Contraception for Public health Students

1. Menstruation
Contraception
Reproductive Cancer
Dr Fahmida Rashid Swati
Assistant Professor
Ob-gyn,CMC
dr.fahmida seating mail.com

3. What is Ovary and Uterus?

4. 4

5. Incineration can help to reduce the waste.
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Social, cultural, and religious restrictions
Girls are not prepared and aware about menstruation
Difficulties and challenges at home,institute, and work places.
Very less or no knowledge about reproductive tract infections
Do not have access to sanitary products
Unable to afford such products due to high cost.
Environmental pollution & health hazards due to menstrual wastage

6. What is Menstrual Cycle?
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7. Regular natural
change that occurs
in the female
reproductive
system that makes
pregnancy possible.
Required for the
production of egg, and
for the preparation of
the uterus for
pregnancy
The egg is released
from an ovary
around day fourteen
in the cycle
If pregnancy does not
occur, the lining is
released in what is
known as menstruation

8. Hormones involved

9. First period -12 and 15 years of age(menarche)
Length -24 to 38 days (an average of 28 days)
Amount-20 to 80ml/cycle
Duration-2 to 8 days
Stops after menopause (45 and 55 years)
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15. What are the Common Symptoms during period?
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17. How to deal with the symptoms?
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20. General length of the Menstrual cycle based on age
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21. How to deal with menstrual flow ?
Disposable sanitary pads: single use
Reusable cloth pads: washed, dried and reused.
Select that prevents flow from spoiling cloths
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22. How to use the sanitary pads?
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23. ● No need to feel overwhelmed or feel dirty , it,s a natural
process , just like yawning, sneezing, hunger or thirst, etc.
● The only thing you need to do is take special care of your
body’s hygiene and avoid unwanted infections during this
time.
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24. What can happen if hygiene is not maintained?
 During the periods, the area around the
genitals is moist - there is a possibility of
several types of infections if the area remains
damp for too long.
 That cause itching and irritation in the vagina
 Due to this dampness, rashes in the along the
line of innerwear area are also common.
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Why to Maintain hygiene during menstrual cycle?
Ensure your everyday life does not get interrupted
Prevention of possible Urinary tract Infections
Ensures embarrassment free life which makes you feel confident
about yourself and your body.

26. How to Maintain hygiene during menstrual cycle?
Staying healthy and active
A balanced diet
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27. How to Maintain hygiene during menstrual cycle?
Record your period dates
Carry a pad on nearing your period
Wear a Inner wares with liner a few
days before your periods
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28. How to Maintain hygiene during menstrual cycle?
General Hygiene:
1. Bath/day
2.Wash genital area every time you use toilet
3.Using clean undergarments and change regularly
4.Preferably a cotton undergarment
5.Change pads regularly
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29. Things Everyone Should Know About Menstrual Hygiene
1.Choose The Right Sanitation Method- Stick to single brand and a
single method for some time to see if it suits your need.
2.Change Every 4 To 6 Hours
●Women with heavy bleeding should change it more frequently.
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30. Things Everyone Should Know About Menstrual Hygiene
.Trust Water
●Washing properly with a right technique - from up (vagina) to down (anus) and
do not do the inverse else the bacteria from the anus might cling to your vagina
and wouldn’t get washed-off increasing chances of infection.
.Disinfect Your Inner wear In Case Of A Stain
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31. Things Everyone Should Know About Menstrual Hygiene
5.Disposing Off Your Pads Properly
●It may cause infection and create foul smell.
●Do not flush the pads down the sewer as it can clog
the toilets.
● Wrap the used pads safely in a piece of paper
before throwing it into the bin.
●Do not forget to wash your hands once you have
disposed off the pad
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34. How much waste of sanitary pads is being generated?
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35. What are the Menstrual Waste Disposal Techniques Used by Women?
1. Appropriate disposal of used menstrual material – lacking.
2. Toilet facilities- lack bins for the disposal of sanitary pads and
hand washing facilities for menstruating women.
2. In rural areas, mostly women use reusable and non-commercial
sanitary materials like reusable pads or cloths.
3. In urban areas, sanitary pad disposed by flushing in toilets and
throwing in dustbins or through solid waste management.
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What are the Menstrual Waste Disposal Techniques Used by Women?
• In academy , due to lack of sanitary facilities, girls throw their pads in toilets.
• In some cases, girls threw away their used menstrual clothes without washing
them.
• Or, absent from work/ school/college due to lack of disposal system, broken
lock/doors of toilets, lack of water tap, bucket, and poor water supply .
• At home, they dispose the waste by wrapping and throwing in the dustbin along with
other domestic waste.
• In public places, they flush them in the toilets or wrap and throw them in the dustbins.
• Where dustbins are not placed they leave the soiled pads wrapped or unwrapped in the
toilet corners.
• This makes the toilets dirty, breeding place for flies and mosquitoes, and also
unhygienic for other toilet users and cleaners.

