This document discusses contraception methods, including temporary and permanent options. It provides an overview of hormonal methods like combined oral contraceptives and progestin-only pills, long-acting reversible contraceptives like implants and IUDs, barrier methods, fertility awareness-based methods, and permanent surgical methods. The document outlines the effectiveness, advantages, disadvantages, and contraindications of different contraception options. It also discusses emergency contraception and contraception options for lactating women. The intended learning objectives are to demonstrate knowledge of family planning and contraception, identify different contraceptive methods, and counsel patients on appropriate options.

1. CONTRACEPTION
Practical view of the contraception
Dr Elhadi Miskeen, MBBS, MD, FAIMER, TUFH
Dr. Suaad Elnour, MBBS, MD, MPHE, MSc
Department of obstetrics and gynecology
College of Medicine, University of Bisha
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2. LEARNING
OBJECTIVES
Contraception & family planning
1. Demonstrate knowledge and understanding of family planning and contraception.
2. Identify different methods of contraception, their efficacy, side effects and failure rate.
3. Counsel lactating and none lactating ladies about different modalities of contraception
4. Demonstrate an appropriate approach in dealing with emergency contraception.

3. FACTS-WHO
• Among the 1.9 billion Women of Reproductive Age group (15-49 years) worldwide
in 2019, 1.1 billion have a need for family planning; of these, 842 million are using
contraceptive methods, and 270 million have an unmet need for contraception.
• The proportion of the need for family planning satisfied by modern methods,
Sustainable Development Goals (SDG) indicator 3.7.1, has stagnated globally at
around 77% from 2015 to 2020 but increased from 55% to 58% in the Africa
region.
• Only one contraceptive method, condoms, can prevent both a pregnancy and the
transmission of sexually transmitted infections, including HIV.
• Use of contraception advances the human right of people to determine the
number and spacing of their children.

4. WHAT IS THE
IDEAL
CONTRACEPTION
Safe
Effective
Acceptable
Inexpensive
Reversible
Simple to administer
Independent of coitus
Long lasting to avoid frequent administration
Requiring minimal or no medical supervision

5. 100% EFFECTIVE WAY
TO PREVENT
PREGNANCY AND STD
IS TO BE SEXUALLY
ABSTINENT OR TO
POSTPONE SEXUAL
INVOLVEMENT
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6. CONTRACEPTION MALE /FEMALE
TEMPORARY
Hormonal
Methods
Barrier
methods
Behavioral
Methods
PERMANENT
Vasectomy
Bilateral
tubal ligation

7. TEMPORARY METHODS
• Condom
• Diaphragm
• Cervical cap
BARRIER
• OCP (Combined-progesterone based)
• Implants
• Patch
Hormonal
• Copper T
• Lavenogestral containg device (Mirena)
IUD

8. HORMONAL
CONTRACEPTION
All hormonal contraception
mechanism
• Stop ovulation
• Prevent the uterine lining
from building up
• Making cervical mucous thick
to prevent penetration of
sperm
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9. Combined methods

10. Male condom
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11. Combined pill
• Oral contraceptive made from synthetic
hormones
• 97%-99% effective
• Contains estrogen and progestin
• 21-day or 28-day form
• Monophasic or multiphasic (fewer side
effects)
• Take pills daily at the same time
ntrol Pills
et a prescription for

12. MINI PILLS
• Contain only progesterone
• Used continuously for 28 days
• It thickens the cervical mucous and makes
the lining of the uterus less receptive to
implantation
• Indicated in breast feeding women

13. COMBINED PILLS
ADVANTAGES
• ↓Acne
• ↓ ABNORMAL Hair growth
• ↓Breast cysts
• ↓ Ovarian cysts
• ↓ Ovarian carcinoma
• ↓ Dysmenorrhea
• ↓ Endometrial carcinoma
• ↓PID
• ↓ Risk of ectopic
• pregnancy
• ↓ Anemia
• ↓ Osteoporos

14. DISADVANTAGE OF COMBINE PILLS
• ↑ Risk of CV disease
• ↑ Risk of breast cancer
• ↑ Risk of cervical cancer
• ↑ Risk of thromboembolic episodes
• ↑ Risk of liver adenoma
• Lipid metabolism disorders
• Nausea
• Depression
• Post-pill amenorrhea
• Weight gain
• Breast tenderness

15. CONTRAINDICATION
• Absolute: CV diseases, liver
damage, hormone-dependent
tumors
• • Relative: age >35 + another
risk factor (smoking, DM etc.)

