1.
Contraception
Dr. Saumya Prasad
M.S (ObGyn)

2.
India was the first country in the
world to have launched a National
programme for Family Planning in
1952.
“The ideal family – two parents, two
children”
The red
triangle is
India’s family
planning
symbol.

3.
Need for contraception
21 % of all pregnancies resulting live births are
unintended
Around 2/5th of all pregnancies are unintended
If unmet needs of contraception is met then we can
avoid:
55 million unwanted pregnancies
22 million fewer abortions
90,000 fewer maternal deaths

4.
Reasons of unintended pregnancies:
Unawareness
Use of traditional methods
Side effects
High cost
Difficult mode of delivery
Fear of irreversibility of fertility

5.
1. Safe
2. 100% effective
3. Free of side effects
4. Easily obtainable
5. Affordable
6. Acceptable to the user
7. Free of effects on future pregnancies
Characteristics Of Ideal Contraceptive

6.
Various Types Of Contraceptives

7.
Options for
contraception
LARC
methods
Non- LARC
methods
Barrier
Methods

8.
TYPES OF MALE CONDOMS
DRY
PRE-
LUBRICATED
SPERMICIDAL
Latex Polyurethane
NIRODH LUBRICATED
Dry condoms
Free of cost by GOI
Nirodh
Kohinoor
Nirodh lubricated
Kamasutra
Rakshak
9

9.
Latex Condoms
• Latex condoms are the most common type of
condoms
• The main advantages of latex condoms are that
they can be stretched a lot before it breaks
• That means it is good at preventing the semen
from going through the condom
Failure rate
Typical use 12%
Perfect use 3%
10

10.
Polyurethane Condoms
• Polyurethane condoms are also very common
• These are very similar to latex condoms in size
• They have a longer shelf life than latex condoms
• They have less allergic reactions to them
• Can be used with oil based lubricant
• These condoms also prevent STI’s
• Slip more, break more
• More expensive
11

11.
Male Condoms
Advantages Disadvantages
Readily available Can cause hypersensitization
Suitable for all age group Difficult to dispose in villages
Harmless method
Prevention against STI RR= 0.1%
If used in later half of pregnancy,
reduces risk of amniotic fluid infection
If used >5years, reduces risk to
cervical intraepithelial dysplasia
MEC
Category 4 None
Category 3 Latex allergy
High risk pregnancy in c/o
failures 12

12.
Female Condoms
• This type of contraceptive is put into the vagina
before having sex
• It has two ends with rings on them
• The end that goes into the vagina has a closed
rim
• The end that stays outside has an open rim
Failure rate
Typical use 21%
Perfect use 5%
13

13.
Occlusive caps
Are not sperm proof mechanical barriers
Retain spermicide with cervical os
Spermicide must be used
Usually manifacured by rubber
Vaginal
diaphragm
Cervical
cap
Vault cap Vinule cap
14

14.
Vaginal Diaphragms
• This is a dome shaped object that is also made
of rubber.
• It fits around the cervix, preventing the sperm
from being able to enter the uterus
• This is used with spermicide
• Available in diff sizes, 60,65,70,75mm
• 3 types- flat type, coil type, arching type
Failure rate
Typical use 16%
Perfect use 6% 15

15.
Cervical Caps
• Rubber caps that are inserted into the vagina
and fits around the uterus
• This blocks the passage way for sperm to
enter the uterus
• This is used with spermicides.
• 3-4 sizes available- 21 to 31 mm.
• Ex- ortho cervical cap, miller cervical cap
Failure rate
Typical use Nulliparous-16%
Parous- 32%
Perfect use Nulliparous- 9%
Parous-26%
16

16.
Vault cap
Rubber or plastic cap
50-75mm in size
Replaced by diaphragm
Ex- dumas
Vinule cap
Type of cervical cap
Used in women with
prolpse
When diaphragm
cannot be retained
Ex- vinule pessary
Disadvantages of occlusive
caps
Spermicide can cause irritation in
the vagina
If the cap is not removed well in
time, vaginal discharge may
present
Allergic reaction due to silicone
cap
TSS is a rare complication
17

17.
18
MEC for occlusive caps
Category 4 None
Category 3 History of TSS
Uterine or vaginal
abnormalities
High risk of HIV
Allergy to latexi
Inability of the user to insert
Category2 FTVD within6-12 weeks
Parous women
Complicated valvular disease

18.
Sponges
• “Today” is most common
• It is saturated with nonoxynol-9
• Nonoxynol- spermicide action
• Blocks the cervix and absorption of semen
• Acts for 24hrs
• Can be removed after 8-24hrs but not
before 6 hours
• Major s/e – TSSS
Failure rate
Typical
use
16%
Perfect
use
9%
19

