2. IDEAL CONTRACEPTIVE
Inexpensive
Easy and simple to use with minimum side
effects
Rapidly reversible
Readily available
Highly effective
Can be administered by non-healthcare
personnel.
3. classifications
A. Natural Methods
• Periodic abstinence
• Withdrawal
• Lactational Amenorrhea Method(LAM)
• Calender rhythm method
B. Barrier Methods
C. Hormonal
D Intrauterine Devices
E.. Sterilization
9. POP: Suitable for -
• Older women,
• Heavy smokers,
• Pts with HTN,Valvular heart ds., DM, or
Migraine,
• Breastfeeding women < 6mo postpartum
(delay until =/> 3w postpartum to avoid
risk of heavy bleeding).
10. Mechanism of action
• Combined pill :
most effective method because they inhibit midcycle
gonadotropin surge and prevent ovulation
• Progestin only pills(pop/minipill):
don’t mainly inhibit ovulation
Both types act by- altering cervical mucus
making it thick viscid and scanty
-alter endometrium so not fit for
implantation
- alter ovarian
responsiveness to gonadotropin stimulation
11. How to prevent ovulation?
• Interfere with the release of GnRH from
hypothalamus so it will suppress LH & FSH
• In high concentration they will inhibit pituitary gland
directly
• Progestin only pills don't inhibit ovulation mainly
because a lower dose of progestin is used in
preparations less than combine forms it is important
to be taken at the same time of the day to ensure that
blood level do not fall below the effective levels
12. Short-term side-effects
• OESTROGENIC
EFFECTS
• Breast tenderness (3.6%),
• Nausea ( 1.5%),
• Dizziness
• Cyclical wt. gain
• Bloating
• Vaginal discharge without
infection
• use a more progestogen-
dominant pill
• PROGESTOGENIC
EFFECTS
• Depression(3.9%),
• Premenstrual tension
• Dry Vagina
• Sustained wt. gain
• Decreased libido
• Lassitude
• Acne
• Use a more oestrogen-
dominant pill
13. • Estrogen cause pigmentation and high level
of estrogen may accelerate the development of
gallbladder disease in young female but not
increase the risk of acute cholelithiasis
• Progestin : because they are structural related
to testosterone they produce androgenic
effects like increase weight and acnes
15. NONCONTRACEPTIVE BENEFITS
• BENEFITS FROM ANTIESTROGENIC
EFFECTS OF PROGESTERON:
1-decrease menses blood loss & improve anemia
2- risk of adeno CA of uterus
3- estrogen receptors in breast so risk
begnin breast disease ?
• BENEFITS FROM INHIBITION OF
OVULATION (dysmenorrhea )
use as therapy of severe dysmenorrhea
• OTHER BENEFITS: risk (PID,Rhumatoid a,
bone loss)
17. Neoplastic effects
• Breast CA
• Endometrial CA : protection related to duration of
use
• Ovarian CA : decrease risk duration related
• Liver adenoma and CA?
• Pituitary adenoma : mask symptoms produced by
prolactinoma amenorrhea and galactorrhea
• colorectal CA: protection
• Liver cyst and adenoma
18. Contraindications
• Absolutes-
• Histoy of vascular disease (thromboembolism)
• Systemic diseases (affect vascular system) SLE , DM
with retinopathy or nephropathy
• Undiagnosed uterine bleeding
• Increase serum TGs
• Heart failure rare because incidence of heart diseases
are mostly after menopause
• Smoking in female more than 35y
20. VAGINAL RING
• Steroids absorbed though vaginal
epithelium directly into circulation
• Contain ethniyl estradiol and
etonogestreland
• Place in vagina for 21 days and remove 7
days to allow withdrawal bleedings
21.
22. TRANSDERMAL PATCH
• It releases norelgestromin &
ethinyl estradiol
• Weekly applied, for 3 weeks, and the last
week of the cycle is a patch-free week
• Normal activities can be done while using the
patch
24. •Sub dermal implants:
• Need trained personal for insertion
and removal.
• Out patients procedure.
• 99.5% effectiveness rate.
• Requires no user motivation so
compliance not problem.
• Amennorhoea is common
25. • Subdermal implantation for continuous release
• Effective for up to 3 years
• Rapid return of fertility
• Problems
• Menstrual irregularity
• Weight gain
• Surgical implantation & removal
28. IUD
-IUD is the world's most widely used method
of reversible birth control.
3 TYPES:
1- Inert ( no longer recommended because of
painful and heavy periods).
2-Copper Releasing (paragard).
3-Progesterone Releasing (IUS):
A-Progestasert
(progesterone T) 1976 -
2001.
B-Mirena
(levonorgestrel).
30. 2. Copper bearing IUCD
- Consist of a plastic frame with copper
wire around the stem.