16. INJECTABLE
1. DEPO PROVERA
2. NORESTERAT
• Women get shots of the
hormone progestin in the
buttocks or arm every
three months from their
doctor. I:e Depo provera
while 2 monthly is
Noresterat
• It is 97–99% effective at
preventing pregnancy. This Photo by Unknown author is licensed under CC BY.

17. Side effects of injectables
Extremely irregular menstrual bleeding and spotting for 3-6 months!
NO PERIOD or after 3-6 months
Weight change
Breast tenderness
Mood change

18. IMPLANT
eg: Implanon
Contains 68 mg etonogestrel
Single rod implanted sub dermally on day 1-5 of cycle
Last for 3 years.
Works by thickening cervical mucus and also inhibits ovulation
Extremely effective in pregnancy prevention > 99%
Irregular bleeding common side effect

19. IUDS
• IUD is the world's most widely
used method of reversible birth
control
• 3 TYPES:
• Inert ( no longer recommended
because of painful and heavy
periods). Eg: lippes loop
• Copper Releasing IUD
• Mirena (levonorgestrel).

20. IUDs
• Banded device
containing 380mm2
copper
• Until no longer required
> 40s
• Emergency
contraception

21. Clinical Use of IUD
• Long-term contraception
Women with contraindications to COC
• Emergency contraceptive(1:1000)
• menorrhagia , endometriosis, chronic pelvic
pain, dysmenorrhea, anaemia Mirena can be
used
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22. ABSOLUTE
CONTRAINDICATION
Pregnancy
Post partum puerperal sepsis
Immediately post-septic abortion
Undiagnosed abnormal vaginal bleeding.
Suspected gynecological malignancy. (Cervical cancer, Endometrial
cancer)
Current STDs.
-Current PID
anatomical abnormalities

23. NATURAL METHODS
Calendar Method (Safe period)
Relies upon the fact that there are
certain days during the menstrual
cycle when conception can occur
following ovulation, the ovum is
viable within reproductive tract for
a maximum of 24 hrs.
The life spam of sperm is longer 3
days.
During 28 day menstrual cycle,
ovulation occur around day 14.
This means that coitus must be
avoided from 8th to 17th day.
Failure rate is high so many
couples find it difficult to adher to
this method.
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24. BARRIER METHOD
Male condom
Female condom
Diaphragm
Cervical Cap

25. Diaphragm

26. SURGERY TUBAL LIGATION
• This involve mechanically blockage of both
fallopian tube to prevent the sperm reaching and
fertilizing the oocyte
• Sterilization performed by laparoscopically(under
GA) or through a suprapubic “mini-laparotomy”
• Failurerate:0.5%
VASECTOMY

27. TUBAL
LIGATION
Advantages:
intended to be permanent • highly effective
• safe
• quick recovery
lack of significant long-term side effects
cost effective

28. TUBAL LIGATION
Disadvantage:
Possibility Of Patient Regret
Difficult To Reverse
Future Pregnancy Could Require Assisted Reproductive
Technology (Such As IVF)
More Expensive Than Vasectomy

29. EMERGENCY
CONTRACETION
After intercourse and before implantation
Indication: failure of condoms
Unprotected intercourse
Within 72 hours after unprotected intercourse
• Levonorgestrel Combined Prescription
• Single dose, the earlier the better
• Prevented 75% of unplanned pregnancies
IUD Emergency Contraception
• Within 5 days after unprotected intercourse
• Copper IUD

30. Contraception in lactating woman
• Breastfeeding women have many
birth control options.
• Many contraceptives can be started
immediately after birth
• Including intrauterine devices
(IUDs), arm implants, Depo-
Provera® shots, and progestin-only
pills

31. THANKS
hadimiskeen19@gmail.com