19.
Spermicide
20
Alter sperm
surface
membrane
permeability
Osmotic
changes
Killing of
sperms
Category 4
Clients with high risk of HIV
Who are HIV positive
Category 2
Who have high risk of pregnancy
Sensitivity to a spermicide
Cervical cancer
MEC criteria for spermicide

20.
Non- LARC Hormonal contraception
Combined oral contraceptive
COC
Patch
Ring
Progesterone only pill

21.
Type of progesterone Monophasic pills Triphasic pills
Levonorgestrel Microgynon 30/ED
Ovranette (30 EE)
Eugynon (30 EE)
Trinodial
Logynon/ ED
Norethisterone Ovysmen / Brevinor (35 EE)
Norimin( 35)
Loestrin 20/30
Trinovum
Binovum
Synphase
Norgestimate Cilest (35 EE)
Desogestrol Mercilon 20 Ee
Marvelon 30 EE
Gestogene Femodene (ED/ 30EE)
Minulet (30 EE)
Femodette(20 EE)
Tri-Minulet
Drospirenone Yasmin (30 EE)
Types of combined oral contraceptive pills

22.
Formulations
Monophasic Biphasic Triphasic
Each tablet contains a
fixed amount of estrogen
and progestin
Each tablet contains a
fixed amount of
estrogen, while the
amount of progestin
increases in the second
half of the cycle
The amount of estrogen
may be fixed or variable,
while the amount of
progestin increases in 3
equal phases

23.
First generation Second
generation
3rd generation 4th new
generation
50mcg of ethinyl
estradiol
30-35 mcg ethinyl
estradiol with
progestin such as
levonorgestrel,
norgestimate
Mala N, Mala D
20-30 ethinyl
estradiol with
desogestrel or
gestone
Femilon, Loette
20-30 ethinyl
esradiol with
drospirenone
dienogest or
nomegestrol
India: Yasmin
Ethinul estradiol
and drospirenone
with weak anti
minerocorticoid
activity; helpful in
PCOD
Different generations of oral contraceptives

24.
Progestin only Pill
Each tablet contains one
•0.075mg Levonorgestrel
•0.030 Norgestrel
•0.075 Desogestrel
•0.035 Norethindrone
•0.50 Ethynodiol diacetate
Started after 6 weeks of
delivery in lactating wome
within first 5 days of the
periods
Safety margin 12 hours
Failure rate 0.5-2/HWY

25.
New Formulations Of Oral Contraceptive
Continuous use of OCs
Seasonale 0.15mg
levonorgestrel +
30mcg EE
Women take a pill every day for
84 days and 7 days hormone free
pill week
Seasonique LNG 0.15mg + EE
0.30mg
84/7 day tablet
Femcon Fes EE 35mcg +
Norethindrne 0.4mg
Chewable spear mint flavoured
tablet
Centchroman 30mg centchroman Once a week OC
One tablet twice weekly from the
1st day of menses for the first 3
months and then once a week

26.
Contraceptive Patch
150 mcg of progestogen + 20 mcg EE
Ortho Evra
Each patch lasts for 1 week, hence
3 patch for each cycle followed by
a week patch free interval
Failure rate: 1/HWY
• 5cm x 5cm
• EE 20mcg/norelgestromin
150mcg
• Cilest via the skin
• Compliance
• Avoids all absorption
problems from GI disorders
• Bulimia/purging/travellers/air
crew
• Constant hormone levels
Not yet available in India

27.
Long Acting
Reversible
Contraceptive
Sub- dermal
Implant
Intra-uterine
system
Injectable
contraception

28.
HORMONAL IMPLANTS
Norplant Consists of 6
capsules with
216mg of
levonorgestrel with
each capsule havig
36mg of LNG
Rate of release of
LNG is 85mcg per
day during first 6
months, 50mcg per
day for next 9
months and then 30
mcg there after
Effective for 5 years
Norplant-2 (Jadelle) 2 rods
Each rod consists
of 75 mg of the drug
Rate of release is
same
Effective for 5 years
Implanon/
Nexplanon
68mg of
etonogestrel
Initially the release
is 60-70mcg per
day which reduces
to 25-30 mcg per
day
Effective for 3 years
Capronor Biodegradable LNG
for faster release of
LNG
For 1 year

29.
Implant failures
Over 50% linked with non-insertion
25% with liver enzyme inducers (mostly
carbamazepine and none with lamotrigine)
Overall 0.049 per 100 implants fitted
 Method failure rate 0.01 per 100 implants
 11.6% of all in-treatment pregnancies were
ectopic

