4. Coitus Interruptus effectively pprreevveennttss pprreeggnnaannccyy && SSTTDD
It has been suggested that the pre-ejaculate ("Cowper's fluid”)
emitted by the penis prior to ejaculation normally
contains spermatozoa (sperm cells), which would compromise the
effectiveness of the method
Typical failure rate : 18 – 20 %
Avoid during fertile period
DOES NOT PREVENT AGAINST STD
5. 11. FFiixxeedd ffeerrttiillee ppeerriioodd (( aavvooiiddaannccee ooff SSII aatt ddaayy 1144 ooff mmeennsseess ))
• Only applicable for those with regular menses, cycle length is
recorded for the min of 6 cycles,
• Fertile period is not only on day fourteen : ovulation varies each
cycle
• Cycle length is recorded for the min of 6 cycles, likely fertile days
are then calculated allowing for the survival of sperm and ova
First fertile day : shortest cycle – 20
Last fertile day : longest cycle – 10
6. Postcoital perineal wwaasshhiinngg pprreevveenntt pprreeggnnaannccyy
• Semen travels at 28mph
• It takes only 5 minutes for them to travel the 6 inches to the cervix
• Perineal washing does NOT effectively cleanse vagina off the sperm
7. Breast feeding pprreevveennttss pprreeggnnaannccyy
LACTATIONAL
AMENORRHEA METHOD
•Exclusive BF during the first 6
months after last childbirth
•Induced amenorrhea
•2% to get pregnant
9. CCaauusseess hhoorrmmoonnaall ddiissttuurrbbaanncceess
• Androgen cause in sebum production and terminal hair growth
• Acne vulgaris – a common skin disorder that involves the sebaceous follicle
• Hirsutism – growth of terminal hair on the body of a woman in similar pattern &
sequence as in post pubertal male
• COCPs - serum free testosterone concentration by inhibiting luteinising hormone
stimulation of ovarian androgens & increasing sex hormone binding globulin (SHBG)
production in the liver
• COCPs – inhibit 5-alpha reductase activity (required to convert testosterone to
dihydrotestosterone in hair follicles and skin)
HHyyppeerraannddrrooggeenniissmm
10. PREMENSTRUAL SYNDROME
• Premenstrual symptom – breast tenderness, bloating, fatique,
headaches, mood swings or irritability
• Premenstrual syndrome (PMS) – pre menstrual symptoms
severe enough to cause impairment of daily activity. Affect 10-
15% of women
• COCPs improve PMS/PMDD by suppressing ovulation
• Drosperinone (a new progestogen derived from spironolactone)
containing COCP was shown to be highly effective in PMS/PMDD
• COCPs are better at improving the physical symptoms of
PMS/PMDD
• If emotional symptoms are predominant, then selective
serotonin reuptake inhibitors (SSRI) are the initial treatment of
choice
11. MMaakkeess oonnee iinnffeerrttiillee
• A woman’s fertility declines with age, genetically determined.
• Fertility is also affected by general and gynaecological health,
concurrent illness, weight, exercise levels, cigarette smoking and
stress. Weight above and below the recommended range for
height can have an impact on fertility
• Systemic review of studies comparing reversible forms of
contraception found between 79% and 96% of women were able
to get pregnant in the 12 months after they stopped taking the pill.
12. MMaayy rreessuulltt iinn wweeiigghhtt ggaaiinn
CCoommppaarreedd wwiitthh ppllaacceebboo oorr nnoo iinntteerrvveennttiioonn,
tthhee uussee ooff ccoommbbiinnaattiioonn ccoonnttrraacceeppttiivveess wwaass
nnoott aassssoocciiaatteedd wwiitthh wweeiigghhtt ggaaiinn
Cochrane review identified 49 randomized controlled trials that
spanned at least three treatment cycles and compared a combination
contraceptive with placebo, no intervention, or another combination
contraceptive that differed in drug, dosage, treatment regimen, or
study length. Only four of the 49 trials had a control group (placebo
or no intervention). None of the four trials found a statistically
significant difference in weight change between the combination
contraceptive and control groups.
• Some women may experience bloating from water retention before or during periods when
COCP.
