This document provides an overview of various contraception methods. It discusses periodic abstinence methods like coitus interruptus and lactational amenorrhea. Mechanical barriers like condoms and diaphragms are covered. Hormonal contraceptives such as implants, injections, pills and IUDs are summarized. The effectiveness, advantages and disadvantages of each method are highlighted. Intrauterine devices, sterilization procedures, and emergency contraception are also summarized. The document aims to inform about the different types of contraception, their characteristics and appropriate usage.

1. CONTRACEPTION
Presenter : Zamilatun hidayah binti Mohd Arifin
Mentor : Dr ikhwan
Supervisor : Dr Nuraini binti Muhammad

2. What is Contraception ?
• Birth control = methods or devices used to
prevent pregnancy
• WHO Definition :
• Methods used by individuals / couples to anticipate their
• Desired number of children
• The spacing between 1 child to another
• Timing of children’s birth

3. Characteristics of Ideal
Contraception ??
• Safe (without danger / serious side effects )
• Highly effective to protect against pregnancy
( at least by 60%)
• Reversible
• Acceptable from the user's personal , religion and cultural
point of view

4. Types of
contraceptive
method
Periodic abstinence
Mechanical barriers
Hormonal contraceptives
Intrauterine devices
Sterilization
Emergency post-coital
contraception

5. Periodic Abstinence
Coitus Interruptus
Lactational
Amenorrhea
Natural Family
Planning

6. Coitus Interruptus
• DEFINITION :
• withdrawal of the entire penis from the vagina before
ejaculation
• EFFICACY :
• The failure rate : ~ 4% in the first year of perfect use.
• In typical use : ~ 22% during the first year of use.
• ADVANTAGES :
• No devices, no cost, no chemical involvement
• DISADVANTAGES :
• Probability of pregnancy is high with incorrect or
inconsistent use.

7. Lactational Amenorrhea
• EFFICACY :
• The perfect-use failure rate within the first 6
months is 0.5%. The typical-use failure rate
within the first 6 months is 2%.
• ADVANTAGES :
• Involution of the uterus occurs more rapidly.
Menses are suppressed.
• Can be used immediately after childbirth.
• Facilitates postpartum weight loss.
• DISADVANTAGES :
• Return to fertility is uncertain.
• Frequent breastfeeding may be inconvenient.
• Should not be used if the mother has human
immunodeficiency virus (HIV) infection.

8. Natural Family Planning
• Avoid intercourse during a woman's fertile period(D10-D16)
• Calendar method : The menses is recorded for 6 cycles to
approximate the fertile period.

9. • Efficacy :
• The failure rate in typical use is estimated to be approximately
25%.
• Advantages :
• No adverse effects from hormones occur.
• Disadvantages :
• This is most suitable for women with regular and predictable
cycles.
• Requires discipline.

10. Mechanical Barriers
Male Condom
Female Condom
Diaphragm
Cervical Cap

11. Male Condom
Efficacy
• The failure rate : ~ 3%.
Advantages
• Readily available and inexpensive
• Effective against both pregnancy and STDs
Disadvantages
• Decrease enjoyment of sex
• Latex allergy
• Condom breakage and slippage decrease effectiveness

12. Female Condom
• Efficacy
• Trials have demonstrated a pregnancy rate of 15% in 6 months.
• Advantages
• It can be inserted as long as 8 hours before intercourse.
• Disadvantages
• Difficult to place in the vagina. The inner ring may cause
discomfort.
• May cause a urinary tract infection if left in vagina for a
prolonged period.

13. Diaphragm
• Spermicidal cream or jelly is applied to the inside of the dome
• Once in position, the diaphragm provides effective contraception
for 6 hours.
• Efficacy
• The typical-use failure rate within the first year is estimated to
be 20%.
• Advantages
• The diaphragm does not entail hormonal usage.
• Disadvantages
• Prolonged use during multiple acts of intercourse may increase
the risk of urinary tract infections.
• May cause vaginal erosions.

14. Cervical Cap
• It is inserted as long as 8 hours before coitus and can be left in
place for as long as 48 hours.
• Efficacy
• With perfect use in the first year, the failure rate for nulliparous
women is 9%, as opposed to 20% in parous women.
• Advantages
• It provides continuous contraceptive protection for its duration
of use
• The cervical cap does not involve use of hormones.
• Disadvantages
• Cervical erosion may lead to vaginal spotting.
• Severe obesity may make placement difficult.

