NURSING LECTURE

2. Types of Birth Control
• Hormonal
• IUD
• sterilization
• Barrier
• Natural methods

3. Hormonal Methods
• Combined hormonal (CHC)
• Progesterone only
• Emergency contraception (EC)
• LNG-IUD(Mirena)

4. Combined hormonal contraception
Includes:
• Combined oral contraception pills(COC)
• Combined transdermal patch
• Combined vaginal ring
How does it work?
• inhibit ovulation
• Thinning of uterine lining
• Thickening of cervical mucus

5. What assessment needed before prescribing CHC?
• Medical conditions(past-present)
• Family history
• Drug history
• Risk factors of migraine & cardiovascular disease
(smoking-obesity-hypertention,thrombophilia-
previous VTE,hyperlipidemia)
• BP
• BMI

6. Relative contraindication
Absolute contraindication

9. Benefits
üEffective method
(perfect use:99.7%-typical use:91%)
üReduce menstrual pain & bleeding
üDecreases incidence of ovarian cysts
üPrevents ovarian and uterine cancer
üDecreases acne

10. Side-effects
• Unscheduled bleeding
• Mood changes
• Weight change
• Breast tenderness- Nausea-headaches (old generation)
Health risks:
• VTE (twice non-CHC users)
• Cardiovascular disase & stroke
• Breast cancer

11. Taking the Pill
• Once a day at the same time everyday
• From day 1-5 of menstrual cycle
• Use additional method if used > day 5 (for 7 days)
• Use additional method when on antibiotics
• Use additional method for 1 week if missing ≥ 2 pill
• Annual follow up visit
• used till the age of 50 years as long as no risk factors

12. Progesterone only Contraceptives :
1.Progesterone only pills (POP)
2.Injections (Depo-Provera)
3.Implants (Implanon)

13. 1.Progesterone only pills (POP)
Mode of action:Alter cervical mucus-inhibit ovulation
Efficacy: 99%
Intake:
one pill same time every day without pill-free interval
From day 1-5 of menstrual cycle
Use additional method if used > day 5 (for 2days)
Use condoms when on antibiotics
Missed pill (>3h)including vomiting &diarrhea:
additional method for 2 days & take the missed pill
side effect:Unscheduled bleeding

15. 2-Injections (Depo-Provera)
How does it work?
• inhibit ovulation
• Thinning of uterine lining
• Thickening of cervical mucus
Intake:
• given once every three months
• From day 1-5 of menstrual cycle
• Use additional method if used > day 5 (for 7 days)
• Intramuscular

17. Benefits:
• Amenorrhea (HMB& dysmenorrhea ttt)
• Protection against ovarian & endometrial cancer
• Effective :perfect use:99.7% -typical use:94%
Health risks:
• Small loss of BMD that recover after stoppage (not for
patient <18y)
• Breast cancer(small risk ,decrease wiith time after
stoppage)
• Cardiovacular risk (±)

18. SIDE EFFECTS
• irregular menstrual bleeding( for 3-6 months)
• Weight change (NOT EVERY WOMAN )
• Injection site reaction
• Alopecia
• headache
• Mood change
• Return fertility (6-12month)

19. 3-IMPLANON
Mode of action: as COC
Intake:
• Single subdermal rod
• For 3 years
• Timing : as COC
• 99.95% effectiveness rate
Side effects:
• Unscheduled bleeding
• Insertion site:
Non insertion-deep insertion-
breakage-fibrosis-pain-alter sensation-scarring

21. Emergency Contraception (EC)
aim: prevent pregnancy follow unprotected intercourse or
failure of contraception method
Mode of action:
• high amount of hormone that prevents ovulation
• Alters the environment of the uterus, making it
disruptive to the egg and sperm
Must be taken within 72 hours

22. INTRAUTERINE DEVICES (IUD)
• T-shaped placed in the uterus for 3/5/10years)
• Preferred to be on period during insertion
• Effective immediately
• Efficacy: 98 %
Mode of action:
• Prevent fertilization(Copper is toxic to ovum & sperm )
• Anti-implantation
• Alter cervical mucus

23. • Types: Cu-IUD,LNG-IUD(mirena)

25. Risks:
• Perforation
• Expulsion
• Bleeding & pain (3-6mh)
• Infection(first 3 wk only)
• Ectopic pregnancy (in case of failure of IUD)
Tips after insertion:
• Information about the type & duration of the IUD
• Check the threads after each menstruation
• Symptoms require attention:
(pelvic infection-pain-menstrual abnormalities-missed
period-non-palbable threads

26. STERILIZATION
• permanent method of contraception
• Idea: prevents eggs from reaching sperm
• Forms:
üFemale = Tubal occlusion:Ligation(laparoscopic)
Essure (hysteroscopic)
üMale = Vasectomy

27. TUBAL occlusion
• Fallopian tubes are :
1-tied,cut, cauterized
2-occluded by ring or clips
3-essure

28. VASECTOMY
• Ligation of Vas Deferens tube
• Safer , easier and Faster recovery than a tubal ligation

29. BARRIER METHODS
Mode of action: barrier to sperm reaching the cervix
Forms:
• Spermicides (Chemicals kill sperm in the vagina) (left in
place for at least 6 hours after intercourse)
• Male Condom
• Female Condom
• Diaphragm & Cervical Cap (left in place for at least 6
hours after intercourse)
Disadvantage:
higher failure rates due to design and human error

31. Natural methods
Lactation amenorrhea method (98%)
Baby <6mth-mother amenorrhic-exclusive breast feeding
(every 4-6h,no other liquid &solid)
Withdrawal method
Removal of penis from the vagina before ejaculation
Fertility Awareness Method
abstains from sex during the calculated fertile time
Abstinence (100%)
partners do not engage in sexual intercourse