PPT on the topic contraception for medical students

1. Contraception?
Dr.K S Bhatia
Department of Physiology
Dr.YSPGMC Nahan HP

2. Contraception
Birth control, also known as contraception,
is designed to prevent pregnancy.
• Spacing methods(Temporary methods)
• Terminal methods (Permanent methods)

3. I.Hormonal/Chemical methods
Methods
• Oral Contraceptives
(Birth Control Pills)
• Injections (Depo-Provera)
• Implants (Norplant I & II)

4. Oral contraceptives:How does the pill
work?
• Stops ovulation/implantation
• Thins uterine lining
• Thickens cervical mucus

5. 1.COMBINED PILLS
• Ethyl estradiol (20-50μg) + norethesterone (0.5-
2mg).
• Mala-N ….21 tabs.
• Mala-D…..28 tabs.(21+7)
• 5th day of menstural cycle.

6. 2.Sequential pill
• High dose of oestrogen + low dose of progesterone
• From 5th day to 15th day only oestrogen pill given
• Followed by both oestrogen and progesterone pill
for next 5 days.
• Not used due to high incidence pf endometrial
carcinoma.

7. 3.Mini pill
• Progesterone only pill.
• Low dose norethesterone--0.35mg or norgestrel—0.075
mg.
• Daily dose.
• Makes cervical mucus thick
• Decreases motility of fallopian tubes.

8. 4.Postcoital pill or morning after pill
• Recmmended with in 72 hrs after unprotected
intercourse.
• Causes hypermotility of fallopian tubes and
uterus…prevents fertilization and implantation.
• If ovulation and fertilization occur it prevents Blastocyst
implantation.

9. Advantages and Disadvantages
• 100% effective
• Hypertension
• Risk of thromboembolism
• Obesty
• Diabetes
• Carcinogenic effects(breast and cervix cancer)

10. Contraindictions
Absolute…
• liver disease
• Hyperlipidemia
• Breast ,cervix and uterus carcinoma
Relative…..
• Age above 35 year

11. Birth Control Pills

12. Prevents pregnancy
Eases menstrual
cramps
Shortens period
Regulates period
 Decreases incidence of
ovarian cysts
 Prevents ovarian and
uterine cancer
 Prevents acne
• Breast tenderness
• Nausea
• headache
• Mood changes
• Weight gain
• Spotting
Side-effects
Positive Benefits of Birth Control Pills

13. II.Depot preperations
• Birth control shot given once every three months to
prevent pregnancy
• 99.7% effective preventing pregnancy
• No daily pills to remember

14. How does the shot work?
• The same way as the Pill!
• Stops ovulation
• Stops menstrual cycles!!
• Thickens cervical mucus

15. Depot preperations
• Injectable preperations
• Subdermal implants
• Vaginal rings

16. Injectable preperations
i.Oily progestrin preperations.
a)Medoxyprogesterone acetate.
• Every 3-6 month
• Dose is 150-400mg.
b)Norethindrone enanthate 200mg every 3 month.
I/M dose given in first 5 days of bleeding phase.
ii.Combined preperations.
• Oestrogen+progesterone
• Dose once a month I/M

17. III.SUBDERMAL IMPLANTS
• Implants are placed in the body filled with hormone
that prevents pregnancy
• Physically inserted in simple 15 minute outpatient
procedure
• Plastic capsules the size of paper matchsticks
inserted under the skin in the arm
• 99.95% effectiveness rate

18. Norplant I vs. Norplant II
• Six strips
levonorgestrel(35mg)
• Five years
• Two capsules
levonorgestrel
• Three years

19. Norplant Implant

20. Norplant Considerations
• Should be considered long term birth control.
• Requires no upkeep 
• Extremely effective in pregnancy prevention > 99%

21. 3.Vaginal Ring (NuvaRing)
• 95-99% Effective A new ring is inserted into the
vagina each month.
• Does not require a "fitting" by a health care provider,
• Does not require spermicide.
• Can make periods more regular and less painful.
• Ability to become pregnant returns quickly when use
is stopped.
NuvaRing is a flexible plastic (ethylene-
vinyl acetate copolymer) ring that
releases a low dose of a progestin and an
estrogen over 3 weeks.

22. Non-steriodal contraceptive drugs
• Centchroman
• Dose 30mg twice a week X 12 weeks followed by
once in a week.
• Suppression of corpus luteum function
• Interfere in fallopan tube motility and implantation.

23. Non scalpel vas occlusion
• Elastomer is injected in vas deferens which hardened
in 20 min.
• reversible.

24. The Patch

25. Emergency contraception pills can reduce the
chance of a pregnancy by 75-84% if taken within 72
hours of unprotected sex!
Emergency Contraception

26. Emergency Contraception (ECP)
• Must be taken within 72 hours of the act of
unprotected intercourse or failure of contraception
method.
• Must receive ECP from a physician.
• 75 – 84% effective in reducing pregnancy.

