The document discusses various methods of contraception including spacing methods like barrier methods (condoms, diaphragms), chemical methods (spermicides, IUCD), and hormonal methods (OCPs, injections, implants, patches, rings). It also discusses terminal methods like male and female sterilization. It provides details on mechanisms of action, effectiveness, side effects for different contraceptive methods.

2.  Practices that help individuals/couples to
attain certain objectives:
• To avoid unwanted birth
• To bring about wanted births
• To regulate the intervals between
pregnancies
• To control the time at which births occur
in relation to the age of parents and
• To determine the number of children in
the family

3. Prevent ovulation;
Prevent fertilization;
Keep sperm &
oocyte away from
each other.
Prevent implantation

4.  Spacing methods
• Physical methods (Barrier
methods )
• Condom, Diaphragm
• Chemical methods
 Spermicide pessary
• IUCD
 1st, 2nd, 3rd generation
• Hormonal methods
 COC, Mini pill, EC
• Miscellaneous
 Safe period, Coitus
interruptus
 Terminal methods
• Male sterilization
• Female sterilization

5.  Oral Contraceptives
(Birth Control Pill)
 COCP
 PROGESTIN ONLY PILL
 Injections (Depo-
Provera)
 Implants (Norplant I & II
 Patches
 Vaginal rings
 Hormone releasing
IUCD

6.  Prevents ovulation
 Thickens mucus at the cervix so sperm cannot pass through
 Changes the environment of the uterus and fallopian tubes to
prevent fertilization or implantation should fertilization occur

7.  Contain Synthetic
Estrogen/Progestin
 Modern E2 Dosage
≤ 50 Mcg
 Despite Diversity,
Side Effects and
Efficacies are
Similar
 Requires Patient
Compliance

8.  Suppresses LH / FSH Release
 (E2 FSH, P LH)
 Progestin Thickens Cervical Mucus and Alters Endometrium
 Major Effect Is Anovulation and Impairment of Sperm Transport
and Oöcyte Implantation
Combined OCP’s: Additional Benefits
 Menstrual Regulation
 Decreased Risk of Anemia
 Ovarian, Endometrial CA: Risk
 Lower PID Risk
 Prevention of Benign Breast Disease

10. • “The Pill”
 Synthetic
“progestins”
mimic effect of
progesterone.
 Inhibits FSH &
LH, and their
effects on
follicle
development
• Norplant
• Depo-provera

11.  Breakthrough
Bleeding (≤ 25%)
 Amenorrhea
 Breast Tenderness,
Nausea
 H/A (+/–)
 ?HTN
 ?Weight Gain
 Thromboembolism
(Greater if ≥ 35 y/o
and Smoker)
 MI (Smokers Only):
< 15 cig/day: 3X Risk
> 15 cig/day : 21X Risk
 Liver Adenomas
(Very Rare)
Risks

14.  Inhibits Ovulation
 150 mg q 3months (14 day grace period)
 Delayed Ovulation After Discontinuation
 Main Side-Effects:
• Amenorrhea
• DUB
• Weight Gain
• Hair Loss

15.  Implantable for ≤ 5Years
 Similar Side Effects as Depo-Provera
 Avg.Yearly Failure Rate: 0.8/100 (Increases : > 2/100
after 5 years)
 Occasionally Difficult to Remove

16.  Male / Female
 condom
 Diaphragm
 Block sperm from
reaching the egg
 Some are used with
spermicides, which kill
sperm.

17.  Diaphragm: High Failure Rates
– Must Remain in ~6 Hrs post-coitus
– Best if Combined with Spermicide
– UTI Potential
 Condom: STD Protection, Inconsistent Use by Men
 Female Condom: Cumbersome, Learning Curve

18.  COPPER-T
 MULTILOAD
 MIRENA (progestin releasing
IUCD)
LIPPE’S
LOOP

20.  The progestin released by the levonorgestrel
(LNg) IUD prevents fertilization by making the
mucus in the cervix thick and sticky, so sperm
can't get through to the uterus.The progestin
and IUD change the uterine lining, preventing
implantation in the rare case that fertilization
occurs.
 The copper in the copper IUD is toxic to sperm.
It causes changes in the uterus and fallopian
tubes that kill sperm
 NOT ABORTIFACIENT
 Prevents Conception:
– Sperm Transport Inhibited
– Sperm Survival / Capacitation
Diminished
 Prevents Implantation: hCG Levels = 0

22. PID: Usually 20 Insertional Contamination
– Unproven Role for Prophylactic ABx
Hypermenorrhea
Expulsion
Perforation (< 0.1%)
Failure: IUD Should be Removed
??Ectopic

