2. • DEFINITION
• TYPES
• MECHANISM OF ACTIONS
• SIDE EFFECTS
• ADVANTAGES AND DISADVANTAGES
2
3. “Outercourse”
• Can be primary or temporary means of preventing
pregnancy
• Can also be used when it’s not advisable to have
intercourse for other reasons, such as after childbirth or
abortion
• No undesirable contraceptive side effects
• Does not eliminate chances of spreading STDs, especially
if it involves oral or anal sex
…is to prevent
pregnancy, not to
protect against
STI’s
3
4. Definition
• The prevention of an unwanted pregnancy
using a contraceptive which acts by preventing
fertilization of the ovum by spermatozoa
4
5. Unmet need for FP
• family planning (FP) (any method) has
improved to 21 % of currently married
women from 27% with 14 percent having an
unmet need for spacing and 7 percent having
an unmet need for limiting family size.
5
6. Factors affecting choice of method
Whether or not a method:
• is permanent or reversible
• is effective
• is inexpensive
• is perceived to be safe
• is easy to obtain
• is easy to use and
discontinue
• has frequent or undesirable
side effects
6
7. Factors affecting choice cont’d
• can be used while b/feeding
• protects against STIs
• requires partner
cooperation
• must be used each time the
couple have sexual
intercourse
7
8. ‘Contraceptive Method Mix’
• Refers to the variety of contraceptives
available to clients through a family planning
programme
8
11. Combined oral contraceptives (COCs)
• Consists of oestrogen (E) and progestin (P)
– Low dose
– Ultra low dose
• Monophasic pills - same dose of E/P all through the course
• Biphasic pills - fixed dose or E/P & more P in the last 14/7
• Triphasic pills - variable dose of E/P
• Sequential pills - fixed dose of E, No P for first 7/7 then P for 14/7
11
12. Other of oral contraceptives
• Progestin-only pill
– Low dose of progestin and no estrogen
– For women who should not take estrogen (breastfeeding, high b.p., at
risk for blood clots, smoke)
12
13. How hormonal
contraceptives
work
FSH & LH trigger
ovulation
Gonadotropin releasing
hormone (GnRH) triggers
release of gonadotropins
FSH & LH
Estrogen & progesterone in
hormonal contraceptives
inhibit LH, FSH, and GnRH
secretion, preventing ovulation
Progesterone also:
•thickens cervical mucus to prevent
Passage of sperm into the uterus
•changes uterine lining to inhibit implantation
13
14. Mechanism of action
- COCs
• Prevents ovulation by inhibiting
gonadotrophin secretion via an effect on both
pituitary and hypothalamic centres
• The progestin suppresses LH secretion (& thus
prevents ovulation, while the oestrogenic
agent suppresses FSH secretion (& thus
prevents the selection and emergence of a
dominant follicle)
14
15. Efficacy of COC
• Typical usage is associated with a 3.0% failure
rate during the first year of use
• Efficacy decreases significantly when the
oestrogen component is removed
15
16. WHO Categories for Temporary
Methods
• The scientific meetings classified known
medical conditions that might affect eligibility
for the use of a contraceptive method into
one of the four following categories
16
17. WHO Categories for Temporary
Methods
• WHO 1 Can use the method. No restriction on
use.
• WHO 2 Can use the method. Advantages
generally outweigh theoretical or proven
risks. Category 2 conditions could be
considered in choosing a method. If the client
chooses the method, more than usual follow-
up may be needed
17
18. WHO Categories for Temporary
Methods cont
• WHO 3 Should not use the method unless a
doctor or nurse makes a clinical judgement
that the client can safely use it. Theoretical or
proven risks usually outweigh the advantages
of the method. Method of last choice, for
which regular monitoring will be needed.
18
19. WHO Categories for Temporary
Methods cont
• WHO 4 Should not use the method. Condition
represents an unacceptable health risk if
method is used.