27. ECP
• Floods the ovaries with high amount of hormone
and prevents ovulation.
• Alters the environment of the uterus, making it
disruptive to the egg and sper

28. BARRIER METHODS
• Spermicides
• Male Condom
• Female Condom
• Diaphragm
• Cervical Cap

29. BARRIER METHOD
• Prevents pregnancy blocks the meeting of
egg and sperm.
• Barrier methods have higher failure rates
than hormonal methods due to design and
human error.

30. SPERMICIDES
• Chemicals kill sperm in the
vagina
• Different forms:
-Jelly
-Foam
-Suppository
• Some work instantly, others
require pre-insertion
• Only 76% effective (used
alone)

31. MALE CONDOM
• Most common and effective
barrier method when used
properly
• Latex and Polyurethan
• prevention of pregnancy and
spread of STD’s (including
HIV)

32. MALE CONDOM
• Perfect effectiveness rate = 97%
• Typical effectiveness rate = 88%
• Latex and polyurethane condoms are
available
• Combining condoms with spermicides
raises effectiveness levels to 99%

33. FEMALE CONDOM
• Made as an alternative to male condoms
• Polyurethane
• Physically inserted in the vagina
• Perfect rate = 95%
• Typical rate = 79%

34. The Female Condom

35. DIAPRAGHM
• Perfect Effectiveness Rate = 94%
• Typical Effectiveness Rate = 80%
• Latex barrier placed inside vagina during
intercourse
• Fitted by physician
• Spermicidal jelly before insertion
• Inserted up to 18 hours before intercourse and
can be left in for a total of 24 hours

36. DIAPHRAGM
• The diaphragm is a flexible
rubber cup that is filled with
spermicide.
• Self-inserted over the cervix
prior to intercourse.
• The device is left in place
several hours after intercourse.
• Fitted by a health care
professional.
• More expensive than other
barrier methods, such as
condoms

37. CERVICAL CAP
• Latex barrier inserted in vagina before intercourse
• “Caps” around cervix.
• Fill with spermicidal jelly prior to use.
• Can be left in body for up to a total of 48 hours
• Must be left in place six hours after sexual intercourse.
• Perfect effectiveness rate = 91%
• Typical effectiveness rate = 80%

38. Cervical Cap
The cervical cap is a flexible rubber
cup-like device that is filled with
spermicide and self-inserted over the
cervix prior to intercourse. The device
is left in place several hours after
intercourse. The cap is a prescribed
device fitted by a health care
professional and can be more
expensive than other barrier methods,
such as condoms.

39. Sponge

40. INTRAUTERINE DEVICES
(IUD)
• T-shaped object placed in the
uterus to prevent pregnancy
• Must be on period during
insertion
• Extremely effective without
using hormones > 97 %
• Must be in monogamous
relationship

41. • IUD shows copper as the active contraceptive,
• Others use progesterone in a plastic device.
• IUDs come with increased risk of ectopic pregnancy and
perforation of the uterus.
• Do not protect against sexually transmitted disease.
• IUDs are prescribed and placed by health care
providers.

42. Copper T vs.. Progestasert
• 10 years
• 99.2 % effective
• Copper on IUD acts as
spermicide.
• IUD blocks egg from
implanting
• Must check string before
sex and after shedding of
uterine lining.
• 1 year
• 98% effective
• T shaped plastic that
releases hormones over
a one year time frame
• Thickens mucus, blocking
egg
• Check string before sex &
after shedding of uterine
lining.

43. STERILIZATION
• Permanent methods.
• Female = Tubal Ligation (Tubectomy)
• Male = Vasectomy

44. TUBAL LIGATION
• Surgical procedure performed on a woman
• Fallopian tubes are cut, tied, cauterized, prevents eggs from
reaching sperm
• Failure rates vary by procedure, from 0.8%-3.7%
• May experience heavier periods

45. • Surgical sterilization which permanently prevents the
transport of the egg to the uterus by means of sealing
the fallopian tubes is called tubal ligation.
• This operation can be performed laparoscopically or in
conjunction with a Cesarean section.
• Tubal ligation is considered permanent, but surgical
reversal can be performed in some cases

46. LAPAROSCOPY-’BAND-AID’
STERILIZATION

47. VASECTOMY
• Male sterilization procedure.
• Ligation of Vas Deferens tube.
• No-scalpel technique available.
• Faster and easier recovery than a tubal
ligation.
• Failure rate = 0.1%, more effective than
female sterilization.

48. During a vasectomy (“cutting the vas”) a SURGEON
cuts and ligates (ties off) the ductus deferens. Sperm are
still produced but cannot exit the body. Sperm eventually
deteriorate and are phagocytized. A man is sterile, but
because testosterone is still produced he retains his sex
drive and secondary sex characteristics.