• Some progestogen ie Drospirenone counteracts the mechanism of water retention thus many
women enjoys the freedom from water related weight gain/ discomfort
13. May cause rreedduuccttiioonn iinn sseexxuuaall ddrriivvee
• Findings from studies of the sexual effects of hormonal contraceptives have been
inconsistent, and the pharmacologic basis for these effects is unclear
• When women on the Pill were tested, levels of a chemical which wipes out testosterone
were found to be seven times higher than in those who had never taken it
15. OOVVAARRIIAANN CCAARRCCIINNOOMMAA
• OCP (chemoprevention) has highest protective effect against ovarian
cancer
• OCP for 5 years reduces the relative risk of developing epithelial ovarian
cancer by 50%
• Trials evaluating role of OCP as primary prevention of ovarian cancer
particularly hereditary ovarian cancer due to BRCA 1 or BRCA 2 (CASH &
SEER)
i. 5 years use of OCP in nulliparous women reduced the risk of ovarian
cancer to similar with non user multipara
ii. 10 years use of OCP reduced the risk in women with family history ovarian
cancer to lower than those non users and has no family history
Oral contraceptive use and the risk of ovarian cancer: the Centers for Disease Control
Cancer and Steroid Hormone Study. Journal of the American Medical Association
249(12):1596-9. 1983 Mar 25. 11 p
16. EENNDDOOMMEETTRRIIAALL CCAANNCCEERR
• The use of COCP for 1 year decrease the risk of endometrial cancer by more than
40%
• A meta-analysis has shown that
17. CCOOLLOONN CCAANNCCEERR
• Lesser known benefit of COCPs is protection against colon cancer
• A cohort study – women who used COCP for ≥ 96 months had 20-
40% lower risk of developing colorectal cancer
19. Fear ooff PPeerrffoorraattiioonn// EExxppuullssiioonn
• The rate of uterine perforation associated with intrauterine
contraceptive use is vveerryy llooww (00––22..33 ppeerr 11000000 iinnsseerrttiioonnss).
• Expulsion of intrauterine contraception occurs in approximately 11 iinn
2200 wwoommeenn aanndd iiss mmoosstt ccoommmmoonn iinn tthhee ffiirrsstt 33 mmoonntthhss after
insertion and often during menstruation
Harrison-Woolrych M, Ashton J, Coulter D. Uterine perforation on intrauterine device insertion: is
the incidence higher than previously reported? Contraception 2003; 67: 53–56. 59 World Health
Organization (WHO). Mechanism of Action,
Caliskan E, Öztürk N, Dilbaz BÖ, Dilbaz S. Analysis of risk factors associated with uterine
perforation by intrauterine devices. Eur J Contracept Reprod Health Care 2003; 8:150–155.
20. Increases the risk of pelvic iinnffllaammmmaattoorryy ddiisseeaassee
Women should be advised there may be an
increased risk of pelvic infection in the 20 days
following insertion of intrauterine contraception
but the risk is the same as the non-IUD-using
population thereafter (Grade B).
• Pelvic inflammatory disease (PID) among IUD users is most strongly
related to the insertion procedure and to the background risk of STIs.
• A review of 12 randomised trial identified low rates of PID (1.6 per 1000
woman-years).After adjusting for confounding factors, although a six-fold
increase in the risk of PID occurs in the 20 days after insertion, the
overall risk is low. After this time the risk is low and remains low unless
there is exposure to STIs
Farley TM, Rosenberg MJ, Rowe PJ, Chen JH, Meirik O.
Intrauterine contraceptive devices and pelvic inflammatory disease: an international
perspective. Lancet 1992; 339:785–788.
21. Causes excessive ppeerr vvaaggiinnaall bblleeeeddiinngg
An increase amounting to approximately
20 ml per period without significant
variations during the study was recorded.
No significant influence upon serum iron
and TIBC was found
In general, Cu-IUDs do not have any effect on ovulation. Nevertheless, a
shorter luteal phase (post-ovulation) with earlier onset of
menstruation has been documented. Spotting, light bleeding, heavier
or longer periods are common in the first 3 to 6 months following Cu-
IUD insertion. These bleeding patterns are not harmful and usually
decrease with time.
World Health Organization. Selected Practice Recommendations for Contraceptive Use (2nd edn).
2005.http://www.who.int/reproductive-health/publications/spr_2/index.html [Accessed 12 October
2007].
Faculty of Family Planning and Reproductive Health Care Clinical Effectiveness Unit. UK Selected
Practice Recommendations for Contraceptive Use. 2002.http://www.fsrh.org/admin/uploads/Final
%20UK%20recommendations1.pdf [Accessed 12 October 2007].