30.
Classification based on the content of IUD
Inert (non-medicated) Inserted by “push out
technique”
Lippe’s loop, saf T coil
Bioactive (medicated ) Withdrawal technique Cu T 200, Multi Load 250,
Cu T 380A, Cu T 300 A
Hormone releasing IUDs Withdrawal technique Mirena, LNG IUS

31.
Cu 380A
Its has 380
Mm2
Release of Cu is abt
50mcg per day
Multiload copper
devices
No plunger
250mm
Release about 75mcg
per day2
Levonorgestrel
intrauterine system
Contains 52mg LNG
with a release of
20mch per day
Low failure rate: 1-
3/1000 women
Progestasert
Contains 38mg
progesterone that
release 65mcg per
day
It is effective fro 1
year
Other IUS are copper T 200C, Copper 7, Copper T 200
Intrauterine devices

32.
Gynefix
Frameless IUD
Contain 6 bracelet of
copper that are crimped
on to a string and affixed
to the fundal myometrium
Contains 330mm2 of
copper
Higher expulsion rate

33.
Injectable progestogen contraceptive
Depot medroxy
progesterone
acetate (DMPA)
Microcrystals
suspended in an aq
solution and given as
150mg intramuscular
injection by the Z track
technique every 3
months
Given within the first
7 days of the current
menstrual cycle
Efficacy is equal to
sterilization
New formulation
contain 30% less
progestogen than
DMPA and is given
subcutaneously
Norethindrone
enanthate (NET-
EN)
Given in a dose of
200mg i.m every 2
months
Same way

34.
DMPA
IN GOVT OF INDIA
CONTRACEPTIVE
BASKET
Once every three months, women in the age group of 18-45 years will be
given DMPA injections free of cost at all state-run primary health centres
and hospitals.
It will be administered by doctors and staff nurses at government
hospitals nearly four times a year to women who want to delay or avoid
pregnancies.

35.
Nestragel
Successful phase 2 trial
Suppressed ovulation for
21 days
Well tolerated
No androgenic properties
Applied in dose
2.3mg/day once for 21
days with 7 free days
Transdermal contraceptive gel

36.
Male contraceptive
Gossypol
It is an aldehyde derieved from seeds, stem and roots of cotton plant
Inhibits spermatogenesis, decereases epididymal motility, decreases
conversion of proacrosin to acrosin
Administered 10-20mg daily for 3 months and then 20mg twice weekly

37.
Quinacrine pellets
Intratubal chemical methods
Pellets have being inserted in the
fallopian tubes transervically to result
in permanent sterilization by
producing scarring to block the
fallopian tubesEssure system
Transcervical method
Cornual end of fallopian tube is
occluded with a microinsert with
fine stainless steel inner coil and
an expandable outer coil of nickel
and titanium
Very expensive
Success rate of 99%

38.
Adiana
Hysteroscopic sterilization
2 step process controlled thermal
damage o endosalpinx followed by
insertion of biocompatible matrix plus
within the tubal lumen
Ulipristil-IUD
Failure rate 0.1-2.5
IUD impregnated with SPRM
Act by suppression of ovulation,
endometrial atrophy

39.
104mg/0.65ml suspension for injection of medroxyprogesterone acetate
Licensed for self administration
Given every 13 weeks +/-7 days
SC pre-filled Uniject injector given into front upper thigh or abdomen
Use if i.m is C/I or unsafe
In thin women
Less invassive

40.
IUB and SPHERA
The IUB is a revolutionary new product
in the intrauterine contraception field.
The IUB is a three-dimensional, ball-
shaped device that is inserted into the
uterine cavity to prevent pregnancy.
Its efficacy is similar to current copper
intrauterine devices (IUD), however its
insertion is simpler, its improved safety
profile has been demonstrated in a clinical
trial and it is expected to offer a better
quality of life over current devices

41.
Fertility regulating vaccine
Anti Hcg vaccine
Uses tetanus toxoid diphtheria as carriers
The antibodies produced by the anti hcg vaccine neutralize hcg from
fertilized egg leading to endometrial shedding with loss of fertilized
ovum
However the initial results are not very promising

42.
REMOTE CONTROL CONTRACEPTIVE CHIP

43.
Conclusion
India's public sector programme claims to provide a
“cafeteria approach” with a “basket of choices”.
The method-mix in this programme includes five official
methods :
1. Female sterilisation,
2. Male sterilisation
3. Intrauterine contraceptive device (IUCD)
4. Oral contraceptives
5. Condoms