- Surface of the copper determines the
effectiveness and active life of the
device.
- Most IUCD licensed for use over 5-10
years and because of gradual absoption
of copper, these IUCD renewed after 3-5
years.
Copper Salt gives some protection against
bacterial infection.
31. Mechanism of Action:
- All IUCD cause a foreign body reaction in the
endometrium with increased prostaglandin
production and Leucocyte infeltration. This
reaction enhanced by copper which effect
endometrial enzymes and oestrogen uptake and
also inhibit sperm transport.
- Alteration of uterine and tubal fluid impairs the
viability of the gametes.
- The progesterone IUCD (LNG.IUS) cause
endometrial suppression and change in the
cervical mucus and utro tubal fluid impair
sperm migration.
32. Clinical uses
• Long-term contraception
• Women with contraindications to COC
• Side effects-menorrhagia , endometriosis,
chronic
pelvic pain, dysmenorrhea , anemia.
34. EMERGENCY
CONTRACEPTION/POST- COITAL
CONTRACEPTION
• After intercourse and before implantation
• Indication: failure of condoms
• Unprotected intercourse
• Within 72 hours after unprotected intercourse
• 2 METHODS- 1)HORMONAL -Levonorgestrel
0.75mg tablet (2nd tablet after 12 hours) or
• Two oral contraceptive pills- Ethinyl estradiol 50mcg(same dose
after 12 hours) or
• Mifepristone 10mg once within 72 hours
• 2)IUD Emergency Contraception
• Within 5 days after unprotected intercourse
• Copper IUD
37. Natural methods
• Lactational amenorrhea(LAM)
• Prolonged and sustained breast-feeding offers a
natural protection of pregnancy.
• More effective in women who are amenorrhoeic
than who are menstruating
• The risk of pregnancy to a woman who is fully
breast feeding and amenorrhoeic is less than 2
per cent in first 6 months. Otherwise failure
rate is high(1-10%)
• Support of iucd,condom or injectable steroids
38. Barrier methods of contraception
Two types :
1. Physical barrier methods- such as
condoms, diaphragm, and cervical caps, that prevent
pregnancy by blocking the entry of sperm into the
upper genital tract;
2. Chemical barrier methods
(spermicides) that kill or inactivate sperm on contact. (
less effective , used in combination , no STDs protection )
39. Barrier methods of contraception
• easily available, reversible, and have fewer
side effects than hormonal methods.
• effective and acceptable if used consistently
and correctly.
• Protect against STD
40. Natural Methods:
1.) Calendar Method (Safe period)
- relies upon the fact that there are certain days
during the menstrual cycle when conception can
occur following ovulation, the ovum is viable
within reproductive tract for a maximum of 24
hrs.
- The life spam of sperm is longer 3 days.
- During 28 day menstrual cycle, ovulation occur
around day 14. This means that coitus must be
avoided from 8th to 17th day.
- Failure rate is high so many couples find it
difficult to adher to this method.
41. 2.) Ovulationmethod(Thebilling’s
method)
- Ovulation prediction can be enhaced by several
complementary methods including *Basal body
temperature (BBT) rise in progesterone following
ovulates – rise temp. BBT 0.2-0.4°C, until the onset
of menstruation .
* Cervicalmucus– several days before
ovulation mucus appearance of raw egg white,
clear, slippery and stretchy (spinnbarkeit). The
final day of fertile mucus is considered to be the
day when ovulation is most likely to occur and
abstinence must be maintained from first day of
fertile mucus until 3 days after the peak day. The
end of the fertile period is characterized by
appearance of (infertile mucus) which is scanty
and viscous.
42. *Failure rate of natural method mucus and
BBT and Calendar method 2.8 %.
3-personal fertility monitors: small devices
able to detect urine concentration of
oestrone and LH indicate start and end of
fertile period.
- Failure rate 6.2%.
- Disadvantage – provide no protection
from STD .
43. Male condoms
• It is one of the most popular mechanical
barriers. Among all of the barrier methods, the
condom provides the most effective protection
of the genital tract from STDs. Its usage has
increased because of the concern regarding the
acquisition of HIV and STDs.
44. Male condoms
• Increasing the efficacy :
• reservoir tip
• The addition of spermicidal
lubricant to the condom. (water-based not oil-
based)
• the addition of an intravaginal spermicidal
agent .
45. Female condoms
• It contains 2 flexible rings. The ring at the
closed end of the sheath serves as an insertion
mechanism and internal anchor that is placed
inside the vaginal canal. The other ring forms
the external patent edge of the device and
remains outside of the canal after insertion.
