Contraceptive methods I
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Contraceptive methods part 1 for UG MBBS students including information on types of contraceptives, cafeteria choice, Barrier methods,IUD,Mirena.
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Contraceptive methods I
- 1. Contraceptive methods- I Dr Mamta Gehlawat MBBS MD PGDHHM PGDG Asst Prof Comm Med GMC SDPT
- 2. Contraceptive methods= preventive methods to help women avoid unwanted pregnancies
- 3. An ideal contraceptive? • Safe • Effective • Acceptable • Inexpensive • Reversible • Simple to use • Independent of coitus • Long lasting • Need minimum supervision
- 5. Cafeteria choice Health Worker Eligible couple Options
- 6. Any contraceptive • Ideal/perfect use • Practical/in practice/typical use • Failure rate expressed in no. of pregnancy per 100 women-years • Pearl index: the number of failures of a contraceptive method per 100 woman years of exposure
- 7. Conventional contraceptives? • Methods requiring action at the time of coitus/sexual intercourse • Eg. Condom, spermicide etc
- 8. Types of contraceptive methods Contraceptives Spacing Barrier Physical Chemical Combined IUD Hormonal Post conceptional Misc. Terminal Male Sterilisation Female Sterilisation
- 9. Barrier methods= to prevent live sperm from meeting the ovum
- 10. barrier methods- Why ? Why not? No S/E like pill/IUD Need high motivation STD prevention Less effective than pill/IUD PID risk reduction Need consistent/careful use Cervical cancer risk reduction
- 11. Physical methods • Condom • Diaphragm • Vaginal sponge Male Female
- 12. Condom
- 13. Condom • Made of latex/rubber • To be fitted on erect penis before intercourse • Expel air first to keep space for semen • To withdraw carefully to avoid spill in vagina • Each sexual act needs new condom • Combination with spermicide gives added protection • Pearl index= 2 – 14 mostly due to incorrect use
- 14. Advantages/ Disadvantages of condoms
- 16. Female condom • Prelubricated with silicon • Effective against STD • High cost • Poor acceptability • Pearl Index= 5-21
- 17. Diaphragm
- 18. Diaphragm/Dutch cap • Shallow cup of rubber/plastic • Flexible rim of metal/spring • Different sizes available • For women with good vaginal tone • Kept in place for 6 hrs after coitus • Used along with spermicide • Pearl index= 6-12 • S/E – nil • Need training/privacy/fitting • Variations of diaphragm= cervical cap/vault cap/vimule cap
- 19. Vaginal Sponge (TODAY) • Polyurethane sponge with spermicide nonoxynol-9 • Less effective than diaphragm • Pearl index= 9-40
- 20. Chemical Methods= Spermicides • Foams- tablets/ aerosols • Creams, jellies, pastes- squeezed from tubes • Suppositories- inserted manually • Soluble films- C film inserted manually
- 21. Chemical Methods
- 22. Spermicides • Surface active agents = kill sperms by cutting sperm cell oxygen supply • Drawbacks- High failure rate, action before intercourse, correct application into vagina, irritation, messy • No safe spermicide available • Recommended only for combination with other barriers
- 23. Take a Break.. Lets continue after…. https://youtu.be/Zx8zbTMTncs
- 26. First generation IUD = non medicated/inert IUD
- 27. Comment on Images A and B A B
- 28. Second generation IUD = Copper IUD Newer Cu-T devices= 5 years life
- 29. Advantages of copper devices • Low expulsion rate • Lower S/E- pain and bleeding • Easy and better tolerated in nulliparous too • More effective • Can be a post-coital contraceptive too
- 31. Third generation IUD = Hormone releasing IUD
- 32. Progestasert Mirena/ LNG 20 Has 38mg Progesterone Has 52 mg Levonorgestrel Releases 65mcg per day Releases 20mcg per day
- 34. MOA IUD= foreign body reaction Cellular-biochemical changes in uterine wall Hormones= increase cervical mucus viscosity Features Longer continuation rate = good effectiveness Medicated IUD need periodic replacement Cu T 380A= 10 years Cu T 200= 4 years Progestasert= Annually LNG IUD= 7 years
- 35. Advantages Quick & simple insertion Long duration, continuation Cheap, no hormonal S/E Pearl Index= 0.2 – 3 Doesn’t interfere with lactation Contraindications Pregnancy h/o ectopic pregnancy h/o Pelvic inflamm. disease CA reproductive tract h/o bleeding tendency
- 36. Ideal IUD candidate • Has borne atleast one child • No h/o pelvic disease • Has normal menstrual periods • Is willing to check for IUD threads/tail • Has no problem with need of follow up/treatments • Is in a monogamous relationship
- 37. IUDs are not recommended for nulliparous or polygamous women Due to risk of PID possible infertility
- 38. When to insert IUD? • During menstruation/ first 10 days of cycle • Immediate postpartum insertion = within first week of postpartum • Post-puerperal insertion = 6-8 weeks after delivery • Immediately after first trimester MTP Why follow up is needed? • For continued support to woman • To confirm presence of IUD • To diagnose/treat any side-effects/complications • Follow up after 1st and 3rd periods after insertion • Bi-annual follow ups
- 39. Side effects/ complications… Bleeding Pain Pelvic infection Pregnancy
- 40. …Side effects/ complications Uterine perforation Ectopic pregnancy Expulsion
Editor's Notes
- How we evaluate the pros and cons after knowing about things available at the cafeteria..
- The health worker tells pros n cons of all methods to the couple and let them decide
- Expel air by squeezing the tip of condom
- Manufacture= in Chennai and Trivandrum latex/rubber industries
- Internal ring covers cervix
- Made of Polyethylene/other polymers
- Double S shaped loop, available in 4 sizes A- D, S/E pain and bleeding. Lippes loop popular from 1960-80
- In 1970s, metallic copper- strong antifertility effect. Number means sq mm of Copper surface area on device
- Mirena=white one
- Affect chances of fertilization mainly