19
20. Absolute contraindications to COC use
• thrombophlebitis,
thromboembolic disorders,
CVA, coronary occlusion
• markedly impaired liver
function
• known or suspected breast
cancer
• undiagnosed abnormal
vaginal bleeding
• known or suspected
pregnancy
• smokers over the age of 35
years
20
21. Relative contraindications to COC use
• Migraine headaches
• Hypertension
• H/O gestational diabetes
• Elective surgery
• Epilepsy
• H/O obstructive jaundice in
pregn
• Sickle cell disease or sickle C
disease
• Diabetes mellitus
• Gall bladder disease
21
22. Clinical problems associated with COCs
• Breakthrough bleeding
• Amenorrhoea
• weight gain
• Acne
• Ovarian cysts
• Drugs that affect efficacy
• Migraine headaches
22
23. Non-Contraceptive Benefits of OCs
These can broadly be grouped into two main
categories:
• Benefits that incidentally accrue when OC is
specifically utilized for contraception &;
• Benefits that result from the use of OCs to
treat problems or disorders
23
24. Non contraceptive incidental benefits
of OCs
• less endometrial cancer
• less ovarian cancer
• fewer ectopic pregns.
• more regular menses
• less PID
• less rheumatoid arthritis
• increased bone density
• ~ less endometriosis
• ~ less benign breast disease
• ~ fewer ovarian cysts
24
25. OC as treatment
• DUB
• dysmenorrhoea
• endometriosis prophylaxis
• acne & hirsutism
• hormone therapy for
hypothalamic amenorrhoea
• control of bleeding
• ~ functional ovarian cysts
• ~ premenstrual syndrome
25
26. Pill taking
• Effective contraception is present during the
first cycle of pill use, provided the pills are
started no later than the 5th day of the cycle
and no pills are missed
26
27. Missed Pills
• If a woman misses 1 pill, she should take that
pill as soon as she remembers and take the
next pill as usual. No back-up is needed.
• If she misses 2 pills in the first two weeks, she
should take two pills on each of the next two
days, and back-up for the next 7 days
27
28. Missed pills cont’d
• If 2 pills are missed in the third week, or if
more than 2 active pills are missed at any
time, another form of contraception should be
used as back-up immediately and for 7 days or
start a new pack with back-up for 7 days
without taking the iron tablets
28
29. The Progestin-Only Pill (POP) Minipill
• The minipill contains a small dose of
progestational agent (25% of that in COC) and
must be taken daily, in a continuous fashion
29
30. Mechanism of Action - POP
The contraceptive effect is more dependent
upon endometrial and cervical mucus effects,
since the gonadotrophins are not consistently
suppressed
• The endometrium involutes and becomes
hostile to implantation and the cervical mucus
becomes thick and impermeable
30
31. POP cont’d
• There are no significant metabolic effects
(lipid levels, CHO metabolism and coagulation
factors remain unchanged)
• There is an immediate return to fertility upon
discontinuation
• Failure rates range form 1.1 to 9.6% per 100
women in the first year of use
31
32. POP cont’d
Pill taking
• The minipill should be started on the first day of
menses and a back-up method must be used for
the first 7 days
• The pill should be taken at the same time of the
day
• If more than 3 hours late in taking a pill, a back-
up method should be used for 48 hours
32
33. Problems associated with POP
POP have unpredictable effect
on ovulation
• 40% of patients can expect
to have normal ovulatory
cycles
• 40% short irregular cycles
• 20% total lack of cycles
ranging from irregular
bleeding to spotting and
amenorrhoea
• development of functional
cysts
• levonorgestrel minipill may
be associated with acne
33
34. POP
There are two situations where excellent
efficacy is achieved:
• In lactating women, the contribution of the
minipill is combined with prolactin-induced
suppression of ovulation adding up to very
effective protection
• In women over age 40, reduced fecundity
adds to the minipill’s effects.
34
35. Other hormonal methods
(contain both estrogen and progestin)
• Vaginal ring (Nuvaring)
– 2” ring inserted into the vagina during period
– Worn for 3 weeks, removed for 1 week, then
replaced with new ring
– Cost per year: $580
– Pros: no daily pill; spontaneity
– Cons: no STD protection, not effective for women
over 198 lbs.
• Transdermal patch (Ortho Evra)
– Patch is placed on buttock, abdomen, outer upper
arm, or upper torso
– Replaced weekly for 3 weeks, then a patch-free
week
– Cost per year: $420
– Pros: no daily pill; spontaneity
– Cons: no STD protection, skin irritation
35
36. Implant contraception - jadelle
• Progestin circulating at levels 1/4 to 1/10th of
those in COC, prevents conception by
suppressing ovulation and thickening cervical
mucus to inhibit sperm penetration
• Side effects include changes in menstrual
patter, weight gain, headache, and effects on
mood
36
37. 37
What is JADELLE®
Two Silastic rods
containing 75 mg of
levonorgestrel (LNG)
which are inserted
just under the skin
(subdermal) of a
woman’s upper arm.
