Contraception is designed to prevent pregnancy due to coital act by means with these measures:TEMPORARY or PERMANENT

1. CONTRACEPTION

2. Contraception is designed to prevent pregnancy due to
coital act by means with these measures
a)TEMPORARY
- Barrier methods
- Intrauterine contraceptive devices (IUCDs)
- Oral contraceptive pills (OCPs)
- Injectable and emergency contraception
b) PERMENANT
- Female sterilization----tubal ligation
- Male sterilization ----vasectomy

3. Barrier Methods
• Prevents sperm deposition in vagina / prevent
sperm penetration through the cervical canal.
• Eg:
– Male condom
– Female condom
– Diaphragm
– Cervical cap

4. ADVANTAGES
-reduce incidence of tubal infertility
and ectopic pregnancy
-cheaper
no contraindications and side effect
-easy to carry, simple and disposable.
-protection against STI and PID
DISADVANTAGES
-accidentally break or slip during coitus
-inadequate sexual pleasure
-allergic reactions
-need to discard after use
Condom
a thin rubber sheath made of polyurethane

5. Diaphragm
An intravaginal device made from latex with flexible metal or spring ring at
the margin
ADVANTAGES
-cheap
-can be use repeatedly for a long time
-reduces PID and STI for some extent
-protects against cervical cancer and
pre-cancer
DISADVANTAGES
-risk of UTI and vaginal irritations
-not suitable for women with uterine
prolapse.

6. cervical cap
- smaller than diaphragm
- can be used longer than diaphragm
ADVANTAGES DISADVANTAGES
- washable (used many times)
- can be used in longer hours than
diaphragm
- smaller than diaphragm and easy to
manage and store
- cannot be used during menstruation
-difficult for some women to insert
-pushed out by some penis sizes,
heavy thrusting, certain sexual
positions
-different sizes for every women
-risk of discharge or any infections.

7. Intrauterine Contraceptive
Device (IUCD)
types
• 1) Copper IUCD
• 2) Hormone releasing IUD

8. Has a capsule containing
levonogestrel around its
stem
Releases a daily dose of
20microgram of
hormone
Copper IUCD Mirena
MOA Releases free copper and copper salts
-causing a toxic effect to sperm and the
egg
- Produces alterations in cervical mucus
and endometrial secretions
- Endometrium becomes decidualised and
with atrophy of glands
- Inhibition of sperm capacitation and
survival
Thickening of cervical mucus
- Creating a barrier to sperm penetration
- In some woman, ovulation is inhibited
effectiveness Duration of use : 3-5 years
Failure rate : 0.8% after 1 year of use
Duration of use : 5 years
Failure rate : 0.1% after 1 year of use
: 0.7% after 5 years of use

9. Copper IUCD Mirena
advantages • Good for those with:-
- contraindication to take oestrogen
- Useful for patients who are not
compliant to taking medicines
•Does not alter normal hormonal
physiological system of the body
•Could be used as an emergency
contraception up to 5days (pregnancy
rate 0.09%)
•Can be used while breastfeeding
•No proven effect on weight
•Fertility returns quickly after removal
•Fewer menstrual cramps
•Lighter periods and less blood
•Less likely to interact with other
medications
•Lower risk of ectopic pregnancy (<1%).
disadvantages •Higher risk of pelvic infection
•Occasionally can have problem of
missing strings, lost IUCD that may
require investigation or surgical
exploration/ removal
•No STD protection
•Menses may be heavier and painful
•Irregular periods and spotting between
menses often occurs after insertion
•Cramping or backache
•Mild or moderate discomfort
•Ovarian cyst (usually benign)
•Transient risk of PID
Therapeutic
benefits
- - treatment of heavy menstrual bleeding
- Part of hormone replacement therapy
(HRT) regimen
Risk of ectopic
pregnancy
3-5% <1%

10. ORAL CONTRACEPTIVES
• Introduced in early 1960s
• Most widely used form
of reversible birth control
• Have contraceptive and
noncontraceptive benefits
• 2 types
– Estrogen + progestin
combination
– progestin alone

11. Monophasic
•Same amount of estrogen and
progestin in each active pill (21 days of
injjesting active pills)
Biphasic
•Same amount of estrogen but
halfway through the cycle,
progestin is increased.
•Triphasic
•3 different doses of hormones.
•Depending on brand, estrogen
may increase.
VARIETY OF COMBINATION PILLS:

12. Estrogen:
• Prevention of estrogen surge, which prevents LH surge
→ no ovulation
• Suppression of gonadotropin secretion during follicular
phase, preventing follicular maturation and preventing
ovarian hormone production
Progesterone:
• Creates thick cervical mucus to hinder sperm penetration
• Impairs normal tubal motility and peristalsis
• Also block the LH surge and thus inhibit ovulation
MECHANISMOF ACTIONS