24.  Advantages :(Burkman, 2007)
 Continuous, sustained release:
 avoids peak& low drug levels
 Longer dosing interval:
 improves patient compliance
 Avoids first-pass:
 met& enzymatic degradation by GIT
 induction of hepatic protein synthesis e.g. extrinsic clotting
factors.
 TD:
 Can be given when oral route is not suitable
 Unaffected by vomiting or diarrhea.
 Drug administration stops with patch removal

25.  ORTHO EVRA: FDA 2001
 0.75 mg EE
 6.0 mg norelgestromin: active
metabolite of norgestimate:
 (Cilest: EE, 30ug, Norgestimate, 250
Ug)
 EVRA
 0.6 mg EE
 6.0 mg Norelgestromin

26.  3 separate layers:
 Lower: packing, light
brown, flexible 4.5 x
4.5 cm
 Middle: adhesive,
contains the active
hormones
 Top: protecting the
adhesive layer &
removed prior to
application

28.  4 sites:
 Upper Torso
 (excluding the breasts)
 Upper outer arm
 Lower abdomen
 Buttock
 Two consecutive patches
should not be placed over the
exact same area.
 Hormonal absorption from the
lower abdomen is 20% lower
than that from the other 3 sites
 Regimens:
1. Recommended
• One patch/w for 3ws, followed
by a patch-free w.
• The first patch should be
placed on 1st day of the
menstrual cycle
• If a patch change is missed
for 2 d:
 clinical efficacy is maintained:
backup contraception is not
needed.

30.  After childbirth and non-
breast feeding women:
 Wait 4 w
 Backup contraception for
7 days.
 • After a first-trimester
abortion or miscarriage:
 immediately (the same
day).
 Backup contraception is
not necessary if the patch
is started within 5 days.
 One patch/w for 12 Ws, 1
patch-free w:
• Fewer
 median bleeding days (6
Vs14 d)
 bleeding episodes (1 Vs 3
episodes)
 bleeding or spotting
episodes (2 Vs 3 episodes)
• Delayed median time to first
bleeding to 54 d compared
with 25 d with cyclic use
• Suppress estrogen
withdrawal headaches

32.  new device is light and
supple, and doesn't fly
out of the user's hand the
way a diaphragm does.
 There is no wrong way to
insert it--if it lies
comfortably in the
vagina, then it's in
correctly
 releases 15 [micro]g of
ethinyl estradiol and 120
[micro]g of etonogestrel
daily, and is worn for 3
out of every 4 weeks
 Non-hormonal vaginal
contraceptive ring
 Releases ferrous
gluconate,ascorbic
acid,glycine in spermicidal
conc.
Lunelle (monthly inj)
better alternative for teens than
Depo-Provera because it is
associated with fewer side
effects such as weight gain, hair
loss, and decreased libido.
It contains 25 mg
medroxyprogesterone acetate
and 5 mg estradiol cypionate
Ovaprene

33.  Identifies the time during a woman's
cycle when she is most likely to
become pregnant (fertile). An
additional method or abstinence
should be used during this time of
fertility.
 Prevent fertilization.
• Coitus interruptus
Least effective of all
• Rhythm 50%
failure rate
 Avoid intercourse during
woman’s likely fertile period
 ~ 1 week before ovulation to ~
4 days after ovulation

34.  SAFE PERIOD METHOD:
DURING THE FERTILE PERIOD, COITUS IS AVOIDED.THE REST OF
THE CYCLE IS ‘SAFE’
 OVULATION TESTS:
 BASAL BODY TEMPERATURE CHARTS
 CERVICAL MUCUS : BILLINGS METHOD
 SYMPTOTHERMIC:‘SELF RECOGNITION’

36.  Men:Vasectomy blocks the release of sperm.
 Women:Tubal ligation surgery or tubal implants block
the movement of an egg through the fallopian tube,
preventing fertilization.

39. .
MALE STERILISATION:
A SIMPLE OUT PATIENT PROCEDURE.
THE ‘VAS DEFERENS’ IS ISOLATED AND
CUT.
THE TWO ENDS ARE LIGATED.
LATEST METHOD: NSV: NON SCALPEL
VASECTOMY.
LEAST DONE IN INDIA DUE TO
PREJUDICE & SUPERSTITIONS.

41. IUCD, OCP’s
 Specific OCP Regimens Given ≤ 72 Hours After
Unprotected Intercourse
~ 75% Effective
 Yuzpe Method: Ovral 2 tabs po now and 2 tabs
120 later
 Progestin only pills 2tabs stat
 IUCD can be inserted up to 5 days after
unprotected intercourse