This document provides information on various contraception methods. It defines contraception as any method used to prevent pregnancy and notes that contraception allows people to choose whether and when to have children. The document then discusses female contraception methods including hormonal, non-hormonal, IUD, barrier, injectable, implant, and emergency options. It also covers natural family planning methods like the rhythm method, basal body temperature tracking, and cervical mucus monitoring. The document emphasizes that contraception provides effective family planning and various methods exist, with suitability depending on a person's history and examination.

1. CONTRACEPTION
Associate Prof Dr
Hanifullah Khan
ultrasound scan of
IUCD in situ

2. Objectives
Understand the definition, classification & terminology
Understand the reason for contraception
Know the advantages & side-effects
Know the proper use of each method
To be able to advise on the use

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Introduction
Definition – any method used to prevent
pregnancy
• Allows to choose
whether & when to
have a child

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Reproduction
Ovulation
Fertile period
Fertilisation
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Female Contraception
Reversibl Non-
Hormon Non-
CO
PO
IU
Barrie
Spermicide
Tubal
PO
Injectable
Implant
Emergenc
Miren

7. COMBINED CONTRACEPTION
• BENEFICIAL EFFECTS ON FUTURE
FERTILITY
– ↓ ASCENDING INFECTION & PID
(PROGESTOGENIC EFFECT)

8. PROGESTOGEN ONLY
CONTRACEPTION
● POP
● SUBDERMAL
IMPLANTS
● INJECTABLES
● COMBINED
INJECTABLES
● EMERGENCY
CONTRACEPTION

11. Emergency Contraception
Levonor
gestrel
0.15 mg
+ethinyl
estradio
Nordette
(light
orange
tablets)
4 tablets/
dose
2 doses
Levonor
gestrel
0.75 mg
Plan B 1 tablet/
dose
2 doses
First dose
within 72
hours of
unprotected
intercourse;
second dose
• COPPER-
CONTAINING
INTRAUTERINE
DEVICE (IUD)
INSERTED WITHIN
120 HOURS OF
UNPROTECTED
INTERCOURSE TO
PREVENT
COURSE
– EITHER A HIGH-
DOSE
COMBINATION
OF ESTROGEN &
PROGESTIN OR
– PROGESTIN-
ONLY
– USED WITHIN 72
HOURS OF
UNPROTECTED
INTERCOURSE
TO PREVENT
PREGNANCY
• TAKEN AFTER SI
BUT BEFORE
IMPLANTATION
• MORE
EFFECTIVE THE
SOONER THEY
ARE INITIATED

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2003 25
NATURAL METHODS
Avoid sex at the fertile times
Unsuitable for:
Women who can't check their temperature and cervix every day
Couples who are even slightly disorganised
Women with very irregular periods
!
!

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2003 28
Methods
Coitus Interruptus
Rhythm Method
Calendar
BBT
Cervical Mucous (Ovulation)
Symptothermal
Ovulation Predictor Kits
Abstinence
Lactational Amenorrhoea Method

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2003 38
Shortest cycle (S) minus 18 = Last infertile day of the pre-ovulatory phase
Longest cycle (L) minus 11 = Last fertile day
For example:-
Length of cycles during last six months = 28, 29, 28, 27, 30, 28
(S = 27) S - 18 = Last infertile day 27 - 18 = 9
(L = 30) L - 11 = Last fertile day 30 - 11 = 19

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2003
39
Basal Body Temperature Method
Keeping track of body temperature
Body temperature rises two days prior to ovulation.

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2003 42
Ovulation (Billing) Method
Requires feeling and observing the cervical mucus
to determine the time of ovulation.
Note the production of clear, watery mucus in the
days immediately before ovulation
To avoid pregnancy, intercourse is avoided for
several days following change in the color and
consistency of cervical mucus.

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2003 45
Sensation
at Vulva
Finger Test Appearance
Moist
or
Sticky
Early Mucus
Scanty
Thick
White
Sticky
Holds its shape
Wetter
Transitional Mucus
Increasing Amounts
Thinner
Cloudy
Slightly Stretchy
Slippery
Highly Fertile Mucus
Profuse
Thin
Transparent
Stretchy
(like raw egg white)

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2003
46
Mucus changes throughout the cycle
Complete cycle showing typical pattern of menstruation, pre-
ovulatory dry days,
mucus days with increasingly fertile characteristics
approaching peak day,
the abrupt change back to less fertile characteristics,
the count of four after peak day and post-ovulatory dry days

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2003
48
Interpretation of the Sympto-Thermal Chart
This sympto-thermal chart shows the correlation between all
indicators of fertility

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2003 49
Fertility Chart

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2003
50
Ovulation Predictor Kits
used to test urine to identify hormones that indicate ovulation is about to
occur
electronic fertility computer tells a woman which days she is fertile
Persona: fertile days are indicated with a red light and infertile days with a
green light
failure rate as low as 6% among women who abstain on fertile days as
indicated by the device

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2003 57
LAM
Conditions to be fulfilled
Fully BF
No periods
Recommended up to 6 months - the longer LAM is used, the
more likely it is that ovulation will precede the first menses

23. INTRAUTERINE DEVICES

24. Copper IUDs: Mechanisms of Action
Interfere with reproductive
process before ova reach
uterine cavity
Thicken cervical mucus
Interfere with ability of
sperm to pass through
uterine cavity
Change endometrial
lining

25. IUDs: Who Should Not Use
(WHO Class 4)
IUDs should not be used if woman:
Is pregnant (known or suspected)
Has unexplained vaginal bleeding until the cause is determined and any serious problems are treated
Has current, recent PID
Has acute purulent (pus-like) discharge
Has distorted uterine cavity
Has malignant trophoblast disease
Has genital tract cancer
Has an active genital tract infection (e.g., vaginitis, cervicitis)
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rce: WHO 1996.

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IUDs: Common Side Effects
Copper-releasing:
Heavier menstrual bleeding
Irregular or heavy vaginal bleeding
Intermenstrual cramps
Increased menstrual cramping or pain
Vaginal discharge
Progestin-releasing:
Amenorrhea or very light menstrual bleeding/spotting

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IUDs: Possible Other Problems
Missing strings
Slight increased risk of pelvic infection (up to 20 days after insertion)
Perforation of the uterus (rare)
Spontaneous expulsion
Ectopic pregnancy
Spontaneous abortion
Partner complains about feeling strings

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Failure rates
Implants, IUDs and LNG-IUS - <1% #
Contraceptive pills - 5% #
Male condoms - 14% #
Diaphragm with spermicide - 20% #
Cap with spermicide - 20-40% #
'Natural' methods - 35% #
Withdrawal - 19%

30. KEY POINTS
Contraception provides an effective means to plan a family
Many methods are available -
suitability has to be decided based on a proper history & examination
Pregnancy should be ruled out first
You should know the advantages & side effects
Contraception also provides non-contraceptive benefits

31. Further reading
Cleland et al. Family Planning as a cost saving
preventive health service. NEJM April 20, 2011.
Trussell J. Update on the cost effectiveness of
contraceptives in the United States. Contraception
2010;82:391.
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