22. Higher rriisskk ooff EEccttooppiicc PPrreeggnnaannccyy
WWoommeenn sshhoouulldd bbee iinnffoorrmmeedd tthhaatt tthhee oovveerraallll rriisskk ooff eeccttooppiicc pprreeggnnaannccyy iiss rreedduucceedd
wwiitthh uussee ooff iinnttrraauutteerriinnee ccoonnttrraacceeppttiioonn wwhheenn ccoommppaarreedd ttoo uussiinngg nnoo ccoonnttrraacceeppttiioonn
aanndd nnoo ppaarrttiiccuullaarr ddeevviiccee iiss aassssoocciiaatteedd wwiitthh aa lloowweerr rraattee ooff eeccttooppiicc pprreeggnnaannccyy ((GGrraaddee
AA))..
• Intrauterine methods are such effective contraceptives that the absolute risk of
pregnancy (intrauterine and ectopic) while using these methods is very low.
• A previous ectopic pregnancy is not a contraindication to the use of intrauterine
contraception
• Contraceptives that inhibit ovulation will reduce the risk of ectopic pregnancy to a
greater degree. A meta-analysis of case-control studies showed no increased risk of
ectopic pregnancy with current Cu-IUD use (adjusted odds ratio 1.06; 95% CI0.91–
1.24)
24. Interferes with sseexxuuaall iinntteerrccoouurrssee
DDooeess nnoott iinntteerrffeerree wwiitthh sseexxuuaall
ffuunnccttiioonn
•Prospective studies have generally reported no change or
improvements in sexual function, sexual desire, sexual satisfaction,
coital frequency, and self-perceived femininity
• Important to emphasize the “ttuubbaall lliiggaattiioonn ““ ddooeess nnoott iinntteerrffeerree wwiitthh
sseexxuuaall iinntteerrccoouurrssee
25. Causes eeaarrllyy mmeennooppaauussee
SStteerriilliizzaattiioonn nnoott pprroovveenn ttoo ccaauussee
ddeettrriimmeennttaall eeffffeecctt oonn oovvaarriiaann
ffuunnccttiioonn
Theory of early menopause:
1.interruption and reduction of blood supply to the ovaries. This could cause ovarian
dysfunction and alter the ovaries' production and/or release of estrogen and
progesterone;
On theoretical grounds alone, such theories arouse suspicion.
Two thirds of the ovarian blood supply comes from the uterine artery, through the
tubal artery, and one-third is from the ovarian artery.
Given that the anastomotic network between the tubal and ovarian arteries is
extensive, it is unlikely that interruption of one of these arteries would result in
clinically remarkable reduction in blood flow to the ovaries
Studies of more objective measures of ovarian function do not show any consistent
changes in progesterone or estrogen levels ( longest follow up 6.9 years)
26. Causes abnormal uutteerriinnee bblleeeeddiinngg
No significant menstrual changes
after sterilization
Postulation that tubal occlusion may cause menstrual changes through
1.interruption and reduction of blood supply to the ovaries. This could cause ovarian
dysfunction and alter the ovaries' production and/or release of estrogen and
progesterone;
2. interference with the direct diffusion of estrogen and progesterone from the
ovaries to the uterus, leading to endometrial malfunction;
3. interference with the prostaglandin feedback mechanism between the uterus and
ovary with deficient prostaglandin production and disturbances in ovarian
steroidogenesis; and
4.uterine vascular congestion.
Most cohort studies that controlled for previous menstrual history, previous
contraception, or increasing age showed no significant menstrual changes after
sterilization
27. IIss 110000%% ppeerrcceenntt eeffffeeccttiivvee
EEvveerryy ccoonnttrraacceeppttiioonn mmaayy
ffaaiill
• CREST study reported a 10-year cumulative failure rate of 1.85% for all
sterilization methods. (0 .75% for unipolar coagulation and postpartum partial
salpingectomy to a high of 3.65% for spring clip application)
• Reasons for sterilization failure include undetected preexisting pregnancy
(luteal phase pregnancy), occlusion of the wrong structure, incomplete or
inadequate occlusion, slippage of a mechanical device, development of a
tuboperitoneal fistula, and spontaneous reanastomosis or recanalization of
the previously separated tubal segments.
• When sterilization failure occurs, the pregnancy is more likely to be ectopic
• The overall risk of pregnancy is low among sterilized women. Therefore, the
absolute risk of ectopic pregnancy among them is substantially lower than the
absolute risk of ectopic pregnancy among women not using contraception
Koetsawang S, Gates DS, Suwanichati S et al: Long-term follow-up of laparoscopic sterilizations
by electrocoagulation, the Hulka clip and the tubal ring. Contraception 41:9, 1990
Peterson HB, Xia Z, Hughes JM et al: The risk of pregnancy after tubal sterilization: findings
from the US collaborative review of sterilization. Am J Obstet Gynecol 174:1161, 1996
