Seminar gyni obs Family planning by Solomon -C2 student

1. Presenters: Solomon N
Liyew A
Modulated by: Dr. Tizazu(MD, Obstetrician and Gynecologist)

2. OUT LINES
Introduction
Definition
Objectives of FP
Classifications of FP methods
NFP methods
Barrier methods
IUCD
Hormonal methods
Permanent methods
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3. 3
INTRODUCTION
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4. 4
CONT. …
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5. CONT. …
 Rapid population growth (96% in developing
countries) is a critical issue worldwide.
 Family planning matters save women’s lives
preventing unintended pregnancies.
 Slower population growth, conserves
resources, improves health and living
standards.
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6. DEFINITION
 Having the number of children you want when you
want them.
It is not to control births, but to plan pregnancies
but birth control includes abortion to prevent a
birth…where as FP as defined by UN & WHO
encompasses service leading upto conception and
does not promote abortion as a FP method.
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7. CONT. …
 Contraception and fertility control are not
synonymous.
 Fertility control includes both fertility inhibition
(contraception) and fertility stimulation
 While the fertility stimulation is related to the problem
of the infertile couples,
 The term contraception includes all measures,
temporary or permanent, designed to prevent Px due to
the coital act.
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8. Family planning is:
1. Having the number of children based on the
couple’s belief, health and economic situation.
2. Spacing births properly.
3. Making sure pregnancies occur only during the
right time in a mother’s life.
4. Helping childless couples have children
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9. Objectives of FP
 To avoid unwanted pregnancies.
 To bring about wanted births.
 To regulate the intervals between pregnancies.
 To control the time at which births occur in relation to
the ages of the parent ; and
 To determine the number of children in the family.
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10.  Ideal contraceptive methods should be:
widely acceptable,
inexpensive,
simple to use,
safe,
highly effective and
requiring minimal motivation, maintenance and
supervision.
 So far there is no universally acceptable ideal method.
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11. Contraceptive efficiency:
It is the measurement of unplanned pregnancies even
after the use of contraceptive measures in the presence of
factors affecting.
can be measured by the pearl index.
 Pearl Index: no. Of failures/100 woman-years of exposure
Failure rate = Total accidental pregnancies × 1200
Total months of exposure
1200=12 months per 100 women
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13. Health Rationale
 Saves women’s lives and improves their health
 Spaces pregnancies, which saves children’s lives
and improves their health
 Benefits couple, family and community
 Helps adolescents make responsible choices
 Allows men to share responsibility for reproductive
health and child rearing
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14. Benefits of family planning
1. For the Mothers
Protection from early and unwanted pregnancy
Prevention of unsafe abortions
Protection from STDs
Increased education opportunities
Increased job possibilities
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15. Cont. …
2. For the Children
Better health
More food and resources available
Greater opportunity for emotional support from
parents
Better opportunity for education
3. For the Fathers:
Protection from STDs
Less emotional and economic strain
Improved quality of life
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16. Cont. …
4. For the community
 Reduced strain on environmental resources (land, food,
water)
 Reduced strain on community resources (healthcare,
educational and social services)
 Greater participation by individuals in community
affairs
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17. Choosing a method
Choosing a method depends on:
Efficacy
Convenience
Duration of action
Reversibility and time to return of fertility
Effect on uterine bleeding
Frequency of side effects and adverse events
Affordability
Protection against sexually transmitted diseases
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18. Medical Eligibility Criteria for
Contraceptive Use, WHO
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No restriction of method use
Method advantages outweigh risks
Method poses an unacceptably high
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19. TYPES OF CONTRACEPTION
Hormonal Combined hormonal contraception
Progestogen-only contraception
Emergency hormonal contraception
Non
hormonal
Traditional methods
Barrier methods
Intra-uterine devices
Sterilization: male and female
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20. 20
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21. 21
CONTRACEPTIVE
METHODS
NATURAL ARTIFICIAL
PERMANENT
TEMPORARY
BTL
VASECTOMY
BARRIER
IUCD (copper T)
HORMONAL
ABSTINENCE
WITHDRAWAL
SDM
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22. Classification
Natural FP Methods
 Calendar Rhythm
 Cervical mucus (billings)
 Basal Body Temperature
 Sympto-thermal
 Lactation Amenorrhea
 Coitus interruptus (withdrawal)
 Abstinence
Hormonal methods
– OCP (COC, POCP)
– Hormone bearing IUDs
– Injectables
– Implants
– Contraceptive Skin patches
– Vaginal rings
Intrauterine devices
– Inert forms
– Copper bearing
– Hormone bearing
Barrier methods
Condom(Male, Female)
Spermicides
Cervical caps
Diaphragm
Permanent methods
– Vasectomy
– BTL
Emergency Contraception
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23. A . Abstinence
Delay sexual activity until financially, emotionally, and
physically ready for the responsibilities of childbearing.
