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Contraception for undergraduate


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Undergraduate course lectures in Obstetrics&Gynecology Prepared by Dr Manal Behery Professor of OB&GYNE .Faculty of medicine ,Zagazig University

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Contraception for undergraduate

  1. 1. contraception DR Manal Behery 2014
  2. 2. Definition of Contraception • Contraception = “Against Conception” • The intentional prevention of pregnancy through the use of various devices, agents,drugs, sexual practices or surgical procedures.
  3. 3. Expanding Methods Mix
  4. 4. How do you choose?
  5. 5. Top five factors to consider when selecting a method of fertility control. •Cost •Effectiveness of protections from STDs •Safety and side effects •Comfort and ease of use •Reversibility and future fertility
  6. 6. The only 100% effective way to prevent pregnancy and STD is to be sexually Abstinent or to Postpone sexual involvement.
  7. 7. Four Types of Birth Control • Hormonal Methods • Barrier methods! • Surgical Methods • Behavioral Methods
  8. 8. Hormonal Methods • Oral Contraceptives (Birth Control Pill) • Injections (Depo-Provera) • Implants (Norplant I & II) • Vaginal ring
  9. 9. Oral contraceptive pills (OCP) • Oral contraceptive made from synthetic hormones • 97%-99% effective • Combined pill or mini-pill
  10. 10. Birth Control Pills • Women must have a pap smear to get a prescription for • birth control pills • Pills DO NOT prevent STD’s
  11. 11. Combined pill • Contains estrogen and progestin • 21-day or 28-day form • Monophasic or multiphasic (fewer side effects)
  12. 12. Mini-pill • Contains only progestin • Used continuously 28 days • Effect: thickens the cervical mucus and makes the lining of the uterus less receptive to implantation • Indicated because of medical reasons and women breatsfeeding
  13. 13. How does the pill work? • Stops ovulation • Thins uterine lining • Thickens cervical mucus
  14. 14. Pro’s • ↓ Acne • ↓ Hair growth • ↓Breast cysts • ↓ Ovarian cysts • ↓ Ovarian carcinoma • ↓ Dysmenorrhea • ↓ Endometrial carcinoma • ↓ PID • ↓ Risk of ectopic pregnancy • ↓ Anemia • ↓ Osteoporosis
  15. 15. Contraindications • Absolute: CV diseases, liver damage, hormone-dependent tumors • Relative: age >35 + another risk factor (smoking, DM etc.)
  16. 16. Con’s • ↑ 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
  17. 17. Taking the Pill • Once a day at the same time everyday • Use condoms for first month • Use condoms when on antibiotics • Use condoms for 1 week if you miss a pill or take one late • The pill offers no protection from STD’s
  18. 18. Injection or "shot"— • Women get shots of the hormone progestin in the buttocks or arm every three months from their doctor. • It is 97–99% effective at preventing pregnancy.
  19. 19. Depo-Provera (the shot)
  20. 20. How does the shot work? • The same way as the Pill! • Stops ovulation • Stops menstrual cycles!! • Thickens cervical mucus
  21. 21. SIDE EFFECTS • Extremely irregular menstrual bleeding and spotting for 3-6 months! • NO PERIOD  after 3-6 months • Weight change • Breast tenderness • Mood change *not every woman has side-effects!
  22. 22. Contraceptive patch • Transdermal delivery system • Effect: same as OCP • Application: stuck on skin every week • Side effects: same as OCP, greater risk (con) • Pro: better compliance
  23. 23. The Patch
  24. 24. IMPLANTS • Physically inserted in simple 15 minute outpatient procedure • Plastic capsules the size of paper matchsticks inserted under the skin in the arm • 99.5% effectiveness rate
  25. 25. Norplant Implant
  26. 26. Contraceptive implants • Slow release of a progestin over a period of three years • Effect: prevents the release of the egg from the ovary (ovulation); promotes thick cervical mucus • Application: inserted in the upper arm under local anesthesia • Side effects: irregular bleeding • Pro: fertility rapidly returns
  27. 27. Implanon • Contains 68 mg etonogestrel • Single rod implanted subdermally 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
  28. 28. What if…. …the condom broke or slipped off... …you forgot your regular birth control... …you were forced to have sex... Association of Reproductive Health Professionals
  29. 29. Emergency Contraception (ECP) • Must be taken within 72 hours of the act of unprotected intercourse or failure of contraception method • Must receive ECP from a physician • 75 – 84% effective in reducing pregnancy
  30. 30. How EC ACT? • Floods the ovaries with high amount of hormone and prevents ovulation • Alters the environment of the uterus, making it disruptive to the egg and sperm • Two sets of pills taken exactly 12 hours apart
  31. 31. Emergency Contraceptive Pills: Combined VS Progestin only Preven plan A Plan B
  32. 32. Morning-after pill • Side effects: nausea,abdominal pain, fatigue, headache, dizziness, and breast tenderness
  33. 33. NuvaRing – The Ring 92% - 99%
  34. 34. Vaginal Ring (NuvaRing) • 95-99% Effective A new ring is inserted into the vagina each month • Does not require a "fitting" by a health care provider, • does not require spermicide, can make periods more regular and less painful, • no pill to take daily, ability to become pregnant returns quickly when use is stopped.