37. What are the Consequences of Menstrual Waste Disposal?
● Materials clog the sewer pipelines
● Disturb the soil microflora and decomposition takes time
● Water bodies get contaminated.
● Materials soaked with blood are breeding places for germs and pathogenic microbes .
● Sanitary products soaked with blood of an infected women/girl may contain hepatitis and
HIV viruses which retain their infectivity in soil and live up to six months in soil.
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What are the Strategies for the Management of Menstrual Waste?
● The toilets must be designed and built to be girl/women friendly .
sanitary napkin vending machines in toilets - to meet the emergency needs of the
girls/women in schools.
● There should be a separate collection system for the menstrual wastes without affecting the
privacy and dignity of women.
● Dustbins should be covered by lid and emptied from time to time to keep the toilets clean from
flies, mosquitoes, and bad odor.
● there must be water availability, toilet paper, dustbin, and a sink to wash menstrual products.
● proper safety tools should be provided to the cleaners so that they are not exposed to pathogenic
organisms and harmful gases.

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40. What are the Better Ways/Ideas of Disposing Menstrual Wastes?
Reusable Cloth Pads .
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Incinerators
Clay or Cemented Incinerators
Biodegradable Products

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Incinerators

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43. low-cost incinerator
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mud incinerator

44. AWARENESS ABOUT PERIODS LEADS TO
 BETTER REPRODUCTIVE HEALTH
 GREATER SELF-ESTEM AND CONFIDENCE
 BETTER ACADEMIC PERFORMANCE
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45. “A PERIOD IS A SIGN OF HEALTH AND FERTLITY”
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47. Contraception is a stepping stone for
effective Pre pregnancy care

48. Fertilization

49. Family Planning Methods

51. So…which one to choose?

52. Natural Methods
• Abstinence
• Calendar method
• Cervical Mucus
• Coitus Interruptus

53. Abstinence

54. Calendar method

55. Cervical Mucus

56. Coitus Interruptus or Withdrawal
Method

57. LACTATIONAL AMENORRHOEA METHOD
(LAM)
 Exclusive BF during the
first 6 months after last
childbirth
 Induced amenorrhea

58. ARTIFICIAL METHODS
IUCD

59. Condoms

60. Female
Condom

62. Progestogen-only
injection- 3 monthly shot
Injectable Contraception

63. Benefits
Suitable for women
who forget to take pills.
Who wish for a secret or ‘private’ method
In whom oestrogen is contraindicated:
○ hypertension
○ diabetes mellitus
○ age >35yr
○ smoker

64. Implantable rods
3 year protection

65. 5 Year Protection

66. IMPLANT
S

67. Intrauterine device (IUD)
10 year Protection

68. Birth Control Pills
21days (7d pill free period)
28days (1week of placebo or sugar pills)
7d of pill free period/placebo –
women will have a ‘withdrawal bleed’