The only method that is 100% effective.
Advantages
It protects you from STDs and pregnancy.
Disadvantages
Coping with peer pressure
Motivation is essential
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NATURAL FAMILY PLANNING
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24. B. Post-coital Douching
 Involves washing the vagina by spraying a cleaning
solution into the vagina after intercourse
 Ineffective and unreliable method
 Disadvantages
Pushes sperm deeper into the vagina increasing the risk of
pregnancy
Increases the risk of PID
Increases the risk of ectopic pregnancy
Increases the risk of vaginal yeast infections
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25. C. Lactational Amenorrhea Method (LAM)
Based on scientific evidence that a woman is not fertile and
unlikely to become pregnant during full lactation or
exclusive breastfeeding (Ovulation is suppressed during
lactation).
Breastfeeding with no supplemental feeding of any type is
given (not even water) and the infant is feeding both(6 hrs)
day and night(4hrs) with little separation from the mother.
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26. Irregular secretion of GnRH interferes
with release of follicle stimulating
hormone (FSH) and leutinizing
hormone (LH)
Frequent intense suckling disrupts
secretion of Gonadotrophin releasing
hormone (GnRH)
Decreased FSH and LH
disrupts follicular
development in the ovary to
suppress ovulation
LAM: Mechanisms of Action
β -Endorphins induced by suckling also induce a
decline in the secretion of dopamine, which normally
suppresses the release of prolactin. This results in a
condition of amenorrhea and anovulation
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27. Cont. …
It provides maximum protection as long as:
 The woman is less than six months postpartum
 She is breastfeeding exclusively
 She is amenorrheic
NB. If these conditions are not met, the risk of
unintended pregnancy while breastfeeding is high.
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28. Cont. …
 Use of COCs generally is not advised during
lactation because they reduce the amount and
quality of breast milk.
Can be used after 6 weeks, once milk production is
established.
Progestin-only OCs, implants, and injectable
contraception do not affect milk quality or
quantity
Adv. Free and easily available, decrease breast ca
Disadv. Px occur
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29. D. Coitus interrupts (withdrawal) method
 Involves removing the penis before ejaculation
 Objective is to keep the sperm from entering the vagina
Adv.
Free
Dis adv.
Pregnancy could occurme contains sperm cells
Depends on male control
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30. E. Rhythm method
 Also called Periodic abstinence or natural contraception.
 Relies on abstinence from sexual intercourse during the most
fertile phase of a woman’s menstrual cycle.
 It needs identification of the fertile (unsafe) and
infertile(safe) phases of the menstrual cycle
 Fertilization takes place within the tube, and the ovum remains
in the tube for approximately 1–3 days after ovulation;
 from the time of ovulation to 2–3 days thereafter;
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31. Cont. …
Various methods are used;
Calendar method
Basal Body Temperature
Cervical Mucus(billings) method
Sympto-Thermal Methods
 The combined temp and calendar method
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32. 1. Calendar method
Requires recording the length of 12 consecutive menstrual
cycles.