13. CONTRAINDICATIONS
•Pregnant or breastfeeding
•History of pulmonary embolism and myocardial infarction
•Stroke
•Liver disease
•Smoker
•Estrogen dependent tumor –breast, endometrium
•Uncontrolled HTN, unexplained vaginal bleeding

14. Common SIDE EFFECTS
Weight gain, Mood swings, Breast tenderness, nausea,
Headaches, Acne, facial hair growth
Potential adverse EFFECTS
•Myocardial infarction
•Venous thromboembolism
•Breakthrough bleeding – most common reason for
discontinuation

15. PROGESTINE ONLY CONTRACEPTIVE
MECHANISM OF ACTION
•Thickens cervical mucous, thins endometrium, inconsistent
ovulation suppression
• Alter frequency of GnRH pulsing and decrease anterior pituitary
gland responsiveness to GnRH.
• Secondary mechanisms of pregnancy prevention include
alterations in tubal peristalsis, endometrial receptivity, and cervical
mucus secretions, which together prevent the proper transport of
both egg and sperm.

16. advantage
•Alternative to combined pill for some women
whom oestrogen is contraindicated.
•Suitable for woman whose blood pressure
increase during treatment with oestrogen.
•28 days of active pills.
•The pill is taken daily without interruption

17. EMERGENCY CONTRACEPTION
• A back-up method that is used after intercourse
has taken place and before implantation has
occurred.
• Indications :
a) Unprotected intercourse
b) Condom ruptured
c) Missed pill or delay in taking POP for >3 hours
d) Sexual assault or rape

18. Hormonal emergency contraception
Examples of medication
• Levonogestrel
• Ulipristal acetate (ellaOne)
• Mifepristone (RU 486)

19. INJECTABLE
CONTRACEPTION

20. Long Acting Reversible
Contraceptives(LARCs)
• Depo-Provera and Nexplanon
• Slowly released
• Protect against functional ovarian cyst and
ectopic pregnancy
• Not user dependent and high efficacy rates
• Cost-effective than COCP of 12 months use

21. Depo-Provera
contains 150 mg medroxyprogesterone
acetate(MDPA), IM injection, every 3 months
-Very effective, failure rate <1 per 100 woman
years
• MOA:
a) Inhibition of ovulation,by suppressing the LH
peak
b) Cervical mucus is thicken, thus penetration of
sperm is prevented
c) Endometrium is atrophied to prevent
blastocyst implantation

22. • Advantages:
a) Not secreted in breast milk.It also
promotes lactogenesis. Very useful to
breast-feeding mother.
b) No estrogen. No increased risk of
DVT,stroke or myocardial infarction.
c) Improve PMS and can be used to treat
menstrual problems – painful / heavy
periods
d) Protective against endometrial cancer and
reduction in PID, endometriosis,ectopic
pregnancy and ovarian cancer

23. • Disadvantages:
a) Weight gain
b) Menstrual irregularities,abdominal
pain,discomfort and amenorrhea
c) Duration to return to fertility after
discontinuation is usually delayed for
several months (10-12months)
d) It causes low estrogen levels -> loss of
bone mineral density ->
OSTEOPOROSIS!

25. Norethisterone enanthate
• Alternative depot, similar efficacy
• Only lasts for 8 weeks and not widely used
• Given at two-monthly intervals
• recommended as a short term interim
contraception (eg, while waiting vasectomy to
become effective)
• The return of fertility is quicker

26. IMPLANON
Nexplanon(Progestagon-only subdermal implant)
- Single 40mm rod
- consists of levonogestrel or etonogestrel that is
constantly released in small amounts inside the
bloodstream.
- Inserted at upper arm subdermally with local
anaesthetic
- Last for 3 years, radio opaque
- Highly effective, failure rate <0.1 per 100 woman
years
- No drop in bone density
- Removal usually easy and rapid resumption of
fertility.
- Side effects- menstrual disturbance, amenorrhea,
irregular bleeding in the first year

29. Vaginal Ring
• a.k.a Nuvaring
• has to be inserted in vagina
• contraindication: person with blood clotting disorders and
women weights over 90kg as it may be less clinically effective
• efficacy: similar to OCP use
Like most birth control pills, the ring contains the hormones estrogen
and progestin, which are similar to hormones our bodies make
naturally. The vaginal lining absorbs the hormones.
- Stops ovulation and thickens cervical mucus

30. • How does it acts?
A.Delivers 15mcg of ethinyl estradiol and 120mcg of etonogestrel per day
• Side Effects;
1. Vaginitis
2. Leukorrhea
3. Weight Gain
4. Nausea
5. Headache
6. Breakthrough bleeding