15. Spermicidal Agents
• Attacking the sperm's flagella and body thus reducing their
mobility.
• Efficacy
• The perfect-use failure rate within the first year is 6%. The
typical-use failure rate within the first year is 26%.
• Advantages
• Ease of application, easily accessible, available over the
counter, and inexpensive.
• Disadvantages
• Vaginal irritation is possible
• May cause an allergic reaction.
• Increased vaginal colonization with the bacteria

16. Hormonal
Contraceptives
Implants
Injectable
Depomedroxyprogesterone
Acetate
Progestin-Only Oral
Contraceptives
Combination Oral
Contraceptives

17. Implants
• 40 mm long and 2 mm in diameter and containing 68 mg of etonogestrel.
• The mechanism of action :
• Suppression of the LH surge
• Development of viscous and scant cervical mucus
• Prevention of endometrial growth and development.
• Efficacy
• Pregnancy rates with proper insertion and use remain 0.05% for at
least three years.
• Advantages
• Longevity of its effectiveness
• Prompt return to the previous state of fertility occurs upon removal
• Disadvantages
• Menstrual irregularities
• Headache, breast tenderness and moodiness

18. Timing of Insertion
• Day 1 - Day 5 of menses. If later than Day 2, additional
contraception is advice until Day 7. If after Day 7, must
make sure abstinence.
• Immediately after 1st trimester abortion.
• Day 21 after 2nd trimester abortion or delivery.
• During breasfeeding.

19. Injectable Depomedroxyprogesterone
Acetate
• Synthetic progestin that is injected intramuscularly
• Every 3 months (or 12 weeks), women get shots of the hormone
progestin in the buttocks or arm from their doctor.
• Efficacy
• Within the first year of perfect use, the failure rate is 0.3%.
• Advantages
• Dysmenorrhea is decreased
• Risks of endometrial and ovarian cancer are decreased
• Disadvantages
• Disruption of the menstrual cycle
• Can delay the return to fertility
• Weight gain, depression, and menstrual irregularities
• Changes in bone mineral density

20. • Suitable for women
who forget to take pills, particularly travellers,
due to frequent changes in time zones
In whom oestrogen is contraindicated:
○ mild to moderate hypertension
○ diabetes mellitus in the absence of vascular
disease
○ age >35yo & smoking

21. Progestin-Only Oral Contraceptives
• Mechanisms of action include :
• Suppresses ovulation
• Thickens cervical mucus
• Alters the endometrium
• Efficacy
• Failure rates with typical use are estimated to be 7% in the first year of use
• Advantages
• Lack of estrogen-like effect
• Decreased dysmenorrhea, decreased menstrual blood loss, and decreased
premenstrual syndrome symptoms
• Fertility is immediately reestablished after the cessation of progestin-only
oral contraceptives.
• Disadvantages
• Unscheduled bleeding and spotting
• Nausea, breast tenderness, headache, and amenorrhea.

22. • Suitable for women with
Lactation , migraine, older women who smoke
Hpt, valvular heart disease ,Sickle cell disease,SLE
and other autoimmune disease

23. When to start
Onepilldailytakencontinuouslywithoutabreak
Besttobetakenatsamehoureveryday(within3hrsat
the most)
ContraceptionisimmediateifstartsthepillsonD1menses,
no eXtra
If1stpillafterD5,eXtracontraceptionneededfor2days
Postpartum(notBF):startday21afterdelivery
Posttermination/ERPOC:onthedayofabortionorTOP

24. If ˃ 3hours late or 27hours since last dose
Take missed pill ASAP
Take subsequent pill at the usual time
Use extra contraception for the next 2days

25. Combination Oral Contraceptives
• The progestin component consists of norethindrone, levonorgestrel,
norgestrel, norethindrone acetate, ethynodiol diacetate, norgestimate, and
desogestrel.
• The most recent addition to the progestin group is the addition of
drospirenone (Yasmin)
• inhibition of both FSH and LH - prevent ovulation.
• They also alter the consistency of cervical mucus
• Efficacy
• Failure rates range from 0.1% with perfect use to 5% with typical use.
• Advantages
• Used as treatment for menstrual irregularity
• Reduces functional ovarian cysts.
• Disadvantages
• Nausea, breast tenderness, breakthrough bleeding, amenorrhea, and
headaches.