Calculation:
1st day of fertile period = shortest cycle-18 days
Last day of fertile period = longest cycle-11 days
Sexual intercourse is abstained b/n these days
User effectiveness is 20-30/100 women-years
Adv. No side effects or health issues
Completely natural and free
Drawbacks: Only for educated and responsible couples
High Failure rate
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33. 2. Basal Body Temperature
more reliable evidence of ovulation
Is based on Temp. changes
A rise of 0.4 - 0.8 °C above the mean Temp. of the
pre-ovulatory phase for 3 days indicates ovulation has
occurred.
Abstinence is required from the time of menses until
3 days after the rise in temperature.
 True basal temperatures are recorded, i.e, fever due
to other causes??
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34. 3. Cervical Mucus(billings) method
 Also called the ovulation method
 Women takes sample of her mucus everyday for a month
 Under estrogen influence, the mucus increases in quantity
and more slippery and elastic until a peak day is reached.
 Scanty and dry under the influence of progesterone
 Women should avoid unprotected sex from the days
secretions start until four days after the peak day.
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35. 35
Cervical Mucus Cycle
Beginning Peak End
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36. Cont. …
 Adv.
Free
Can be stopped at any time
Helps women to be aware of their cycle
 Dis adv.
Failure rate is 20% per year
Requires effort and work
Because sperm may survive 5 to 7 days in the female genital tract
User effectiveness is 15-20/100 women years
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37. 4. Sympto-Thermal Methods
• If used properly, probably is the most effective of all the
periodic abstinence approaches.
• It combines the cervical mucus and the temp methods.
• In addition, symptoms that may occur just prior to
ovulation,- bloating , slight cramping and breast tenderness, are
used as adjuncts
5. The combined temp and calendar method;
 Failure rates of only 5 px/ 100 women year
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38. Barrier methods
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39. Physicalmethods
1. condoms :
A. Male condom
 Made up of fine latex sheath
 Most widely used barrier in males
 Highly effective if used correctly
Failure rate: 2-3 %…
mainly due to improper and inconsistent use
Advantage:
 Simple spacing method
 No side effects
 Easily available, safe & inexpensive
 Protects against STD
 Also protection from cervical Neoplasia
Disadvantage:
 Chances of slip off and tear off
 Some men are allergic to latex
 Those with spermicide may cause irritation
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40. B. Female condom
Strong, soft, transparent vaginal pouch made of polyurethane sheath
 Inserted before sexual intercourse
Has two flexible rings
 The outer ring…the larger, open ring stays outside the
vagina,
 The inner ring …at the closed end of the condom eases
insertion into the vagina, covering the cervix and holding
the condom in place
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41. Cont. …
 Breakage, less and slippage more, than male condom
 Inserted for up to 8 hours
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Adv
Stronger
Offers greater protection
No side effects of hormone
Prevention stds
Dis adv.
Allergy
Tear or damage unnoticed
Difficulties in insertion and
removal
More expensive
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42. 2. diaphragm
 A mechanical barrier between the
vagina and the cervical canal..
Proper fitting is key
A contraceptive jelly or cream
should be placed on the cervical side
before insertion.
 6 hrs prior to intercourse & left
in place for 6–8 hrs after.
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43. Cont. …
 Pearl index 10–20
 If intercourse is repeated, additional spermicidal
inserted into the vagina without removing the
diaphragm.
 It is then removed, washed with soap, dry, and store away
from heat.
 not be dusted with talc powder
Adv- Some protection against STD and reused – 1 yrs.
Dis adv;
 Vaginal wall irritation
 Risk of UTI
 Requiring fitting by a physician or a trained
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44. 3. Cervical cap
 Is a rubber cup with metallic rim designed to fit the cervix
 smaller as compared to diaphragm
 Used with a spermicide
 Applied over cervix before intercourse
 left in place for 8–48 hours after intercourse
 Pearl Index 11 – 19 %
Dis adv.
difficulty in placing
displacement high
Cervicitis and local irritation
a foul discharge if >1 day of use
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45. Chemical barriers
 Spermicidal agents which can destroy sperms
when applied in female genital tract 10-15
min before each sexual act
 used alone or in conjunction with a
diaphragm , cervical cup or condom.
