertilize the egg is inhibited by the presence of copper ions.
  170. 170. Inflammatory changes to prevent implantation.
  171. 171. I.U.C.D. inserted in the first 7 days of cycle
  172. 172. With antibiotics cover Azithromycin 1g single dose and Doxycyclone 100g
  173. 173. Pregnancy with I.U.C.D.
  174. 174. ↑ E.T, remove coil, miscarriage </li></li></ul><li>Advantages:<br /><ul><li>Long term efficacy
  175. 175. Lack of hormonal side effects</li></ul>Disadvantages:<br /><ul><li>↑ Menorrhagia
  176. 176. ↑ PID
  177. 177. Perforation and expulsion
  178. 178. Actinomycosis->cx smear
  179. 179. Lost coil </li></li></ul><li>Contraindications to the Use of Combined Hormonal Methods <br /><ul><li>History of heart attack,stroke, and breast cancer
  180. 180. Labile hypertension
  181. 181. Advanced diabetes
  182. 182. Hepatic failure
  183. 183. Migraine with aura
  184. 184. Unexplained uterine bleeding </li></li></ul><li>IV. Female sterilization and Vasectomy <br />
  185. 185. Sterilization <br /><ul><li>Permanent sterilization is the most common method of birth control used.
  186. 186. Mini laparotomy sterilization
  187. 187. Laparoscopic sterilization</li></ul>Disadvantages:<br /><ul><li>Does not protect against sexually transmitted infections, including HIV/AIDS
  188. 188. Requires surgery
  189. 189. Has risks associated with surgery
  190. 190. May not be reversible
  191. 191. Possible regret
  192. 192. Possibility of Post Tubal Ligation Syndrome</li></ul>Advantages:<br /><ul><li>Permanent birth control
  193. 193. Immediately effective
  194. 194. Requires no daily attention
  195. 195. Not messy
  196. 196. Cost-effective in the long run</li></li></ul><li>filshie clip tubal ligation <br /><ul><li> One common form of laparoscopic (camera) sterilization is the use of Filshie clips to occlude both fallopian tubes.</li></ul>Hulka clip sterlization<br /><ul><li>One common form of female sterilization is the use of Hulka clips to block the fallopian tubes. </li></li></ul><li>Vasectomy (interruption of the vas deferens)<br /><ul><li>It is a minor surgical procedure wherein the vasadeferentia of a man are severed, and then tied/sealed in a manner which prevents sperm from entering the seminal stream. </li></li></ul><li>Risks include:<br /><ul><li>Infection
  197. 197. Bleeding
  198. 198. Scrotal pain or swelling at the time of the procedure </li></ul>There are no long–term hormonal, metabolic, or autoimmune effects associated with Vasectomy. <br />
  199. 199. Thank You !<br />

×