38. Jadelle description
• Two rods containing 75mg LNG crystals embedded in a
coplolymer and encased in silastic tubing
• Rods are 43mm long and 2.5mm wide
• Lasts for 5 years
• Rods are easier and more convenient to insert and remove
• Norplant and Jadelle are bioequivalent over 5 years of use
38
40. 40
JADELLE®: Contraceptive Benefits
• Highly effective (0.051,2 pregnancies per 100
women during the first year of use)
• Rapidly effective (< 72 hours)
• Pelvic examination not required prior to use
• Does not interfere with intercourse
• Does not affect breastfeeding
1 Perfect-use estimate is equal to typical-use estimate.
2 Trussell et al 1998.
41. 41
JADELLE®: Noncontraceptive Benefits
• Decreases ectopic pregnancy
• May decrease menstrual cramps
• May decrease menstrual bleeding
• May improve anemia
• Protects against endometrial cancer
• Decreases benign breast disease
• Protects against some causes of PID
42. Disadvantages
• disruption of bleeding
patterns in up to 80% of
users
• implants must be inserted
and removed in a surgical
procedure by trained
personnel
• implants can be visible
under the naked eye
• does not protect against
STI/HIV
• acne
• 30% of pregnancies are
ectopic
42
43. Absolute contraindications
• active thrombophlebitis or
thromboemboilc
phenomena
• undiagnosed genital
bleeding
• acute liver disease
• benign or malignant liver
tumours
• known or suspected breast
cancer
43
44. IMPLANON
• A single implant 4 cm long contains 60 mg of
3-keto desogestrel
• The hormone is released at a rate of about 60
micro grams per day
• Is designed to be provide contraception for 2-
3 years
• Efficacy and side effects are similar to those of
JADELLE
44
45. Injectable Contraception:
Depo-Provera
• Comes as microcrystals, suspended in an
aqueous solution
• Correct dose is150 mg IM (gluteal or deltoid)
every 3 months
• Relies on higher peaks of progestin to inhibit
ovulation and thicken cervical mucus. The
progestin level is high enough to block the LH
surge
45
46. Depo-Provera
cont’d
• The injection should be given within the first 5
days of the current menstrual cycle, otherwise
a back-up method is necessary for 2 weeks
• The injection must be given deeply in muscle
46
47. Depo-Provera
Advantages
• easy to use, no daily or
coital acton required
• safe no serious health
effects
• effective as sterilization,
IUCD & implant
contraception
• free from eostrogen related
problems
• private use not detectable
• enhances lactation
• has noncontraceptive
benefits
47
50. Intrauterine Devices (IUDs)
• Small plastic objects inserted into
uterus
• 2 types
– Hormone-releasing (progesterone)
– Copper-releasing
• Have fine strings threads attached
that hang in hang slightly out of
cervix into vagina for removal
• Very high continuation rate (how many women are still
using it one year after starting) compared w/other
methods
progesterone
50
52. IUD Mechanisms of Action
Levonorgestrel-Releasing IUD
(LNG-IUS, Mirena®)
– Inhibits fertilization
– Thickens cervical mucous
– Inhibits sperm function
– Thins and suppresses the
endometrium
Jonsson B, et al. Contraception. 1991;43:447-458; Videla-Rivero L, et al. Contraception.
1987;36:217-226; Kulier R, et al. Cochrane Database Syst Rev. 2006;3: CD005347.
Copper-Releasing IUD
(ParaGard® T380A)
– Inhibits fertilization
– Releases copper ions (Cu2+)
that reduce sperm motility
– May disrupt the normal
division of oocytes and the
formation of fertilizable ova
52
53. Efficacy of IUDS
• The actual failure rate in the first year is
approximately 3%, with a 10% expulsion rate,
and a 15% rate of removal, mainly for
bleeding and pain.
