Contraception

1. METHODS OF POPULATION
CONTROL

2. • Contraceptive or fertility Regulating methods are preventive methods
to help women avoid unwanted pregnancies.
• They include all temporary and permanent measures to prevent
pregnancy.

3. IDEAL CONTRACEPTIVE

Safe

Effective

Acceptable

Inexpensive

Reversible

Simple to administer

Independent of coitus

Long-lasting

Little or no medical supervision

4. • The present approach in family planning programmes is to
offer all methods from which an individual can choose
according to his needs and wishes and to promote family
planning as a way of life.
• Conventional contraceptives denote methods used that require
action at the time of coitus.
E.g. : Condoms , spermicides , etc .

5. Spacing methods
 Barrier methods
A) PHYSICAL METHODS
B) CHEMICAL METHODS
C) COMBINED METHODS
 Intra-uterine devices
 Hormonal methods
 Post-conceptional methods
 Miscellaneous

6. TERMINAL METHODS
Male sterilisation
Female sterilisation

7. BARRIER METHODS
Occlusive methods:
The aim of these methods is to prevent sperm from meeting
Ovum.
Eg: Male condom, female condom
Advantages :
Free from side effects associated with pills & IUD.
Protection from STD’s , pelvic inflammatory diseases & cancer
Cervix.

8. Disadvantages
High degree of motivation
Less effective than pill or loop
They should be used consistently & carefully.

9. INTRA UTERINE DEVICES
2 types of IUDs
1. Nonmedicated 2. Medicated
1.Cu IUDs 2. Hormone Releasing
• Both types ( Medicated & Nonmedicated ) IUDs made up of
polyethylene or other polymers.

10. • Non medicated/ Inert/ First generation IUDs :
• Loops, spirals, coils, rings, bows etc.

12. MEDICATED IUDs
Importance of medicated IUDs :
• Reduce incidence of side effects
• To increase contraceptive effective ness
• More expensive
SECOND GENERATION IUDs :
• Metallic copper had a strong antifertility effect
• Number of cu bearing devices are available
1. Earlier devices
a. Copper – 7
b. copper – T- 200 B

13. 2. Newer devices
a. variants of the T devices
i. T cu – 220C
ii. T cu – 380 A or Ag
b. Nova T
c. Multi load devices
i. ML – Cu -250
ii. ML – Cu- 375
Numbers represents the surface area of
the copper on the device (in. sq mm).

14. THIRD GENERATION IUD
• Most widely used hormonal devices are
1.Progestasert
• T shape device filled with 38 mg of progesterone
• It has direct effect on uterine lining, cervical mucus and sperms
• 2. Levonorgestrel (LNG – 20)
• T shaped device
• It has 1. low pregnancy rate
2. less number of ectopic pregnancies
3. Lower menstrual blood loss
4. Fewer days of bleeding

16. MOA
• Foreign body reaction.
• Cellular and biochemical changes.
• Impair the viability of the gamete.
• Reduce the chances of fertilisation rather than implantation.
• Copper enhances the Cellular response in the endometrium.
• Affects the enzymes in the uterus.
• Alter biochemical composition ofcervical mucus.
• Hormonal devices increase viscosity of the cervical mucus.

17. Advantages
• 1. Simplicity
• 2. Insertion takes few minutes
• 3. Once inserted IUD stays in place as long as required
• 4. Reversible
• 5. In expensive
• 6. High continuation rates
• 7. Single act of motivation
• 8. Free of systemic side effects

18. HORMONAL CONTRACEPTIVES
• Hormonal contraceptives when properly used are the most effective
methods of contraception
• They provide the best means of ensuring spacing between one
childbirth and another
• GONADAL STEROIDES:
a. synthetic steroids: eg ethinyl oestradiol and mestranol.
b. synthetic progestogens: they are pregnanes , oestranes and
gonanes.

19. CLASSIFICATION
a) ORAL PILLS
1.Combined pills
2.Progestogen only pill
3.Post coital pill
4.Once a month pill
5.Male pill
b) DEPOT FORMULATIONS
1. Injectables
2. Subcutaneous implants
3. vaginal rings

20. ORAL PILLS
1. Combined pill:
It is one of the major spacing methods of contraception.It
contains 30-35 mcg of a synthetic oestrogen and 0.5 to 1
mcg of a progesterone.
The pill should be taken at a fixed time everyday.