 Various preparations as
1) Foams
2) Creams. Jellies, Paste
3) Suppositories
4) Soluble films
Adv:
Inexpensive
Well tolerated
Good protection
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46. Intrauterine contraceptive device
(IUD)
Two types of IUD :
1. Copper T 380A (Paragard)
2. Levonorgestrel releasing IUD- Mirena, Skyla and Liletta
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Proper placement of cu T
380A
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47. Description of IUD’s
i. Cu T 380A: carries 380 mm2 area of
copper wire wound around the vertical &
horizontal arms. It is removed every 10
years
ii. Multiload Cu375: it has 375 mm2 of
copper wire. It is removed every 5 years
iii. Multiload Cu250: No introducer &
plunger and removed every 3 years.
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48. Mechanism of Action
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 Intense local endometrial inflammatory response
is induced, by copper-containing devices.
 Lead to decreased sperm and egg viability.
 The progestin renders the endometrium atrophic
 Impaired sperm ascent
 Prevent implantation
 Thick cervical mucus,
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49. Levonorgestrel Intrauterine system:>99%
 There are Three different levonorgestrel-releasing
intrauterine systems-IUD- Mirena, Skyla and Liletta
 Their T-shaped radiopaque frames have a stem
wrapped with a cylinder reservoir that contains the
levonorgestrel.
 The cylinder has a permeable membrane that
regulates continuous daily hormone release
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Cont. …
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50. a. Mirena
 For 5-7 years
 Initial levonorgestrel
release rate is 20
mcg/day; rate reduced
by 50% after 5 years
 Follow up 4-12 weeks
after insertion
b. Skyla and liletta
 For 3 years
 Levonorgestrel release
rate is 14 mcg/day and 5
mcg/day after 3 years
 Follow up 4-6 weeks
after insertion
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Cont. …
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51. Initiation: within 7 days after menstrual period
begins /Immediately to 2 wks following abortion/
Side effects:
 Mal positioning of the device
Pain or bleeding
Irregular spotting for up to 6 mths after insertion
and there after to expect monthly menses to be
lighter or even absent /progressive amenorrhea/.
Cycles may be even heaver than the normal/
Menorrhagia, Anemia/
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Cont. …
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52. Fertility issues:
 endometrium recovers quickly, normal
ovulations are established and the fertility
seems to be unaffected after use of an LNG-
IUD.
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Cont. …
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53. Complications
Immediate:
Cramp like pain
Partial or complete perforation
Remote:
Pain
AUB
Pelvic infection
Spontaneous expulsion
Perforation of the uterus
Pregnancy
Missing thread
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54. Indications for removal of IUDs
1. Persistent menstrual problems
2. Tube -ovarian abscess
3. Perforation of the uterus
4. Partial expulsion
5. Pregnancy with IUD
6. Desiring fertility/ planning pregnancy
7. Missing thread
8. One year after menopause
9. Effective life span is over
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55. contraindications
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56. HORMONAL CONTRACEPTION
It is classified in to two
HCPs are one of the most widely used world
wide;
CHCs
POPs
 They are available in the form of pill, injectable,
implant
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57. Composition Route Duration
-CHC (E + P) -Oral(COC, POP, Emergency -Long acting
(L, E+L) ) (LNIURS, implants)
-short acting
-Progesterone only -injectable (MPA) (others)
-implant (levonor)
-IUD (LNIURS)
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Classifications of Hormonal Contraceptives

58. Reversible
CHC
POP
DMPA
Implants
LNRIUS
 CU-IUD
Permanent
Sterilization
Male
female
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Classifications of hormonal Contraceptives….
(According to (CDC)),

59. Cont. …
It is a combination of two steroids hormones
These are:-
Estrogen
Progesterone
 It is given for 21 days and 7 free day period.