• The non medicated IUDs never have to be
replaced
53
54. Timing of IUD insertion
• An IUD can be safely inserted at any time after
delivery, abortion or during the menstrual
cycle
• The IUD can also be inserted at Caesarean
section
– Postplacental
– Immediate postpartum
54
55. IUD Use
and Medical conditions
• a woman with a H/O
ectopic pregn can use a
copper IUD or the
Levonorgestrel IUD
• a progestin releasing IUD
should be considered for
women with bleeding
disorder
• women at risk of bacterial
endocarditis should receive
prophylactic antibiotics at
insertion & removal
• current, recent, or recurrent
PID is a contraindication for
IUD use
55
56. Pregnancy with IUD in situ
• Spontaneous abortion - 40-50%, IUDs should be
removed if pregnancy is diagnosed and the
strings are visible
• Septic abortion - there is no evidence that there
is an increased risk of septic abortion if pregn
occurs, other than with the Dalkon Shield
• Pre-term labour and birth - incidence is
increased 4-fold
56
57. Barrier methods
Have been the most widely used contraceptive
technique throughout recorded history.
• Spermicides - 21% failure rate
• Cervical cap - 18-28%
• Sponge - 18%
• Diaphragm - 18%
• Condom - 12%
57
58. Condoms (male)
• Sheath that fits over the erect penis
• The only temporary method of birth control for men
• Only form of contraception that effectively reduces
STI transmission
• Made of thin latex, polyurethane, or natural membrane
– Natural membrane (from sheep intestines) condoms can permit passage of viruses,
incl. those that cause AIDS, herpes, hepatitis, HPV
• Many varieties
– Different features, shapes, textures, colors, flavors
– Some “extended pleasure” types have a desensitizing agent on the inside to delay
ejaculation
– Lubricated or nonlubricated
• Note: average shelf life of condoms is 5 years; don’t store latex condoms
in hot places (glove compartment, back pocket) b/c heat can deteriorate the
latex
58
59. How to use the (male) condom
• Pinch reservoir tip or twist tip of nonreservoir tip condom before unrolling
condom over the penis to leave room for ejaculate--reduces chance of
condom breaking
• Unroll condom over erect penis before any contact between the penis and
vulva occurs
– Common error: putting on a condom after vaginal penetration but before
ejaculation--increases risk of pregnancy & STI transmission
• Use a water-based lubricant to reduce risk of condom breaking (oil-based
lubricants deteriorate condom)
• Hold condom at the base of the penis before withdrawing from the vagina
to avoid spilling semen inside vagina
59
60. Female condom
• Consists of two flexible polyurethane rings and a soft,
loose-fitting polyurethane sheath
– One ring at closed end fits loosely against cervix; other ring at
open end encircles the labial area
• Can be inserted before sexual activity; don’t need to
remove it immediately following ejaculation
60
61. Costs, pros, & cons of condoms
• Costs
– Male condoms, about $0.75-$1 each
– Female condoms, about $3 each
• Advantages
– STI protection!
– Available w/o prescription or medical intervention
• Disadvantages
– Can reduce sensation
• Polyurethane transmits heat well, so some say that the female condom has less
reduction in sensation
– Interruption of sexual experience (though some couples find sensual
ways of incorporating condoms into foreplay)
– Note: female condom can be inserted several hours before intercourse
61
62. Vaginal spermicides
• Include: foam, sponge, suppositories, creams, film
• Spermicide: chemical that kills sperm (nonoxynol-
9)
• Cost: $0.85 per application
• Advantage: no prescription necessary
• Disadvantages:
– Interruption of sexual experience (except for the
sponge)
– Skin irritation (which can increase susceptibility
to STI infection)
– No protection from STIs
– Not effective enough to be used w/o a condom
or other method
62
63. Cervical barrier devices
• Covering the cervix is one of the
oldest methods in contraceptive history
– Casanova (18th century Europe) promoted
using squeezed-out lemon half; European
women shaped beeswax to cover cervix
• Cervical cap: covers cervix only
• Diaphragm: covers upper vaginal wall
behind cervix underneath pubic bone
• FemCap & Lea’s shield have removal straps
• Lea’s Shield allows a one-way flow of fluid from cervix to
vagina
• Method is usually combined w/spermicide
diaphragm Cerv cap
Lea’s shield
FemCap
63
64. How to use cervical barrier devices
• Diaphragm & cervical cap: need to be fitted (may need to be refitted
w/weight gain or loss >10 lbs.)
• FemCap & Lea’s Shield do not have to be fitted, but still require a
prescription in the U.S.
• Use diaphragm & cervical cap only with water-based lubricants b/c they are
latex (FemCap & L.S. are silicone)
• Can insert up to 6-8 hr. before intercourse; should leave in at least 8 hr after
64
66. Periodic abstinence
• Is keyed to the observation of naturally
occurring signs and symptoms of the fertile
phase of the menstrual cycle.