  35. 35. Hormonal • Pill – Daily – Emergency (not recommended as a regular form of birth control)
  36. 36. Hormonal • Pill • Patch Patch
  37. 37. Hormonal • Pill • Patch • Injection
  38. 38. Hormonal • Pill • Patch • Injection • Ring
  39. 39. Hormonal • Pill • Patch • Injection • Ring • Progesterone IUD IUD
  40. 40. Hormonal • Pill • Patch • Injection • Ring • Progesterone IUD • Implantable device
  41. 41. How Often Do You Take It? Method Frequency Pills Every day
  42. 42. How Often Do You Take It? Method Frequency Pills Every day Patch Once a week
  43. 43. How Often Do You Take It? Method Frequency Pills Every day Patch Once a week Ring Once a month
  44. 44. How Often Do You Take It? Method Frequency Pills Every day Patch Once a week Ring Once a month Injection Every 3 months* Implant (Implanon®) Every 3 years*
  45. 45. How Often Do You Take It? Method Frequency Pills Every day Patch Once a week Ring Once a month Injection Every 3 months* Implant Every 3 years* IUD Every 5 years*
  46. 46. How Often Do You Take It? Method Frequency Pills Every day Patch Once a week Ring Once a month Injection Every 3 months* Implant Every 3 years* IUD Every 5 years*
  47. 47. BARRIER METHOD • Prevents pregnancy blocks the egg and sperm from meeting • • Barrier methods have higher failure rates than hormonal methods due to design and human error
  48. 48. BARRIER METHODS • Spermicides • Male Condom • Female Condom • Diaphragm • Cervical Cap
  49. 49. SPERMICIDES • Chemicals kill sperm in the vagina • Different forms: -Jelly -Film -Foam -Suppository • Some work instantly, others require pre-insertion • Only 76% effective (used alone), should be used in combination with another method i.e., condoms
  50. 50. Foam • 80-85% effective • Works immediately • Effective for an hour • Over the counter • No douching for 6 hours after intercourse • 20% have burning (reaction)
  51. 51. Film • 80-85% effective • Works 10 min after insertion • Effective for an hour • Over the counter • No douching for 6 hours after intercourse • 20% have burning (reaction)
  52. 52. MALE CONDOM • Most common and effective barrier method when used properly • Latex and Polyurethane should only be used in the prevention of pregnancy and spread of STD’s (including HIV)
  53. 53. MALE CONDOM • Perfect effectiveness rate = 97% • Typical effectiveness rate = 88% • Latex and polyurethane condoms are available • Combining condoms with spermicides raises effectiveness levels to 99%
  54. 54. Female Condom • 95% effective • Protects against some STDs • Noisy • Use extra lubrication
  55. 55. Proper Use and Placement of a Female Condom Copyright © 2010 Pearson Education, Inc.
  56. 56. DIAPRAGHM • Perfect Effectiveness Rate = 94% • Typical Effectiveness Rate = 80% • Latex barrier placed inside vagina during intercourse • Fitted by physician • Spermicidal jelly before insertion • Inserted up to 18 hours before intercourse and can be left in for a total of 24 hours
  57. 57. DIAPHRAGM The diaphragm is a flexible rubber cup that is filled with spermicide and self-inserted over the cervix prior to intercourse. The device is left in place several hours after intercourse. The diaphragm is a prescribed device fitted by a health care professional and is more expensive than other barrier methods, such as condoms
  58. 58. Proper Use and Placement of a Diaphragm Copyright © 2010 Pearson Education, Inc.
  59. 59. CERVICAL CAP • Latex barrier inserted in vagina before intercourse • “Caps” around cervix with suction • Fill with spermicidal jelly prior to use • Can be left in body for up to a total of 48 hours • Must be left in place six hours after sexual intercourse • Perfect effectiveness rate = 91% • Typical effectiveness rate = 80%
  60. 60. Cervical Cap The cervical cap is a flexible rubber cup-like device that is filled with spermicide and self-inserted over the cervix prior to intercourse. The device is left in place several hours after intercourse. The cap is a prescribed device fitted by a health care professional and can be more expensive than other barrier methods, such as condoms.
  61. 61. Sponge The sponge is inserted by the woman into the vagina and covers the cervix blocking sperm from entering the cervix. The sponge also contains a spermicide that kills sperm. It is available without a prescription
  62. 62. Copper and levonorgestrel-releasing IUD
  63. 63. Intrauterine Devices (IUD) • T-shaped object placed in the uterus to prevent pregnancy • Must be on period during insertion • A Natural childbirth required to use IUD • Extremely effective without using hormones > 97 % • Must be in monogamous relationship
  64. 64. What are the most cu ( IUD ) used today ? Today two types of cu IUD are used mostly Multiload (left) and cupper T (right) :
  65. 65. Levonorgestrel Intrauterine system • The LNG IUS is made of flexible plastic • The LNG IUS contains a progestin hormone called levonorgestrel which has been used in birth control pills since the 1970s • The safety of levonorgestrel has been proven by clinical use also in sub-dermal implants and intrauterine systems since decades
  66. 66. Mirena: Theoretical Mechanism of Action • Cervical mucus thickened • Sperm motility and function inhibited • Endometrial effects • Ovulation inhibited (in some cycles) Jonsson B et al. Contraception 1991;43:447-458. Nilsson CG et al. Fertil Steril 1984;41:52-55. Videla-Rivero L et al. Contraception 1987;36:217-226.