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60. Estrogen Progestin
Monophasic EE 35 mcg Norethindrone 0.5mg
Biphasic EE 35 mcg Norethindrone 0.5mg
EE 35 mcg Norethindrone 1 mg
Triphasic EE 30 mcg Levonorgestrel 0.05 mg
EE 40 mcg Levonorgestrel 0.075 mg
EE 30 mcg Levonorgestrel 0.125 mg
Types of preparation
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61. BIPHASICS AND TRIPHASICS
Multiphasic pills were developed to reduce
the amount o total progestin per cycle
without sacrifcing contraceptive effcacy or
cycle control.
Useful when there is breakthrough bleeding.
Adv
 Tend to give a more natural bleeding pattern
 Iimitate the normal menstrual cycle & hormonal
fluctuations more closely than monophasics
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62. Mechanisms of Action
Suppress ovulation
Change endometrium making
implantation less likely
Thicken cervical mucus
(preventing sperm
penetration)
Reduce sperm transport
in upper genital tract
(fallopian tubes)
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63. 63
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64. Disadvantage and Side effects
 User dependent( require continued motivation and
daily use)
 Effectiveness may be lowered by certain
drugs
 Forgetfulness increase the failure
Does not protect against STIs
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65. Cont. …
CARDIO VASCULAR SYSTEM
Thrombo embolic disease
Ischemic heart disease especially in predisposed
CENTRAL NERVOUS SYSTEM
STROKE
Liver
slight transient impairment of liver function
cholestasis
increased incidence of gallstone( associated
with high biliary cholesterol secretion).
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66. Cont. …
Carbohydrate metabolism
• Impairment in glucose metabolism, especialy in predisposed.
• Diabetes if present become more difficult to control( b/c of
effect in liver metabolism and progesterone insulin
antagonism effect.
Lactation-decrease milk production .
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67. Conti…
 Nausea and vomiting
 headache ,irritability and depression
 Breast engorgement, tenderness& enlargement
 Skin pigmentation
Menstrual disturbance
 Spotting
 Break though bleeding
 Amenorrhea
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68. Contraindication
 Hypertension
 Some known hyperlipedimia
 Smoking ,<15cigrret/day
 age ≥35
 Obesity and migraine
 Current or treated gall bladder disease
 History of choliostasis
 Mild cirrhosis
 Rifampicin and anti convelsant drugs
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69. Cont. …
 Absolute
• Breast feeding <6 month of post partum
• Multiple cardiovascular risk factor
• HTN >160/110 mmhg
• Current problem of venous thrombo embolism
• Major surgery with prolonged immobilization
• Current ischemic heart disease and stroke
• DM with vascular complication
• Sever cirrhosis
• Women over age 35 years who smoke
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70. Indications for withdrawal in COC
 With Sx/Sn that indicate major side effect.
 Elective surgery:- 4weeks before, but if emergency
use heparin.
 Visual disturbances
 Sudden chest pain with DVT
 Severe cramp & pains in leg
 Severe depression
 when pregnancy is needed
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71. PROGESTRON ONLY PILLS
 Contain only progestin derivatives
 It avoid side effect of estrogen
 It is prepared in the form oral, injectable and
implant.
.
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72. Cont. …
The commonly used progestin are:
levonogestrel 75 g
norethisteron 350 g
ethinodiol di acetate 500 g
desogestrel 75 g
lynestrol 500 g
norgestrel 30 g.
They have to be taken with no hormone free
interval
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73. Mechanism of action
73
1. Thicken cervical mucus ,preventing sperm
penetration
2. Suppress ovulation
3. Makes the endometrial less favorable for
penetration.
4. Reduce sperm transport in upper genital
tract(fallopian tube)
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74. Cont. …
74
 If a woman using a POP misses her dose by
more than three hours it is quite likely that
she is not protected.
Advantages:
 Side effects of estrogen will be eliminated
 No adverse effect on lactation
 No “on & off” regimen during taking
 Can be used in Hypertensive pts.
