This document provides an overview of various contraceptive methods, including hormonal methods like oral contraceptives, implants, and injections. Intrauterine devices (IUDs) and the intrauterine system (IUS) are discussed as mechanical methods. The document reviews how each method works, effectiveness rates, potential side effects, and other considerations. It also addresses some common misconceptions about contraception and cancer/weight risk. Overall, the document aims to educate about reproductive health and the different options available for preventing pregnancy and sexually transmitted infections.

1. Contraception
Update
DR. waled ayad
MD ,proff.obst&gyn.
Trainer of obstet&gyn.egyptian board
Manger of out patient clinic.university hospital

2. 1. IUD/IUS can travel and reach the brain
2. IUDs are abortifacients
3. IUSs provide Relief for Women Suffering from Excessive
Bleeding
4. Breast cancer is a contraindication for IUD use
5. IUD/IUS increase the risk for pelvic inflammatory disease
(PID)
6. IUD/IUS increase the risk of sexually transmitted infections
(STIs)
7. IUD/IUS increase the risk of ectopic pregnancy
8. IUSs can’t be used as emergency contraception
9. IUD/IUS are only for women who have completed their
childbearing
10. Nulliparity is a contraindication for IUDso IUD /IUS use

3. Questions yes or no
1. No
2. No
3. Yes
4. No
5. No
6. No
7. No
8. Yes
9. No
10. No

4. Objective:
• Review of reproductive systems
• To learn about the various methods of
contraception or birth control to prevent
pregnancy and STIs

5. Reproductive system: person with a vagina

6. Menstrual cycle

7. Types of Birth Control

8. Types:-
Hormonal contraception
Mechanical contraception
Natural contraception
Surgical contraception

9. Types of Birth Control

10. Hormonal Methods
 Oral Contraceptives
(Birth Control Pill)
 Injections (Depo-Provera)
 Implants (Norplant I & II)
 Nuva ring

11. Birth Control Pills
 Pills can be taken to prevent pregnancy
 Pills are safe and effective when taken properly
 Pills are over 99% effective

12. How does the pill work?
 Stops ovulation
 Thins uterine lining
 Thickens cervical mucus

13. Oral Contraception and EHC
Combined Oral Contraception
 Monophasic
 fixed amount of an oestrogen and a
progestogen in each active tablet
 Biphasic/Triphasic
 varying amounts of the two hormones
according to the stage of the cycle
 ED (every day)
 includes 7 days of placebo tablets

14. Positive Benefits of Birth Control Pills
 Prevents pregnancy
 Eases menstrual
cramps
 Shortens period
 Regulates period
 Decreases incidence
of ovarian cysts
 Prevents ovarian and
uterine cancer
 Decreases acne

16. Acne , Hirsutism
The pill gives you
pimples, makes your
hair oily and makes you
hairy
 Young people may be advised that
combined oral contraception
(COC) use can improve acne.
 Young women whose acne fails to
improve with COC may wish to
consider switching to a COC
containing a less androgenic
progestogen or one with a higher
estrogen content.
 Young people should be advised
that the progestogen-only implant
may be associated with
improvement, worsening or onset
of acne.

17. WEIGHT
“Taking the Pill
causes weight
gain”
 The limited data that exist
suggest no clear effect on weight
with COC use, and there is
currently insufficient evidence
to prove a clear causal
association between most other
hormonal contraceptives and
weight gain
 except depot
medroxyprogesterone acetate
(DMPA) use may be associated
with a gain of 2–3 kg in weight
over 1 year

18. Smoking
You can not take
hormones when
you are a smoker
“COC can be used by women aged <35
years who smoke.
Excess mortality in heavy smokers becomes
apparent from the age of 35 years,
accounting for 0.7 deaths per 1000 woman-
years “.
“POC (progestogen-only contraception)
does not appear to
increase the risk of stroke or MI, and there
is little or no increase in venous
thromboembolism risk”
Vessey M, Painter R, Yeates D. Mortality in relation to oral
contraceptive use and cigarette smoking. Lancet 2003; 362: 185–191.
Faculty of Family Planning & Reproductive Health Care
Clinical Guidance Contraception for Women Aged Over 40 Years

19. Cancer
The pill can cause
cancer
BMJ. 2010;340:c927.
 A large UK cohort study has shown that oral
contraception use is not associated with an
overall increased risk of cancer, and indeed
oral contraception may reduce overall
cancer risk.
 Research suggests that women taking the
combined contraceptive pill have a lower risk
of ovarian cancer than the general
population. ...The pill is also protective
against endometrial cancer, but can slightly
raise the short-term risk of breast cancer
and cervical cancer
 The evidence with regard to cancer risk and
progestogen-only methods is more limited.
There are no consistent associations between
use of POP or injectable progestogens and
breast cancer incidence. No studies were
indentified in relation to use of the LNG-IUS or
progestogen-only implant and risk of breast
cancer in young women. As with other
progestogen-only methods, any attributable
risk is likely to be very small.

20. Oral Contraception and EHC
Vomiting & Diarrhoea
 If vomiting within 3
hours of taking pill
then absorption will be
reduced and may be
ineffective.
 Diarrhoea alone
without vomiting has to
be severe to reduce the
absorption of the pill.

