This document discusses various methods of contraception, including fertility awareness methods like basal body temperature tracking and cervical mucus monitoring, barrier methods like condoms and diaphragms, hormonal options like combined oral contraceptives and IUDs, and sterilization. It provides details on how each method works, effectiveness rates, potential side effects, and other important factors to consider when choosing a contraceptive approach.

1. Dr. Priya Bagade

2. Issues
 Decision made by individual or by couple
 Many factors influence decision:
 Advantages & disadvantages of various methods
 Side effects & contraindications
 Effectivenes
 Expense
 Spiritual/cultural beliefs
 Practicality of method

3. Some facts
 Correct & consistent use of contraceptives results in lower risk of pregn
ancy
 Using more than one method together dramatically lowers risk of preg
nancy
 Emergency contraception offers last chance to prevent pregnancy after
unprotected intercourse or when extent of protection isn’t clear
 Most contraceptives pose little risk to most users’ health
 Half of all pregnancies are unintended (3.1 million/yr)
 More than 4/10 unintended pregnancies end in elective abortion
 Half of unintended pregnancies result from contraceptive failure
 1/3 of all births are unintended
Source: Contraceptive Technology (19th ed)

4.  Defination:
 CONTRACETION: All measures , temporary or permanent
, designed to prevent pregnancy due to coital act.
 IDEAL CONTRACEPTION: Fulfill following criteria
 Widely accetable
 Inexpensive
 Simple to use
 Safe
 Highly effective
 Require minimal motivation, maintainence, and supervision

5.  Benefits of fertility control:
 Improved quality of life
 Better health
 Less physical & emotional stress of life
 Better education, job & economic opportunities
 Fertility Control: Includes
Fertility Inhibition(Contraception)
 Fertility Stimulation.

6. Basic types of contraception
 Fertility awareness methods
 Barrier methods
 Situational methods
 Spermicides
 IUDs
 Hormonal contraception
 Operative sterilization

7. Fertility Awareness Methods
 Natural Family Planning methods
 Based on understanding ovulatory cycle
 Require periods of abstinence & careful recording of events throughout
cycle
 Cooperation very important
 Free, safe, and acceptable to all spiritual beliefs
 Require extensive initial counseling
 25% of women will experience unintended pregnancy in first year
 Some women combine barrier methods (use during fertile periods) an
d/or combine types of FAM
 More difficult when breastfeeding (masks some signs)

8. Fertility Awareness Methods
 Basal body temperature (BBT)
 Woman takes temp early morning
 Must be before any activity
 Uses BBT thermometer and same method
 Chart for 3-4 months to determine normal pattern
 Temp sometimes drops just before ovulation
 Almost always rises by 0.5 degrees & remains elevated fo
r several days after
 Abstain from intercourse several days before and 3 days
after anticipated ovulation

9. Fertility Awareness Methods
 Calendar method
 Also known as rhythm method
 Assumes ovulation takes place 14 days before start of me
nstrual period
 Sperm viable for 48-72 hours, ovum for 24 hours
 Record menstrual cycles for 6-8 months to determine sh
ortest & longest cycles
 Use record to identify fertile & infertile periods
 Least reliable of FAM

10. Fertility Awareness Methods
 Cervical mucus method
 Also known as Billings or ovulation method
 Involves careful assessment of cervical mucus changes throughout c
ycle
 Ovulation mucus clearer, more stretchable (spinnbarkeit), more per
meable to sperm
 Also ferns when dried on glass slide
 Luteal phase mucus thick, sticky, traps sperm (progesterone influen
ce)
 Woman abstains from intercourse for one cycle & assesses mucus st
atus
 Peak day of wetness & clear, stretchable mucus is assumed day of ov
ulation
 Can be used by women with irregular cycles

11. Fertility Awareness Methods
 Symptothermal method
 Multiple assessments made & recorded
 Cycle days, coitus, cervical mucus changes, BBT, & secon
dary changes (increased libido, bloating, mittelschmerz)
 Combined approach is more effective

12. Situational contraceptives
 Abstinence
 Coitus interruptus (withdrawal)
 Very unreliable
 Demands great self-control
 Pre-ejaculate may contain sperm, esp. after a recent ejaculation
 Douching after intercourse
 Not recommended; may facilitate conception
 Lactational amenorrhea method (LAM)
 Lactation depresses ovarian function
 Exclusive breastfeeding, from the breast (no pumping), in first s
ix months following birth without PP menses is 98% effective
 Even more effective if used with other method of contracep.

13. Barrier Methods
 Male condom
 Female condom
 Diaphragm
 Cervical cap
 Vaginal sponge
 Usually used with spermicides
 All vaginal barriers may cause increased risk of tox
ic shock syndrome if used longer than recommend
ed

14. Spermicides
 Available as creams, jellies, foams, film, suppositories
 May require up to 30 minutes to become effective
 Minimally effective if used alone
 May cause skin/mucus membrane irritation, allergic re
action

15. Barrier methods
 Male condom
 Must be used correctly to be effective
 No side effects
 Inexpensive and easily available
 Usually latex, but other types available for allergic
 Offers protection from pregnancy and STIs
 May also be used for STI protection in oral and anal inte
rcourse

16. Barrier Methods
 Female condoms
 Thin sheath with flexible ring at each end
 May be inserted up to 8 hrs before intercourse
 Internal ring functions like diaphragm to cover cervix
 External ring covers portion of perineum
 Cannot be used with male condom
 Slightly less reliable than other barrier methods
 More expensive than male condom
 Noisy and cumbersome

