Contraception powerpoint disscussing types of contraception, method, usage and contraindication

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