  67. 67. LNG IUS ENDOMETRIAL EFFECTS Ovulation Ovulation Menstruation Days of the menstrual cycle Days of the menstrual cycle
  68. 68. Who can and cannot use the IUD Most women can safely use the IUD But usually cannot use IUD if : • May be pregnant • Gave birth recently (more than 2 days ago) • Unusual vaginal bleeding recently • At high risk for STIs • Infection or problem in female organs
  69. 69. IUD Contraindications • Pregnancy or past ectopic history • Undiagnosed irregular bleeding • Current or suspected pelvic or vaginal infection • HIV or immunosuppressive therapy • Distorted scarred uterine cavities • Small uterus 5.5cm
  70. 70. Possible side-effects If you choose this method, you may have some side-effects. They are not usually signs of illness. After insertion: • Some cramps for several days • Some spotting for a few weeks Other common side-effects: • Longer and heavier periods • Bleeding or spotting between periods • More cramps or pain during periods May get less after a few How would you feel months about these side-effects?
  71. 71. What will happen when Steps: you get your IUD Pelvic examination Cleaning the vagina and cervix Placing IUD in the womb through the cervix • May hurt at insertion • Please tell us if it hurts • Rest as long as you like afterwards • May have cramps for several days after insertion    Afterwards: you can check your IUD from time to time Are you ready to choose this method? What questions do you have?
  72. 72. What to remember • Your kind of IUD: • When to have IUD taken out: • Bleeding changes and cramps are common. Come back if they bother you. • Come back for a check-up in 3 to 6 weeks or after next menstrual period See a nurse or doctor if: • Missed a menstrual period, or think you may be pregnant • Could have an STI or HIV/AIDS • IUD strings seem to have changed length or are missing •Bad pain in lower abdomen Anything else I can repeat or explain? Any other questions?
  73. 73. Female and Male Sterilization Procedure performed on a man or a woman permanently sterilizes Female = Tubal Ligation Male = Vasectomy Copyright © 2010 Pearson Education, Inc.
  74. 74. TUBAL LIGATION • Surgical procedure performed on a woman • Fallopian tubes are cut, tied, cauterized, prevents eggs from reaching sperm • Failure rates vary by procedure, from 0.8%-3.7% • May experience heavier periods Surgical sterilization which permanently prevents the transport of the egg to the uterus by means of sealing the fallopian tubes is called tubal ligation, commonly called "having one's tubes tied." This operation can be performed laparoscopically or in conjunction with a Cesarean section, after the baby is delivered. Tubal ligation is considered permanent, but surgical reversal can be performed in some cases
  75. 75. Laparoscopy-’band-aid’ sterilization
  76. 76. vasectomy • Ligation of Vas Deferens tube • Faster and easier recovery than a tubal ligation • Failure rate = 0.1%, more effective than female sterilization
  77. 77. During a vasectomy (“cutting the vas”) a urologist cuts and ligates (ties off) the ductus deferens. Sperm are still produced but cannot exit the body. Sperm eventually deteriorate and are phagocytized. A man is sterile, but because testosterone is still produced he retains his sex drive and secondary sex characteristics.
  78. 78. METHODS BASED ON INFORMATION • Withdrawal • Natural Family Planning • Fertility Awareness Method • Abstinence
  79. 79. Behavioral Methods • Withdrawal: removing the penis from the vagina just before ejaculation • Abstinence or outercourse(kissing, hugging, touching) • Fertility awareness – Cervical mucus method – Body temperature method – Calendar method
  80. 80. WITHDRAWAL • Removal of penis from the vagina before ejaculation occurs • NOT a sufficient method of birth control by itself • Effectiveness rate is 80% (very unpredictable in teens, wide variation) • 1 of 5 women practicing withdrawal become pregnant • Very difficult for a male to ‘control’
  81. 81. Natural Family Planning & Fertility Awareness Method • Women take a class on the menstrual cycle to calculate more fertile times • NFP abstains from sex during the calculated fertile time • Perfect effectiveness rate = 91% • Typical effectiveness rate = 75% • No 100% safe day-irregular periods
  82. 82. The Fertility Cycle Copyright © 2010 Pearson Education, Inc.
  83. 83. Copyright © 2010 Pearson Education, Inc.
  84. 84. Copyright © 2010 Pearson Education, Inc.
  85. 85. Copyright © 2010 Pearson Education, Inc.
  86. 86. Copyright © 2010 Pearson Education, Inc.