• It takes into account the viability of sperm in
the female reproductive tract and the life span
of the ovum
66
67. Fertility Awareness Methods
• Standard days method
– For women w/cycles btwn 26 & 32 days
– Couples avoid unprotected intercourse btwn days 8-19 of each
menstrual cycle
– Highest rate of effectiveness of natural family planning methods
• Mucus method: based on cyclical changes
– Vaginal secretions change throughout cycle; woman learns to “read”
these changes and keeps a daily chart
• Calendar method: self- knowledge of fertility
– After charting cycles for some time (preferably 1 year), a woman
estimates the time she is ovulating based on the calendar
• Basal body-temperature
– Based on changes in body temperature around ovulation
• Often, some combination of these methods will be used
67
68. Standard Days Method (w/Cyclebeads)
Arevalo M et al., Contraception, 2002;65:333-338.
On WHITE bead days
you can get pregnant.
Avoid unprotected
intercourse to prevent
a pregnancy.
On the day you start your
your period, move the
ring to the RED bead.
Every morning
move the ring
to the next
bead.
Always move
the ring from
the narrow to
the wide end.
1
2
Also, mark this date
on your calendar
When you start your
next period, move the
ring directly to red
bead and begin again.
On BROWN bead
days you can
have intercourse
with very low
probability of
pregnancy.
If you have not started
your period by the day
after you put the ring on
the last brown bread,
contact your provider.
If you start
your period
before you put
the ring on the
darker brown
bead, contact
your provider.
(may not be a good
method for you)
68
69. Basal Body Temperature Method
• BBT=body temp in resting state on waking
• Slight drop immediately before ovulation
• After ovulation, release of progesterone causes slight
increase in temperature
69
70. Cervical Mucus Method
Stanford JB, et al. Obstet Gynecol. 2003;101:1285-1293.
•Slight amount
•Thick
•White
•Sticky
•Holds its shape
•Increasing
amounts
•Thinner
•Cloudy
•Slightly stretchy
•Profuse
•Thin
•Transparent
•Stretchy
Early
Mucus
Transitional
Mucus
Highly Fertile
Mucus
no unprotected
intercourse
70
71. Periodic abstinence
Periodic abstinence is associated with good
efficacy when used correctly and consistently
and the following rules are observed:
• No intercourse during mucus days
• No intercourse within 3days after peak
fecundity
• No intercourse during times of stress
71
72. calendar
• Based on studying cycle length for 6months to
one year
– Subtract 18 from short cycle and 11 from long
cycle
– Avoid intercourse during this interval
72
73. Calendar or Rhythm Method
Low-risk Days
Egg may still
be present Ovulation
These days may be
unsafe if 28-day cycle
varies as much as 8-9
days between shortest
and longest cycles.
Intercourse on these days
may leave live sperm to
fertilize egg.
8
Billings JJ. Med J Aust. 1978;2:436.
Byer/Shainberg/Galliano. Dimensions of Human Sexuality,
5e. 1999, The McGraw-Hill Companies, Inc.
73
74. Withdrawal
• Involves removal of the penis from the vagina
before ejaculation takes place
• 1st year failure rate - 18%
• Some sperm may be released before
ejaculation
• Is a better method than using no method at all
74
75. Lactational Amennorrhoea Method
(LAM)
• High concentrations of prolactin work at both
central and ovarian sites to produce
lactational amenorrhoea and anovulation
• Elevated levels of prolactin inhibit the
pulsatile secretion of GnRH
75
76. LAM
• Only amenorrhoeic women who exclusively
breastfeed at regular intervals, including at
nighttime, during the first 6 months have the
contraceptive protection equivalent to the
provided by oral contraception
76
77. LAM
• With menstruation or after 6 months, the risk
of ovulation increases
• Supplemental feeding increases the risk of
ovulation (and pregnancy) even in
amenorrheic women
• Total protection against pregnancy is achieved
by exclusively b/feeding for 10 weeks
77
78. B/feeding and Contraception
The rule of 3s
• In the presence of FULL b/feeding, a
contraceptive method should be used
beginning in the 3rd postpartum month
• With PARTIAL b/feeding or NO b/feeding, a
contraceptive method should begin during the
3rd postpartum week
78
79. B/feeding and Contraception
• Oral contraception even in low doses