21. Oral Contraception and EHC
Drug Interactions
 The effectiveness of COC, POP and EHC
will be reduced by interaction with
drugs that are enzyme inducers
 Broad spectrum antibiotics may reduce
effectiveness of COC by altering the
bacterial flora of the bowel

22. Oral Contraception and EHC

23. Depo-Provera
 Birth control shot given once every three months to prevent
pregnancy
 99.7% effective preventing pregnancy
 No daily pills to remember

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

25. SIDE EFFECTS
 Extremely irregular menstrual bleeding and
spotting for 3-6 months!
 NO PERIOD  after 3-6 months
 Weight change
 Breast tenderness
 Mood change
*NOT EVERY WOMAN HAS SIDE-EFFECTS!

26. The Patch

27. 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

28. Norplant I vs. Norplant II
 Six capsules
 Five years
 Two capsules
 Three years
The pill works in several ways to prevent
pregnancy. The pill suppresses ovulation so that
an egg is not released from the ovaries, and
changes the cervical mucus, causing it to become
thicker and making it more difficult for sperm to
swim into the womb. The pill also does not allow
the lining of the womb to develop enough to
receive and nurture a fertilized egg. This method of
birth control offers no protection against sexually-
transmitted diseases.

29. Norplant Considerations
 Should be considered long term birth control
 Extremely effective in pregnancy prevention >
99%

30. 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, no
pill to take daily, ability to become pregnant
returns quickly when use is stopped.
Nuva Ring is a flexible
plastic (ethylene-vinyl
acetate copolymer) ring that
releases a low dose of a
progestin and an estrogen
over 3 weeks.

31. BARRIER METHODS
 Spermicides
 Male Condom
 Female Condom
 Diaphragm
 Cervical Cap

32. SPERMICIDES
 Chemicals kill sperm in the vagina
 Different forms:
-Jelly -Foam -Suppository
 Some work instantly, others require pre-insertion
 Only 76% effective (used alone), should be used in
combination with another method i.e., condoms

33. MALE CONDOM
 Most common and effective barrier method when used
properly
 Latex should only be used in the prevention of pregnancy
and spread of STI’s (including HIV)

34. MALE CONDOM
 Typical effectiveness rate = 88%
 available
 Combining condoms with spermicides raises
effectiveness levels to 99%

35. The Female Condom
The female condom is a lubricated polyurethane sheath, similar in appearance to a male condom. It is
inserted into the vagina. The closed end covers the cervix. Like the male condom, it is intended for one-time
use and then discarded.
The sponge is inserted by the woman into the vagina and covers the cervix blocking sperm from entering the
cervix. The sponge also contains a spermicide that kills sperm. It is available without a prescription.

36. 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.

37. Intrauterine Contraception -IUC
• T-Shaped device that is inserted in the uterus
by a Doctor or Nurse Practitioner
• Two types of IUC:
– the Copper intrauterine device (no hormone)
– the levonorgestrel-releasing intrauterine system
(contains a progestin)
• Typical effectiveness rate is 99.8%

39. IUD problems
 Perforation
 Expulsion
 Malposition
 Infection

40. IUD - Infection
 IUD/IUS do not cause pelvic infection
 Risk higher than background only in three weeks after
insertion (1:1000 with screening)
 Select women at low risk of STIs
 Take sexual history
 Screen for infection: chlamydia (+_ N gonorrhoea)
 Or consider prophylactic antibiotics
 If infection with IUD in situ, treat as PID, do not need
to remove IUD (NB Pregnancy risk)
Farley TM et al. Lancet 1992; 339: 785-88 FFPRHC Recommendations for Practice IUD 2004

41. IUD/IUS and Ectopic pregnancy
• Incidence of ectopic pregnancy 0.02 per 100 woman
years.
• This represents an 80-90% reduction
in risk compared with women not
using contraception.
• Between 5-50% of conceptions
with the LNG IUS are ectopic.

42. Mirena

43. METHODS BASED ON
INFORMATION
 Withdrawal
 Natural Family Planning
 Fertility Awareness Method
 Abstinence

44. Surgical
Methods

45. Sterilization
• Tubal ligation - a surgical procedure to close
or block the fallopian tubes ensuring sperm
and egg do not meet

46. Choices of Contraception
in the different ages
Puberty to first sexual

47. Perimenopause
• Still need for contraception
• HRT is not contraceptive
• IUS may be used as part of HRT regime –
endometrial protection, licensed for 4 years
use
• Stop Depo at age 50 yrs – risk of osteoporosis
• Nexplanon/IUS – use FSH to determine when
to stop contraception
• Safer sex message – increase in incidence of
STI in divorced, newly single older people
Choices of Contraception
in the different stages
of reproductive life

48. Breastfeeding
 All LARC methods could be used if no contraindications
 Depo = UKMEC 2 if <6 weeks postpartum
 IUD / IUS = UKMEC 3 if 48 hours – 4/52 postpartum
 CHC contraindicated
 Lactational amenorrhoea – if exclusively breast feeding
including night time feeds – 98% effective

51. Questions?
Thank you