26. When to start
2differentpackaging:28days(1weekofplaceboorsugarpills)
or 21days(7dpillfree period)
7dofpillfreeperiod/placebo- womenwillhavea‘withdrawal
bleed’
Besttobetakenatsametime everyday
Contraceptionis immediate ifstartsthepillsonD1menses
If 1stpillafterD2,othercontraceptionneededfor 7days
Postpartum(notBF):startday21afterdelivery
Posttermination/ERPOC:within7daysoftermination

27.  For COCP containing20mcg/30mcg ethynilestradiol
• If 1or2pillsaremissedatanytime, takethe pillASAP (NO
NEEDEXTRA COVER,DONOTSTOP)
• If 2ormorepillsaremissedin the:
1stweek,needsemergency contraceptionifunprotected
sex andusecondomsfor7 days
2ndweek,usecondomfor7 days
3rdweek,usecondomfor7days andcontinuewithnext
packet withouta break

28. Contraindications
• Cerebrovascular disease or coronary artery disease
• History of deep vein thrombosis, pulmonary embolism, or
congestive heart failure
• Untreated hypertension
• Diabetes with vascular complications
• Breast cancer
• Undiagnosed abnormal vaginal bleeding
• Known or suspected pregnancy
• Active liver disease
• Kidney or adrenal gland insufficiency or liver problems

29. Combination Patch Contraceptive
• Releases estrogen and progesterone directly into the skin
• Each patch contains a 1-week supply of hormones of both
norelgestromin and ethinyl estradiol.
• Advantages :
• Greater compliance
• Decreased adverse effects (nausea and vomiting) due to the
avoidance of the first-pass effect.
• Disadvantages :
• Similar to those of combination oral contraceptives
• May cause skin irritation

30. Contraceptive Vaginal Ring
• The ring is used in the same schedule as oral contraceptives, with 3
weeks of ring usage (ring is left in place for 3 wk) and 1 week without to
produce a withdrawal bleed.
• The ring can be inserted any time during the first 5 days of the menstrual
cycle.
• A new ring should be inserted each month.
• highly effective because it results in complete suppression of ovulation.
• Advantages
• Easily inserted and removed by the woman herself
• Return of fertility is rapid upon discontinuation
• Adverse effects :
• vaginal irritation or discharge.
• Slip out during intercourse

31. Intrauterine Devices
• The levonorgestrel intrauterine system (LNG-IUS)-MIRENA :
• releases 20 mcg of levonorgestrel per day into the uterine cavity
• Cervical mucus to be thicker in consistency
• Uterotubal fluid and motility changes inhibit sperm migration.
• Copper-releasing Intrauterine Contraception :
• Releases copper ions - reduce sperm motility
• Inhibits fertilization
• Disrupt the normal division of oocytes and the formation of
fertilazable ova
• Advantages :
• IUDs produce no adverse systemic effects.
• The risk of pelvic inflammatory disease decreases

32. • When to insert :
• Anytime during menses
• Any other time during cycles if she used appropriate contraception, was not
sexually active or not pregnant
• Any time after a pregnancy, a spontaneous abortion, a misscarriage, or and
induced abortion if a woman has not enggaged in unprotected intercourse
• Disadvantages :
• Risk of uterine perforation at the time of insertion (1%).
• Increased dysmenorrhea and blood loss may occur in the first few
cycles
• The intrauterine device does not protect against sexually transmitted
infections.
• Contraindications :
• Abnormal or distorted uterine cavity
• Undiagnosed genital bleeding, uterine or cervical malignancy
• Known or suspected pregnancy
• Active cervical or endometrial infections.

33. Sterilization
• Elective permanent method of contraception.
• Female Sterilization :
• Bilateral tubal ligation
• Can be performed with laparoscopy, laparotomy
• Efficacy :
• Cumulative 10-year failure rate postpartum salpingectomy, 0.8%.
• Advantages :
• Does not involve hormones.
• DISADVANTAGES :
• Involves general or regional anesthesia.
• It is permanent

34. Vasectomy
• Incision of the scrotal sac, transection of the vas deferens, and
occlusion of both ends by suture ligation or fulguration.
• Complications :
• Hematoma formation, infection and sperm granulomas (1-2%).
• Efficacy
• The failure rate is approximately 0.1%.
• Advantages
• Involves no hormone
• Permanent
• Disadvantages
• Alternative contraception is required until the ejaculate is deemed
free of sperm.
• Vasectomy does not prevent STDs.

35. Emergency Postcoital
Contraception
 Also known as the “morning after pill”
 The pills are 75 to 89 percent effective at preventing pregnancy
 Can be taken up to 3-5days AFTER unprotected sex
 No prescription needed over age of 15
 Effectiveness decreases after 24 hours
 Emergency contraception should only be used after no birth control
was used during sex, or if the birth control method failed, such as if
a condom broke

36. REFERENCES
• http://www.myhealth.gov.my/en/contraception/
• LAMAN WEB KEMENTERIAN KESIHATAN
MALAYSIA
• WORLD HEALTH ORGANISATION
• KEDAH PROTOCOL

37. THANK YOU