32. MALE & FEMALE
STERILIZATION

33. Male Sterilization
VASECTOMY
• The tubes that carry sperm from a man’s testicles to the penis
are cut, blocked or sealed during a minor operation
• This prevents sperm from reaching the seminal fluid (semen),
which is ejaculated from the penis during sex. There will be no
sperm in the semen, so a woman's egg can't be fertilised.
2 types of vasectomy :
• Conventional vasectomy- making 2 incisions in scrotum using
scalpel
• Non-scalpel vasectomy- making a tiny puncture hole into the
skin of the scrotum

34. Advantages :
• Minimal failure rate (0.15%)
• there are rarely long-term effects
• vasectomy does not affect hormone levels or sex drive
• it will not affect the spontaneity of intercourse or
interfere with intercourse
• simpler, safer and more reliable alternative to female
sterilisation
Disadvantages :
• vasectomy doesn’t protect against sexually transmitted
infections
• Additional contraceptive protection is needed for about
2-3months until aspermia is achieved

36. Complications
Haematoma
• A haematoma is when blood collects and clots in the tissue
surrounding a broken blood vessel.
• They are mostly small (pea-sized), but can occasionally be
large (filling the scrotum) . This can cause scrotum to
become very swollen and painful.
Sperm Granulomas
• When the tubes that carry sperm from testicles are cut,
sperm can sometimes leak from them. In rare cases, sperm
can collect in the surrounding tissue, forming hard lumps
that are known as sperm granulomas.
• This can be treated by giving anti-inflammatory medication.

38. FEMALE STERILIZATION
TUBAL LIGATION
• A laparoscopy is the most common method of accessing the
fallopian tubes.
• After the surgeon can access to see the fallopian tube, then
they can start to block the tube.
Blocking the tubes
• applying clips – plastic or titanium clamps are closed over
the fallopian tubes (Filshie clip)
• applying rings – a small loop of the fallopian tube is pulled
through a silicone ring, then clamped shut
• tying and cutting the tube – this destroys 3-4cm of the tube

40. • Common ligation method used is Pomeroy Tubal
Ligation.
• In this procedure, a segment of the tube from
midportion is elevated and an absorbable
ligature is placed across the base, forming a
loop, or knuckle of tube. This knuckle is then
excised.

42. HYSTEROSCOPIC STERILISATION
(transcervical sterilization)
• A hysteroscope, is passed through vagina and cervix. A
guidewire is used to insert a tiny piece of titanium metal
(called a microinsert) into the hysteroscope, then into each
of fallopian tubes.
• The implant causes the fallopian tube to form scar tissue
around it, which eventually blocks the tube.

43. • An imaging test should be done to confirm that the fallopian
tubes are blocked. The tests are :
- hysterosalpingogram (HSG)
- hysterosalpingo-contrast-sonography (HyCoSy) – a type of
ultrasound scan involving injecting dye into the fallopian
tubes.

45. Advantages
• there are rarely any long-term effects on sexual health
• it will not affect person sex drive
• it will not affect the spontaneity of sexual intercourse or
interfere with sex
• it will not affect person hormone levels
Disadvantages
• female sterilisation does not protect against sexually
transmitted infections so a person should still use a condom if
feels unsure about their partner's sexual health
• it is very difficult to reverse a tubal occlusion – this involves
removing the blocked part of the fallopian tube and rejoining
the ends

46. Complications
• with tubal occlusion there is a very small
risk of complications, including internal
bleeding and infection or damage to
other organs
• it is possible for sterilisation to fail – the
fallopian tubes can rejoin and make a
women fertilise.
• If a women get pregnant after sterilize
then, it is possible that the women is in
a high risks of ectopic pregnancy.

47. CASES

48. Case 1
30 years old Para 2, day 1 post SVD with
underlying
1) obese with BMI of 36kg / m2.
2) Hypertension under KK follow up. Not
compliant to medication
Wishes to space out for another three to four
years.

49. Recommended contraception.
• Copper IUCD.
• Barrier method.
Contraindicated contraception
• Oestrogen based contraception.

50. Case 2
26 years old para 2, day 2 post LSCS for fetal
distress.
Patient had poor spacing, first child less than 2
years old.
During counseling, she wished to space out for
another 5 years.
Her desirable family size is 3 children.

51. Recommended contraception
• Hormonal IUD (Mirena)
Not recommended contraception
• Oral contraception
• Barrier method

52. Case 3
A 40 year old Para 3 with cervical carcinoma
stage 2, awaiting treatment
Intrapartum; uneventful
LCB: 1 year ago
Still breastfeeding

53. Recommended contraception
• Mirena IUD
• IM Depo
Not recommended contraception
• Copper IUCD
• Oestrogen based contraception

54. Case 4
35 years old Para 3, day 1 post SVD with
underlying
1) obesity with BMI of 36kg / m2.
2) Underlying haemophilia
Wishes to space out for another three to four
years.

55. Recommended contraception.
• Copper IUCD.
• Barrier method.
Contraindicated contraception
• Oestrogen based contraception.
• Vaginal ring

56. Thank you!