CLINICAL SKILL LAB PRESENTATION
CONTRACEPTIVE
GUDDATA N.

Outline
• Introduction on human conception
• Overview of embryology
• Effects of hormones on reproductive
system
• Types of contraception :
- Modern Vs Traditional
• Emergence contraceptives

Introduction on human conception

Embryology of reproductive system

Effect of hormone on reproductive system
Androgen
Naturally occurring androgen hormones are
1.Testosterone -the principal androgenic
hormone produced by Leydig cell.
2.Dihydroepiandrosterone-produced by
adrenal cortex
3.Androstestenedione
The testis produce other hormones like small
quantity Estradiol, Inhibin , Activin

Cont……..
 Testosterone
The effect of testosterone occur by two mechanisms
1. By action of androgen receptor direct;y
2. By conversion to Estradiol and activation of certain estrogen receptor
 Effect on reproductive system

Female Sex Hormones
The two types of ovarian sex hormones are the estrogens and the progestins. The
most important of the estrogens is estradiol and the most important progestin is
progesterone.

contraceptive
• The term contraceptive include all
measures temporary or permanently
designed to prevent pregnancy due to
coital act.

Criteria for ideal contraceptive
• It should be,
1.Safe
2.Effective
3.Acceptable
4.Inexpensive
5.Simple to administer
6.Easier to use
7.Require little or no medical supervision
8.Independent of coitus.

METHODS OF CONTRACEPTION
• 2 types
• Hormonal and
• Non-hormonal

Hormonal contraception
• contain both estrogen and progestin or
contain only progestin.
• Combined hormonal contraception (E+P):
- combined pill (the pill, COC)
- combined injectables
- combined ring and patch
• Progestogen-only contraception (P only):
- progestogen-only pill (POP)
- progestogen-only Injectables (PIC)
- Implants

Non-hormonal
• Intra-uterine devices
• Barrier methods
• Natural regulation of fertility
– lactation amenorrhoea method (LAM)
– Safe peroid (Periodic abstinence)
– Coitus interruptus
• Sterilization: male and female

Natural methods
• natural methods do not involve the use of
any of the man made devices.
• These methods are useful for timing and
spacing of pregnancies.

Coitus interruptus
• In this method the penis is withdrawn from
the vagina before ejaculation.

Safe period
• based upon the process of ovulation and
menstrual cycle which helps in
determination of the safe period when
coitus can be done and unsafe period
when coitus can be avoided to prevent
pregnancy.
.

Lactation amenorrhoea method (LAM)
• Frequent intense suckling disrupts
secretion of GnRH
• Irregular secretion of GnRH interferes with
release of FSH and LH
• is 98% effective when all 3 criteria are
met:
menstrual periods have not returned
gave birth less than 6 months ago
 fully breastfeeding

Barrier methods
• Barrier methods are those methods which
prevent meeting of sperms with the ovum.
• Physical barrier
Condom;
The diaphragm
Vaginal sponge

Barrier methods
• Chemical barrier: contain spermicide
cream jelly and pastes
suppositories
soluble films

Intra-uterine devices
• The three different types of IUD’s
generations are:
• 1st generation: polyethylene +barium
sulphate- non medicated.
• 2nd generation: made of polyethylene
but copper added with .
• The copper enhances the contraceptive effect.

Intra-uterine devices
• 3rd generation:
• Contains hormones which is released slowly in the
uterus. The hormone affects the lining of uterus
and cervical mucus. It may affects the sperm.
• THERE ARE TWO TYPES OF HORMONE IUD :
• PROGESTASERT: It is T shaped device and
contains progesterone which is a natural hormone.
Progesteron is in more use than the other
hormone devices.
• LEVONORGESTREL DEVICE: This is also a T
shaped device which has levonorgestrel a
synthetic steroid. It is found to be more effective.
• It needs to be changed after five years.

MOA OF IUDs
• prevention of fertilization
• long-term progestin -endometrial atrophy
• endometrial inflammatory- > Cellular and
humoral inflammation > fluid in uterine
cavity and fallopian tubes >decreased
sperm and egg viability

Hormonal methods of contraceptives
Oral Pills
They are
• 1.) COMBINED PILLS: composed of two
oestrogen and progesteogen in very small
doses.
• MOA: inhibit ovulation of ovum by blocking the
secretion of gonadotropin from pituitary gland.
Progestogen also thickens the mucosa of the
cervix which prevents the entry of sperm into the
genital cannal.

Oral pills
• 2. Progestrone only pill
• Known as mini pill.
• Contains only progesteogen
• MOA:
suppress LH
mucus thickening
Endometrium atrophy
• high failure rate.

Contraceptive injections:
• Depot medroxyprogesterone acetate
(DMPA)
• given IM every 12 weeks.
• MOA: It prevents pregnancy by stopping
ovulation.
• Periods may stop while using.
• DMPA is 94-99.8% effective.

The contraceptive implant
• Implanon NXT® is inserted directly under the
skin, on the inner arm above the elbow,
• Continuously releases a low dose of a
progestogen hormone into the blood stream
over a 3 year timeframe.
• MOA: prevent ovulation (egg release from the
ovary).
• replaced every 3 years or can be removed
earlier if required.
• Implants are 99.9% effective

Permanent contraception (sterilisation)
• Sterilisation is permanent contraception
which can’t be reversed.
• Female sterilisation (tubal ligation)
• Male sterilisation (vasectomy)

TRADITIONAL METHODS OF CONTRACEPTION
AND THEIR LIMITATIONS
• The traditional methods of contraception
include the following:
lactational amenorrhea method
coitus interruptus withdrawal method
calendar method or rhythm method
cervical mucus method
abstinence
3/31/2023 27
ARI UNVERSITY

TRADITIONAL METHODS…..
• Natural family planning does not protect
against STIs such as chlamydia or HIV.
You'll need to avoid sex, or use
contraception such as condoms, during
the time you might get pregnant, which
some couples can find difficult.

Emergency contraception
• used to prevent pregnancy after sexual intercourse.
• recommended for use within 5 days.
• They prevent pregnancy by delaying ovulation and they do not
induce an abortion.
• Includes copper-bearing intrauterine devices (IUDs) and the
emergency contraceptive pills (ECPs).
copper-bearing intrauterine emergency contraceptive pill (ECPs).
device (IUDs)

Emergency contraception
1.Emergency contraceptive pill
 After unprotected sex, contraceptive failure or a sexual
assault.
I. Mela-One:- contains levonorgestrel, a synthetic version of
progesterone
MOA: inhibt gonadotopin by negetive feedback
II. Ella One:- contains ulipristal acetate, which stops
progesterone working normally.
 delaying the release of an egg.
2. copper-bearing IUD
Contains copper.
failure rate around 0.7%.
lasts up to twelve years. Following
removal, fertility quickly returns.