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75. Cont. …
Adv.
 Precise timing, failurity
 Acne
 Changes in menstrual pattern(irregular bleeding/spotting
initially )
Contra
• Pregnancy
• Known or suspected cancer reproductive tract and breast
• Undiagnosed genital tract bleeding
• Taking drug like rifampicin, phentoyin,and barbiturates ???
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76. Injectable steroids
1. DMPA (Depo-Provera.
medroxyprogesterone acetate )
 150 mg IM every 3 months.
 It is most effective contraceptive method with
failure rate of 0.3%
s/e-
– Slow return to fertility
– Irregular bleeding
– WT gain
– Amenoria
– Short-term loss of bone mineral density/ Osteoclasts/
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77.  Implant system(1, 2, 6 rods)
 >99%: thin, pliable progestin-containing
cylinders that are implanted subdermally and
release hormone over many years.
.
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Contraceptive implant
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78. Implant systems: after removal fertility comes immediately.
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Cont. …
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79. 79
Cont. …
Implanon
 Single rod containing
Etonogestrel
- Subdermally (medial
surface of the upper
arm 8 to 10 cm from
the elbow)
- every 3 yrs
- 68 mg
- Efficacy is extremely
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80. Cont. …
2) Norplant:
 six rod for five years with each rod
containing 38 mg of levonorgestrel
releasing initially 85ug/day and later
30ug/day over five years.
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81. Implant
3) Jadelle ®
 2 rods
 Effective 5 years
 1-yr failure: 0.05% (1 in 20,000); 5-yr
failure 1.1%
4) Sinoplant – 2 rod used for 4 years
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82. Mechanism of Action
 Suppresses ovulation
 Increases cervical mucus viscosity
 Alters endometrium
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83. Features of Implants
• Highly effective
• Can be used during lactation
• Rapidly reversible
• Contain no estrogen
• Safe
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84. Side effects:
malpositioning of rods during placement.
 Can cause irregular bleeding
 Requires clinician visits for insertion and
removal
 Does not protect from STDs
84
Cont. …
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85. Cont. …
85
Adv;
• Long term use
• Immediate return of fertility on removal
Dis adv;
• Requires trained provider for insertion and
Removal
• Women cannot stop whenever they want.
• Infection at insertion site.
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86. EMERGENCY HORMONAL
CONTRACEPTION
Any woman of reproductive age may need at
some point to avoid unwanted pregnancy,
following situations such as:
 After unprotected sexual intercourse
After incorrect use of regular contraceptive
methods
 Sexual assault
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87. Cont. …
 Condom breakage or slippage.
 Miscalculation of the infertile period when using
periodic abstinence
 failure to abstain from sexual intercourse during
the fertile days.
 Expulsion of an IUD.
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88. Cont. …
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89. Cont. …
The standard regimen consists of the “combined”
oral pills. This regimen is known as the “Yuzpe
method”
High-dose pills containing 50 ug of
ethinylestradiol and 250 ug levonorgestrel (or 500
ug dl-norgestrel)
 Two pills should be taken as the first dose as
soon as convenient but no later than 72 hours
after unprotected intercourse. These should be
followed by two other pills 12 hours later.
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90. Cont. …
low-dose pills containing 30ug ethinylestradiol and
150uglevonorgestrel (or 300 ug dl-norgestrel)
 Four pills should be taken as the first dose as
soon as convenient but no later than 72 hours
after unprotected intercourse. These should be
followed by another four pills 12 hours later.
90
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91. Cont. …
levonorgestrel-only pills (post pill) containing
750ug(0.75mg) levonorgestrel
 One pill should be taken as the first dose
as soon as convenient but no later than 72
hours after unprotected intercourse. This
should be followed by another pill 12 hours
later.
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92. 3. Copper-containing IUDs (CU T 380 A)- >99%
This can be used up to five days after unprotected
intercourse.