diminishes the quantity and quality of breast
milk
• Depo-provera does not affect breast feeding
79
80. B/feeding and Contraception cont’d
• Periodic abstinence cannot be used with a
great deal of confidence
• Barrier methods are an excellent choice for
motivated couples
• IUDs can be inserted after vaginal or C/S
80
82. Ex. of female sterilization procedure
• Laparoscope: narrow, lighted viewing instrument that is inserted
into abdomen to locate the fallopian tubes 82
83. Advantages of female sterilization
• Very effective-failure one in 200
• Permanent
• Nothing to remember
• No interference with sex
• Increased enjoyment-no worries
• No effect on milk
• No health reisks
• Can be done soon after birth
83
84. Disadvantages
• Painful for few days
• Uncommon complications of surgery
– Infection
– Internal infection and bleeding
– anaesthetic risks
– Death
– Ectopic
– Requires trained staff
– Reversal difficult and expensive
– No protection against STI
– No method of proving effectiveness
84
86. Ex. of male sterilization procedure
• Vas deferens on each
side is cut; small
section is removed,
and the ends are tied
off or cauterized
86
87. Advantages of vasectomy
• Very effective-failure 1/700
• Permanent
• Nothing to remember after 20 ejaculations or
3 months
• No interference with sex
• Increased enjoyment
• No apparent longterm health risks
87
88. • Easier to perform,less expensive
• Able to test for effectiveness at any time
88
89. disadvantages
• Complications of surgery
– Discomfort for 2-3 days
– Pain in scrotum
– Brief feeling of faintness
– Bleeding
– Blood clots in scrotum
• Requires someone trained
• Not immediately effective-unless after 20 ejaculations or 3/12
89
91. Reversal of Sterilization
• Pregnancy rates correlate with the length of
remaining tube, a length of 4 cm or more is
optimal
• Pregnancy rates are lowest with
electrocoagulation, and reach 70-80% with
clips, rings and surgical methods such as the
Pomeroy
• About 2 per 1000 women will eventually
undergo tubal anastomosis
91
93. Medical methods for the Male
• Hormonal contraception is inherently a
difficult physiological problem, because unlike
cyclic ovulation in the female,
spermatogenesis is continuous
93
94. Medical methods for the Male
• Sex steroids reduce testosterone synthesis
which leads to loss of libido and development
of female 2o sexual characteristics. Sperm
counts are not reduced adequately
• GnRH analogues also decrease endogenous
synthesis of testosterone, and supplemental
testosterone must be provided
94
95. Medical methods for the Male
• Gossypol a derivative of cotton seed oil,
effectively decreases sperm counts to
contraceptive levels, by incapacitating the
sperm producing cells
• The pills are taken daily for 2 months until
sperm are no longer observed in the ejaculate,
and then weekly
• Fertility returns to normal 3 months after
discontinuation
95
96. Emergency Contraception
• Emergency contraception methods can
prevent pregnancy after unprotected
intercourse, method failure or incorrect
method use
• Can help reduce unplanned pregnancies,
many of which result in unsafe abortion
96
98. Oral contraceptive pills
• Emergency contraceptive pills use the same
ingredients as regular contraceptives
• Should be initiated ideally within 5 days (120
hours) of unprotected intercourse
• Should be taken in two doses 12 hours apart
98
99. COC
• Each of the two doses of COC should contain
at least 100 ug (0.10 mg) Ethinyl Estradiol (EE)
and 500 ug (0.50 mg) Levonorgestrel
99
100. COC
PC-4, Eugoynon 50, Neogynon, Noral, Nordiol,
Ovidon, Ovral, Ovran
• Two tablets per dose: each tablet contains 50
ug EE & either 0.25mg or 0.50 mg
levonorgestrel
100
101. COC
LoFemenal, Microgynon 30, Nordette, Ovral L,
Rigevidon
• Four tablets per dose: each tablet contains 30
ug EE & either 0.15 mg or 0.30 mg
Levonorgestrel
101
102. POP
• Each of the two doses of POP contraceptives
should contain at least 0.75 mg Levonorgestrel
102
103. POP
• Ovrette - 20 tablets per dose, each tablet
contains 0.0375 mg Levonorgestrel
• Microlut, Microval, Norgestron - 25 tablets per
dose, each tablet contains 0.03mg
Levonorgestrel
103
104. IUCDs
• Copper T and others
• Insertion within 120 hours (five days) of
unprotected intercourse
104
