2. Contraception (birth control) prevents
pregnancy by interfering with the normal proce
ss ofovulation, fertilization, and implantation.
There are different kinds of birth control that
act at different points in the process.
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4. Barrier Methods of contraception are meant
to stop the egg and sperm from coming in
contact and fertilizing.
Some of the main types of barrier
contraceptives are male and female condoms,
cervical caps, diaphragms, sponges, and
dental dams
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5. A male condom is one of the most common types
of barrier contraceptives
It is made out of either latex, polyurethane, or
lamb skin
It is put on over an erect penis before having sex
They prevent the semen from entering the uterus
Male condoms also prevent many STI’s (sexually
transmitted infections)
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6. This type of contraceptive is put into the
vagina before having sex
It has two ends with rings on them
The end that goes into the vagina has a
closed rim
The end that stays outside has an open rim
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7. These are little rubber caps that are inserted
into the vagina and fits fits around the uterus
This blocks the passage way for sperm to
enter the uterus
This is used with spermicide
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8. This is an actual sea sponge
It is inserted into the vagina before sex
It has spermicide on it which is a substance
that kills sperm
This substance kills the sperm before it
enters the uterus
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9. This is a dome shaped object that is also
made of rubber.
Just like the cervical cap, it fits around the
cervix, preventing the sperm from being able
to enter the uterus
This is used with spermicide
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10. This contraceptive is mostly used during analingus
and cunnilingus .
Dental dams are latex or polyurethane sheets used
between the mouth and vagina or anus during oral
sex.
A dental dam prevents STI transmission .
Before using a dental dam, a lubricant is usually
put on it .
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14. Centchroman (or 'Ormeloxifene') is a potent
non-steroidal non-hormonal birth control
method. Although it does not contain
hormones, it acts on the hormones produced
in the body, especially progesterone. It is a
once-a-week oral contraceptive which has
been proved to be not only highly effective
but also safe.
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15. Centchroman acts at three points in the
reproductive cycle:
It increases the movement of the fertilized
ovum through the fallopian tubes so that it
reaches the uterus too early when
the endometrium is not ready for implantation at
that time.
It increases the rate of maturation of the ovum so
that it is hypermature when it reaches the
endometrium and fails to implant in it.
It slows down the growth and development of the
endometrium so that it is not adequately
prepared to receive the fertilized ovum when it
reaches the uterus.
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16. You’ve got to take Saheli twice a week for the
first three months. But after that you take just
one pill a week.
Disadvantages :- Centchroman causes delayed
periods in some.
There may be heavier periods in the first three
months with tender breasts, water retention
and some amount of acne.
Periods can get scanty over time in some
women.
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18. you haven't used protection
your normal contraception fails e.g. condom
splits
you have missed more than one
contraceptive pill
you have been vomiting or had diarrhoea
while on the pill
you have missed your injection
you have been forced to have sex without
contraception.
You should not use the ECP as your regular
method of contraception
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19. The ECP is taken after unprotected sex to
prevent pregnancy.
It stops or delays the release of an egg from
your ovaries until sperm aren’t active in your
body any more.
It doesn’t work once the egg has been
fertilised.
It doesn’t harm you or a developing embryo.
The ECP is approved to be taken up to 72 hours
after sex (three days). However for most
women it is still effective up to four days after
sex.
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20. It was first introduced in 1960
It has been used by millions of women
worldwide
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21. Two types of estrogens are used:
1 Ethinyl estradiole
2 Mestranol. Mestranol is converted in the
body to ethinyl estradiole.
Types of progestins used are :
Estrane Norethindrone, ethynodiol diacetate
Gonane Levonorgestrel, desogestrel,
norgestimate ( gonans more potent)
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22. Efficacy
C OCP is highly effective 99.9% in preventing
pregnancy. However the user failure rate is 3-8%
30% of women miss 3 or more pills in the 1st
cycle of use
47% miss 1 or more pills
Indication
Any women seeking a reversible, reliable, coitally-
independent method of contraception, in the absence
of contraindications .
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23. Mechanism of action
Suppression of gonadotropin secretion inhibition of ovulation (main
mechanism)
Development of endometrial atrophy making it unreceptive to implantation
Production of viscous Cx mucous that impede sperm transport
Possible effect on the secretions & peristalsis of the fallopian tube interfering
with ovum & sperm transport
Possible effect on the secretions & peristalsis of the fallopian tube interfering
with ovum & sperm transport
Possible effect on the secretions & peristalsis of the fallopian tube interfering
with ovum & sperm transport
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24. Absolute contraindications
< 6 Wk postpartum if breastfeeding
Smoker ≥ 15 cigarettes/day, > 35 Y of age
HPT systolic ≥ 160 mm Hg or diastolic ≥ 100 mm Hg
Current or past H/O of venous thromboembolism
Ischemic heart disease
H/O cerebrovascular accident
Complicated valvular heart disease.