MOA-
 interference with fertilization
 prevent implantation of a fertilized egg
S/e- Nausea, Vomiting, Breast tenderness, Headache,
menstrual disturbance & Ectopic pregnacy
92
Cont. …
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93. Trials …
 Hormonal male contraception clinical trials began
in the 1970s.
 The method is based on the use of exogenous
testosterone alone or in combination with a
progestin to suppress the endogenous production
of testosterone and spermatogenesis.
 Studies using testosterone alone showed that the
method was very effective with few adverse
effects.
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93
Male Hormonal Contraceptive …
the new era

94.  Addition of a progestin increases the rate and extent
of suppression of spermatogenesis (decrease sperm
count).
 Common adverse effects include acne, injection site
pain, mood change including depression, and
changes in libido.
 Current development includes long-acting injectables
and transdermal gels and novel androgens that may
have both androgenic and progestational activities.
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94
Male Hormonal Contraceptive …
the new era

95. 3/22/2021
Family planning
95
Male Hormonal Contraceptive …
the new era… MOA

96.  Men were given progestogen (NET-EN, 200mg)
and testosterone injections (TU,1000mg) into the
buttock muscles at the beginning of the study and
then at 8, 16 and 24 weeks. (peer reviewed Journal
of Endocrinology and metabolism)- involving 320
men
 Effectiveness- 98.4%
 Acne- 49.9%
 Mood disorder- 0.016%
 did not recover their sperm count one year after stopping
the injections- 5% ??????
96
Male Hormonal Contraceptive …
the new era
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Family planning

97. Terminal methods
 A surgical method where by the reproductive
function of an individual male or female is
purposefully & permanently destroyed
 Vasectomy in male and tubal occlusion in female
 Couple need to be adequately informed before
any permanent procedure
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98. Vasectomy
 Segment of vas deferens of both sides are
resected and cut ends are ligated
 Advantages:
1. Simple
2. Failure rate is low (0.15%)
3. Minimal expenditures
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99. Vasectomy…
 Drawbacks:
1. Additional contraceptive needed for the first 2-
3 months
2. Psychological Fair of impotence
 Candidates:
1. Sexually active, psychological prepared &
completed fertility
2. No eczema or scabies around scrotal region
3. Correct hernia &/or hydrocele before
vasectomy
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100. complications
 Immediate:
1. Wound infection and sepsis
2. Scrotal hematoma
 Remote:
1. Spontaneous recanalization
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101. Female sterilisation
 Most popular method of terminal
contraception world wide
 Occlusion of both fallopian tubes
• Tubal ligation
• Bilaterally
• The most common surgical sterilization
procedure for women
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102. Cont. …
102
• the fallopian tubes are either cut and separated
or they are sealed shut.
• This prevents the egg and sperm from meeting
and thus prevents pregnancy
 Indications:
1. Family planning purposes
2. After having the desired number of children
3. Medico-surgical indications (therapeutic)
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103. Cont. …
• The procedure can be performed
 postpartum (within 48 hours post-vaginal
delivery),
 at the time of cesarean delivery,
 interval or concurrent medical termination
 as an interval procedure (>6 weeks
postpartum) via laparoscopy or mini-
laparotomy (rarer).
 Ligation could be abdominal,or laparascopic
 Different surgical types
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104. Effects of Sterilization
 Benefits
 Effects are immediate
• Does not affect sexual
pleasure
• Vasectomy does not
affect the male’s ability
to have an erection,
achieve orgasm,
ejaculate
• Tubal ligation does not
affect a female’s
hormone production
 Disadvantages
• Complications after
procedure
• Time needed for surgery
and recovery
• Has risks associated with
surgery
• Will not protect from
STIs
• Most are non-reversible
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105. References
105
 Williams Gynecology- 3rd ed
 Current Diagnosis & Treatment Obstetrics
& Gynecology, 11TH Edition
 National Family planning guideline
Ethiopia 2016.
 Goodman & Gilman’s the pharmacological
bases of therapeutics 12th edition
 UpTo Date 2018
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106. Family planning
106
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