69. Non-contraceptive benefits

70. When to start COCP?
Timing of initiation is a commonly encountered
confusion
 Best to be taken at same time every day
 If 1st pill after D2 , other contraception needed for 7 days
 If vomiting or diarrhoea : extra contraception
 Post partum (not BF) : start day 21 after delivery
 Post abortion/MR: within 7 days of termination

71. • If 1 or 2 pills are missed at
anytime, take the pill ASAP
(NO NEED EXTRA COVER,
DO NOT STOP)
If 2 or more pills are missed:
 Missed pills in first week :
EM + Condom for 1/52
 Missed pills in second /
third week : Condom for
1/52

72. BATTLING MYTH !!!
WEIGHT GAIN
HORMONAL DISTURBANCES
INFERILITY

73. Surgical Method
Tubal Ligation (Female) Vasectomy (Male)

74. EMERGENCY
CONTRACEPTION

75. Reproductive Cancer

76. Apex Hospital Cancer Institute
Cervical Cancer
Uterine cancer
Ovarian Cancer
Breast Cancer

77. World 10 most common cancer in women
● Breast
● Colorectum
● Cervix uteri
● Lung
● stomach
● Corpus uteri
● Ovary
● Liver
● Thyroid
● Non – Hodgkin
lymphoma

78. Cervical Cancer
● Third most common cancer in women.
● 8.8 % of all female cancer.
● Responsible for a total of 275,000 deaths;
● 58% were reported from Asia.

79. Uterine Cancer
● 6th most common women cancer.
● Cancer of older women.
● more favourable prognosis than ovarian and
cervical cancer

80. Ovarian Cancer
● most lethal due to late presentation, poor respond to
treatment and high recurrent rate.
● 4.2 % of all cancer deaths in women.

81. Cervical cancer -Risk factors
● STD
● Early age of sexual activity.
● Women with HPV infection.
● Women with multiple
sexual partners.
● Multiple kid .
● lower socio-economic class
● Women who are
married to a man with
multiple sexual
partners.
● Cigarette smoking.
● immunodeficient
.
● uncircumcised sexual
partner.

82. Prevention
● 1. Primary prevention:
healthy lifestyle
HPV vaccination.
● 2. Secondary prevention:screening.
● 3. Tertiary prevention:
● - detection and treatment of an early stage of cancer.

83. 1. HPV vaccination
● HPV is the primary aetiology of cervical cancer.
● Currently 2 types of prophylactic HPV vaccines
available in the market:
● - quadrivalent HPV vaccine against HPV 16,18,6,11
● - bivalent HPV vaccine against HPV 16 and 18

84. 2. Screening of cervical cancer
● women aged between
30 and 49 years.
● Screening interval
every -3 years
● Type of screening tests
● Pap Smear
● visual inspection of cervix
● HPV testing

85. Uterine cancer
● Prolonged exposure to hormone- oestrogen.
● obese women,
● patients with PCOS
● DM and HPT
● Hereditary
● Nulliparous
● Late menopause

86. Prevention
● treating the precursor lesions
● Adding a progestogen for at least 10 - 12 days per cycle
in HRT.
● Women with amenorrhoea or oligomenorrhoea
should be treated with cyclical progestogen.
● Withdrawal bleeding of 3 monthly is sufficient to
prevent endometrial pathology.

87. ● high phyto- oestrogen consumption among post
menopausal women.
● The use of IUCD and tubal ligation.
● Weight reduction and physical activities
● Pregnancy is a physiological protection.
● The use of COCP.

88. ● There is no effective screening method for
endometrial cancer.

89. Ovarian
cancer

90. Risk factors
● LESS risk:
● Parous women
● The birth of the first
child
● Breast feeding
● Tubal ligation.
● OCP
● Increase risk:
● Ovulation induction agent
● History of breast cancer
● Early menache
● late menopause
● HRT
● Genetic factors
● Environmental factors

91. Prevention
● OCP
● Tubal ligation and hysterectomy.
● Prophylactic oopherectomy in geneticaly
predisposed women
● Genetic testing for gene.

92. Screening
● There is no effective screening method.