Migraine headache with focal neurological
symptoms
Current breast cancer
Diabetes with retinopathy/ nephropathy/ neuropathy
Severe liver cirrhosis
Liver tumour ( adenoma or hepatoma)
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25. Non-contraceptive benefits
Cycle regulation
↓↓ menstrual flow ↓↓
anemia
↑↑ bone mineral density
↓↓ dysmenorrhea
↓↓ peri-menopausal
symptoms
↓↓ acne
↓↓ hirsutism
↓↓ ovarian ca 50% ↓↓ after
5 Y of use
↓↓ endometrial ca 50% ↓↓
↓↓ risk of fibroids
Possibly ↓ ovarian cysts
Possibly ↓ benign breast
disease
Possibly ↓ colorectal ca
↓↓ incidence of salpingitis
↓↓ incidence or severity of
premenstrual syndrome
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26. Minor side-effects commonly occure during the 1st
3 cycles & may lead to unnecessary
discontinuation
1. Irregular bleeding (breakthrough bleeding/
spotting)
10-30% in the 1st month of use
improves with time over 3 cycles
amenorrhea 2-3% of the cycles
2. Breast tenderness & nausea
Improve with time
Less with lower estrogen dosage
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27. 1-Venous thromboembolism
VTE 3-4 X higher in users than nonusers
The risk is attributed to the estrogen component of the pill & decline with lower
dosage
2- Myocardial infarction
In the past with pills containing >50μg ethinyl estradiole --- 3X ↑↑ in MI
3-Stroke
Smoking & HPT ↑↑ risk of stroke
4-Gallbladder disease
COCP ↑↑ secretion of cholic acid in bile ↑↑ incidence of gallstone formation
5-Breast cancer
Still controversial
6-Cervical cancer
One study ↑↑ risk of Cx ca in long term COCP users who are HPV positive
28. 1-Breakthrough bleeding
To continue on the same pills with the expectation
that it will improve with time .
If bleeding persists beyond 3 months (or new onset
of bleeding in a long term user ) rule out other
causes of bleeding:
-irregular taking of the pills;
pregnancy;infections; uterine or Cx pathology;
malabsorption/ diarrhea , vomitting
Management of breakthrough bleeding
Oral estrogens: premarine 1.25 mg or estradiole -
17 ß /7 days
Change the another preparation with different
progestin
29. 2-Missed pills
Take the pill as soon as you remember ( this means taking 2 in 1
day)
If 2 pills in a row missed in the 1st 2 wks of the pack take 2
/day for 2 days
If 2 pills in a row missed in the 3rd wk of the pack throw the
remainder of the pack & start a new one / use back up
contraception in the first 7 days of the new pack
If 3 pills in a row missed follow steps above
If intercourse occurred after missing a pill use emergency
contraception
3-Amenorrhea
It occurs in 2-3% of COCP users--Pregnancy should be ruled out
4-Chloasma
Darkening of the facial skin -Use of sunscreen to prevent further
darkening
30. 5-Breast tenderness & galactorrhea
Often resolves with continued use
↓ caffeine intake may help
↓ estrogen content
6-Nausea
↓ with time
Taking the pill with food or bedtime
Rule out Pregnancy
7-Pregnancy
Pills must be stopped immediately
31. Delivers 150μg norgestimate & 20 μg E estradiole
daily
One patch is applied weekly for 3 wks followed by
one patch-free-wk
Mechanism of action similar to COCP
32. A flexible transparent ring 54 mm diameter /4 mm
cross-sectional diameter
Releases 15μg E estradiole & o.12 mg of
desogestrel (etonogestrel)/ day
Ring is used for 3 wks continuous followed by one
ring-free wk
Vaginitis 13.7% (5% Rx related), coital problem or
expulsion 1-2.5%
33.
34. Package contains 28 tab
Started on the 1st day of the menstrual cycle/ or any
day if pregnancy excluded
Must be used at the same time every day within 3 hrs
A back up contraception must be used for 7 days
Norethindrone 0.35 mg MICRONOR
Must be used continuously no pill-free interval
It can be used immediately postpartum with no effect
on lactation
37. 1-Irregular bleeding
A common side effect
Pregnancy, infection & genital pathology must be
ruled out
Rx options
Non steroidal anti-inflammatory for 10 days
Switching to COCP
Adding a short course of estrogen
0.625 mg conjugated equine estrogen
(premarine) for 28 days
1-2 mg micronized 17ß-estradiole—28 days
Transdermal 50-100 μg 17ß-estradiole patch –
25 days
Antiprogestinic agents mifepristone
38. 2-Missed pill
To be taken as soon as possible
Next pill to be taken at the regular time
If delayed > 3hrs use back up contraception
for 48 hrs
If 2 or more pills missed in a row 2 pills/day
for 2 days back up contraception for 48 hrs
Emergency contraception must be used if
intercourse occurred after a missed pill
3- Drug interactions anticonvulsants may ↓↓
effectiveness of POP
39. Desogestrel 75 mcg may be used while you
are breast-feeding. Desogestrel does not
influence the production or the quality of
breast milk
The Desogestrel pack contains 28 tablets
42. How does DMPA works –
Preventing ovulation (egg release from the
ovary)
Thickening of the mucus of the cervix so that
sperm cannot enter the uterus (womb)
Advantages –
long acting, effective method of contraception
inexpensive
undetectable by other people
suitable for women who can’t take contraceptives
that contain oestrogen
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43. Who can use –
Most women are suitable, though it is best
between 18 and 50 years of age. It can be used
while breast feeding – a small amount of
hormone gets into the milk but does not alter the
quality of the milk.