21. • The pill is given orally for 21 days starting on the 5th
day of menstrual
cycle followed by a break of 7 days during which menstruation occurs.
• This is called withdrawal bleeding.
• The department of family welfare , in the Ministry of Health and
Family Welfare Govt. of India has made available low dose of oral
pills – MALA-N and MALA-D.

22. 2. Progesterone only pill
• It is called as minipill or micropill .it contains only progesterone which
is given in small doses through out the cycle.
• These pills have an increased pregnancy rate so not being used , but
can be used for women with cardiovascular problem and for those
with the risk factors for neoplasia.

23. 3. Post coital contraception:
It is used within 48 hrs of unprotected intercourse.
Two methods are available.
a) IUD: e.g. copper device
b) Hormonal: combine oc pill is used. It contains double dose of
the standard combined pill. 2 pills immediately followed by 2 pills
12 hours later.
For emergency contraception a women must take four instead of 2
in each dose.

24. 4. Once a month long acting pill
• Quniestrol , a long acting estrogen is given in combination with a
short acting progesterone.
• Disadvantage: high pregnancy rate and irregular bleeding.

25. 5. Male pill:
The approach is
• a) preventing spermatogenesis.
b) interfering with sperm storage.
c) preventing sperm transport.
d) affecting the seminal fluid constitution.
• An ideal male contraceptive will decrease the sperm count while
leaving testosterone at normal values.

26. Mode of action of oral pill:
• Combined only pill prevents the release of ova from the ovary by
blocking the pituitary secretion of gonadotropin.
• Progesterone only pills render the cervical mucus thick and
scanty and inhibit the sperm penetration.

27. Effectiveness :
• If taken according to the prescribed regimen oral contraceptives of
the combined type are 100% effective.
• It is also influenced by drugs – rifampicin, phenobarbital, ampicillin.

28. BENEFICIAL EFFECTS
Contraceptive benefits- prevention of unwanted pregnancy (failure rate-
0.1per 100 women year).
Non contraceptive benefits-
a. relief of:
menorrhagia (50% ),
dysmenorrhoea (40% ),
premenstrual tension syndrome,
mittleschmerz syndrome.
b. improvement of:
iron def. anemia,hirsutism,
acne, endometriosis, autoimmune disorders of
thyroid, rheumatoid arthritis.

29. c. Marked reduction in: pelvic inflammatory disease, benign breast
cancer, ectopic pregnancy, fibroid uterus, functional ovarian cysts,
carcinoma of ovary (40%) carcinoma of endometrium (50% )
protection against osteoporosis.

30. b) DEPOT FORMULATIONS
• Injectable contraceptives, sub dermal implants and vaginal
rings come in this category.
1. Injectable contraceptives:
There are two types:
PROGESTAGEN ONLY INJECTABLES:
• (a) DMPA: Depot medroxy - progesterone acetate.
• Dose is i.m injection of 150mg every 3months.

31. • It is safe effective and an acceptable contraceptive.
• Acceptable in the postpartum period as a means of spacing.
• Side effects: weight increase, irregular menstrual bleeding.

32. (b) NET-EN
• Norethisterone enantate is given as i.m injection dose of
200mg. every 60 days.
• Contraceptive action is by inhibiting ovulation and
progesterogenic effects on cervical mucus.
ADMINISTRATION:
• Both DMPA ,NET-EN should be given during first five days of
menstrual period.

33. B. COMBINED INJECTABLE :
• They contain a progestogen and an oestrogen.
• Given at monthly intervals.
• Act by suppressing ovulation ,cervical mucus is affected
mainly by progestogen and inhibits sperm penetration.
• CONTRAINDICATIONS: confirmed or suspected pregnancy;
past or present evidence of thromboembolic disorders;
cerebrovascular or coronary artery disease; focal migraine;
malignancy of breast and diabetes with vascular
complications.

34. 2. SUBDERMAL IMPLANTS:
• Norplant : it consists of 6 silastic capsules containing 35mg of
levonorgesterel.
• The capsules are implanted beneath the skin of forearm or
upper arm.
• Effective contraception is provided for 5 years.

35. 3. VAGINAL RINGS
Vaginal rings containing levonorgesterel are highly effective.
• The hormone is slowly absorbed through the vaginal mucosa
, bypassing the digestive tract and liver and allowing a
potentially lower dose.
• The ring is worn in the vagina for 3 weeks and removed for
the 4th
week.

36. THANK YOU