46. Female condoms
- Mechanism of action :
• Prevents passage of sperm
and infections into the vagina
( protection against STDs )
• Can be inserted up to 8 hours
prior to intercourse; can remain in
place up to 8 hours
47. Female condoms
- Efficacy
• Pregnancy rates for the female condom range
between 5 and 21 per 100 women per year.
(higher than male condoms)
• To increase efficacy Simultaneous use of both the
female and male condom is not recommended
• Re-use is not recommended .
48. Diaphragm
• The diaphragm is a shallow latex cup
with a spring mechanism in its rim to hold it
in place in the vagina
• It is inserted before intercourse so that the
posterior rim fits into the posterior fornix and
the anterior rim is placed behind the pubic bone.
• Spermicidal cream is applied to the inside of the
dome, which fits against the vaginal wall.
49. Diaphragm
• It prevents pregnancy by acting as a barrier to the passage of
semen into the cervix
• provides effective contraception for 6 hours.
• After intercourse, the diaphragm must be left in place for at
least 6 hours.
• Effectiveness depends on the age of the user, continuity of use,
and the use of spermicide along with the diaphragm. Failure
rate is estimated to be 20% .
51. Diaphragm
• Disadvantages :
- Prolonged use increase the risk of UTI
- More than 24 hours use is not recommended
due to the possible risk of TSS.
- Might cause vaginal erosions if not placed properly .
- Requires a professional fitting (trained provider is needed) .
52. Cervical cap
• a cup-shaped latex device that fits over the
base of the cervix.
• The cap must be filled one third full with
spermicide prior to insertion
• Inserted 8 hours before coitus and can be left
in place for as long as 48 hours.
53. Cervical cap
• Acts as both mechanical barrier to sperm and as a
chemical agent with the use of spermicide .
• Pregnancy rates range between 4 and 36 per 100 women per
year.
• Effectiveness depends on the parity of women due to
the shape of the cervical os.
• Disadvantages : cervical erosions and vaginal spotting , risk
for TSS , requires professional fitting and training for use ,
high failure rate , and candidates must have a history of normal
results of pap smears.
54.
55. Spermicides
• consist of a base combined with either
nonoxynol-9 or octoxynol
• Surfactant that destroys the sperm cell
membrane
• Forms available : vaginal foams, suppositories,
jellies, films, foaming tablets, and creams.
56. Spermicides
• Failure rate is about 26% within the 1st year of use.
• Advantages : ease of application , available over the
counter , inexpensive and it augments the
contraceptive efficacy of the cervical cap and
diaphragm .
• Disadvantages : minimal protection against STDs ,
risk of vaginal irritation and allergic reaction.
57. Sterilization
• Sterilization :female sterilization and male vasectomy
are permenant method of contaception and highly
effective
• They are generally chosen by relatively older couple who are sure
that they have completed their family.
• Also individual who carry a genetic disorder may choose to be strlizer.
• 28% of reproductive age women undergo tubal ligation and 10% of
men undergo vasectomy.
• Sterilization methods include:
1- Vasectomy in males.
2- Tubal Ligation in females .
58. Tubal Ligation
• This involve mechanically blockage of both
fallopian tubes to prevent the sperm reaching
and fertilizing the oocyte
• sterilization performed by
laparoscopically(under GA) or through a
suprapubic “mini-laparotomy”
• Failure rate: 0.5%
59.
60. Tubal Ligation
Advantages:
• intended to be permanent
• highly effective
• safe
• quick recovery
• lack of significant long-term side effects
• cost effective
61. Tubal Ligation
Disadvantage:
• possibility of patient regret
• difficult to reverse
• future pregnancy could require assisted reproductive
technology (such as IVF)
• more expensive than vasectomy
62. Cont.
Complication:
A women may experience anasthetic problem or damage
to intra-abdominal region during the procedure.
NOTE:
ectopic pregnancy can be a late complication
and any sterilized women who misses her period and has
symptom of pregnancy should seek
medical advice.
63. Vasectomy
Mechanism of action:
Vasectomy involves division of the vas deferens on
each side to prevent the release of sperm during
ejaculation.
Easier than tubal ligation.
Usually done under local anesthesia.
• Failure rate: 0.1%.
64.
65. Vasectomy
Advantages:
• permanent
• highly effective
• safe
• quick recovery
• lack of significant long-term side effects
• cost effective; less expensive than tubal ligation
66. Vasectomy
Disadvantages:
• reversal is difficult, expensive, often
unsuccessful
• not effective until all sperm cleared from the
reproductive tract (may take up to 12 w)
• no protection from STDs
67. Vasectomy…
Complication of vasectomy:
Immediately bleeding, wound infection and hematoma may
occur.
At the cut of vas deferns small lump will apear as a result of a
local inflammation response this is called sperm
granuloma, it needs surgical excision.
some men develop anti-sperm antibody following vasectomy