DMPA contains a progestogen. This is similar to
the hormone progesterone, which is naturally
produced by the female body. DMPA is given by
injection every 12 weeks and is slowly absorbed
into the blood stream to prevent pregnancy.
Depo- Provera
Effectiveness - 99% if you are not late with the
injection
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44. Noristerat - 1ml Noristerat contains 200mg
norethisterone enantate in oily solution .
Intramuscularly provides contraception for
eight weeks ( 2 months ). The first injection
should be given within the first five days of a
menstrual cycle (the first day of menstruation
counting as day 1 )
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48. NORPLANT Levonorgestril
Implanon Etonogestrel
Highly effective failure rate 0.1% / year
6 rods implanted under the skin effective for 5
years
Women < 70 kg effective for 7 Y pearl index < 2
Reversible contraception
Mechanism of action
Suppression of ovulation
Endometrial atrophy
Rendering Cx mucous impermeable to sperms
Prolonged irregular bleeding the major side effect
52. Inara Cu 250 is one of the most effective
types of intrauterine devices used. Reversible
contraceptive in nature, the device offers a
protection term of up to 3 years.
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54. Pregna Copper T 380A is a safe and
trusted birth control device to ease unwanted
pregnancy worries of the user for a period of
up to 10 years.
The Pregna Copper T 380 A is amongst the
most effective methods available with less
then one percent failure rate.
It is ideal for women who want to space their
children or are looking for long
term contraception.
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55. A standout amongst the most generally
utilized copper bearing IUD is the Inara Cu
375. The Cu 375 is ideal for ladies who need
to space their youngsters for effective family
planning, as it is compelling for a time of 5
years.
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56. Prevention of fertilization the chief
mechanism
Inhibition of implantation
Presence of foreign body & copper
biochemical & morphological changes in
the endometrium adversely affect sperm
transport
Copper ion have direct effect on sperm
mobility ↓↓ in its ability to penetrate Cx
mucous
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57. Levonorgestrel releasing devices weak foreign
body reaction & endometrial decidualization &
glandular atrophy estrogen & progestrone
receptors are ↓↓ Cx mucous becomes thick &
impermeable to sperms ovulation may be
inhibited in some women.
Mirena contains 52 mg of levonorgestrel (LNG).
Initially, LNG is released at a rate of
approximately 20 mcg/day. This rate decreases
progressively to half that value after 5 years.
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59. In the absence of contraindications may be
considered for any woman seeking a reliable,
reversible, coitally independent method of
contraception
Women seeking long term birth control
A method requiring less compliance
Women with contraindications to estrogen
Breast feeding women
Copper IUCD used for postcoital contraception
within 7 days
LNG- IUCD ↓↓ menstrual flow & cramping
suitable for women with menorrhagia &
dysmenorrhea
60. Absolute contraindications
Pregnancy
Current, recurrent or recent (within 3 M) PID or
sexually transmitted disease
Puerperal sepsis
Immediate post septic abortion
Severely distorted uterine cavity
Unexplained vaginal bleeding
Cx or endometrial ca
Malignant trophoblastic disease
Copper allergy Copper -IUCD
Breast ca LNG -IUCD
61. Relative contraindications
Risk factor for sexually transmitted diseases
or HIV
Impaired response to infections:
-HIV +ve women
-Women on corticosteroid Rx
48hrs- 4 wks postpartum
Ovarian ca
Benign gestational trophoblastic disease
62. Nonmedicated IUCD or copper IUCD ↓ risk of
endometrial ca
LNG-IUCD ↓ menstrual blood loss 74-97%
improved Hb
LNG-IUCD users ↓ hysterectomy for menorrhagia
64-80%
LNG-IUCD ↓ dysmenorrhea
--------------- protects against enometrial
hyperplasia in women on tamoxifen
-------------- beneficial effects in fibroid related
menorrhagia
63. 1-Bleeding
Copper / nonmedicated IUCD
Irregular menstrual bleeding
↑↑ amount of menstrual bleeding 65% in copper IUCD
users
NSAID or tranexamic acid ↓↓menstrualblood loss
The days of bleeding or spotting ↓↓ overtime 13 days inth
1st months 6 days at 1 year
Discontinuation due to bleeding 20%
LNG-IUCD
↓↓menstrual blood loss 74-97%
Spotting 16 days at 1 M ↓↓ 4 days at 12 M
Discontinuation due to bleeding 14%
Amenorrhea 16-35% at 12 M
64. 2-Pain or dysmenorrhea
6% discontinue use due to pain
Pain may be physiological
LNG-IUCD ↓↓ dysmenorrhea
3-Hormonal LNG-IUCD
Depression
Acne
Headache
Breast tenderness
Low incidence ,maximal at 3 M then ↓↓
No change in Wt
4-Functional ovarian cysts/ LNG-IUCD
30% of users
Resolve spontaneously