17. Barrier methods
 Diaphragm
 Must be used with spermicide
 Requires prescription and fitting by HCP
 Fits over cervix between pubic symphysis and posterior fornix
 Must be inserted before and remain in place at least six hours after i
ntercourse; additional spermicide must be inserted for additional ac
ts of coitus
 No hormones involved; may help protect cervix against HPV
 Requires comfort with insertion and checking placement
 Not recommended for those with hx of recurrent UTI

18. Barrier methods
 Cervical cap
 Fits over cervix by suction (smaller than diaphragm)
 Also used with spermicide
 May be left in place 24- 48 hrs
 May be more difficult to fit than diaphragm
 Requires more comfort with body to place correctly

19. Barrier methods
 Lea’s shield
 Similar to cervical cap, but with valve for passage of secr
etions & air
 One size fits all, but only available by rx in US
 Contraceptive sponge
 Available OTC, one size (expensive)
 Contains nonoxynol-9
 No additional spermicide needed for additional coitus w
ithin 24 hrs sponge may be in place
 Less effective in parous women

20. Intrauterine contraception
 Two forms available
 Paragard (copper T)
 Mirena (releases levonogestrel)
 Trigger spermicidal reaction in body, preventing fe
rtilization
 Provide long-term, highly effective contraception
 Risks include PID, perforation, dysmenorrhea, exp
ulsion
 Also may be used as emergency contraception (Par
agard only)

21. Intrauterine contraception
 Used in parous women in stable, long-term, monogamous re
lationships
 Inserted into uterus by practitioner.
 Nursing action: premedicate with ibuprofen to decrease cra
mping with procedure
 Usually inserted immidiately after menses or during first six
weeks postpartum (may be inserted any time as long as not p
regnant)
 String protrudes through cervix into vagina (path for ascendi
ng infection if exposed to STI)
 Women should check string after each menses
 Warning signs: late period, abnormal bleeding (may happen
with Mirena), abnormal discharge, s/sx of infection

22. Intrauterine contraception
Copper T
 Works by impairing fertilization
 May stay in place up to ten years
 May cause increased bleeding/cramping with periods
 No hormones
 Contraindicated in copper allergy
 Low daily cost
 High user compliance, continuation, & satisfaction
 May help prevent endometrial cancer

23. Intrauterine contraception
 Mirena
 Releases small amount of progesterone (10% of oral cont
raceptives)
 May remain in place for up to 5 yrs
 Decreased bleeding, cramping compared to copper T
 May be recommended to women with menorrhagia
 Some women stop ovulating while it’s in place
 May cease bleeding altogether
 May have irregular bleeding, esp. in first few months

24. Hormonal contraception
 Combined oral contraceptives
 Progesterone-only oral contraceptives
 Implanted contraceptives
 Injected contraceptives
 Other hormonal contraceptives
 Vaginal ring
 Contraceptive patch

25. Hormonal contraception
 Combined oral contraceptives (COCs)
 Birth control pills with both estrogen & progesterone
 Most taken daily for 21 days, with 7 days of placebo or no
pill (exceptions: Seasonale,Seasonique, Yaz)
 Many formulations--monophasic, multiphasic, different
strengths, different progesterones
 Side effects differ somewhat based on formulations
 Very effective if used correctly
 No protection against STI

26. Hormonal contraception
 COCs
 Action:
 Suppress ovulation through negative feedback to hypothalami
c-pituitary axis
 Thickening of cervical mucus to prevent sperm entry
 May also slow tubal motility, disrupt transport of ova, change f
unction of endometrial vessels, cause endometrial atrophy, an
d inhibit implantation (not proven)

27. Hormonal contraception
 COCs
 Contraindications
 Pregnancy
 Hx of thrombophlebitis/thromboembolic disease
 Acute or chronic liver disease or gallbladder disease
 Estrogen-depended carcinoma
 Undiagnosed menorrhagia
 Smoking (esp. if over 35)
 Diabetes
 HTN
 Hyperlipidemia

28. Hormonal contraception
 COCs
 Caution/relative contraindications
 Hx of migraine headaches
 Seizure disorder
 Depression
 Oligomenorrhea
 Amenorrhea
 Often safer than pregnancy

29. Hormonal contraception
 COCs
 Noncontraceptive benefits:
 Decreased risk of ovarian and endometrial cancer
 Relief of menstrual symptoms (e.g. fewer/less painful cramps
, lighter flow)
 Regulation of irregular menses
 Reduced risk of ovarian cysts
 Improvement in menstrual migraines
 Decreased incidence of ectopic pregnancy
 Decreased incidence of benign breast disease & iron deficien
cy anemia
 Some pills decrease PMS symptoms (Yasmin & Yaz)
 Reduced symptoms of endometriosis, acne, hirsutism

30. Hormonal contraception
 Other combined methods
 NuvaRing vaginal ring (must be comfortable inserting)
 Ortho Evra contraceptive patch
 Similar effectiveness, non-contraceptive benefits, contraindications,
and side effects as COCs
 Patch dispenses higher dose of hormones than COCs, with possible
higher risk of venous thromboemobolic conditions
 Ring uses progesterone formulation that may increase risk of VTC a
s well
 Neither require daily use
 Patch replaced weekly for three weeks, then one week without
 Ring left in for three weeks, then one week without

31. Hormonal contraception
 Progesterone only pills (mini-pill)
 Do not suppress ovulation
 Do not affect breast milk supply (good for nursing mom
s)
 Must be taken at same time every day to be effective
 Often causes irregular bleeding
 Not as effective as combined methods
 No risk of venous thromboembolic events

32. Hormonal contraception
 Injectable contraception
 Formulations use progesterone only
 Depo-Provera (DMPA-IM 150 mg/1 ml) most commonly
used
 Given IM every 12 weeks
 NET-EN (Norethisterone enanthate)
 Given 200 mg every 2 monthly.

33. Hormonal contraception
 DMPA actions & advantages
 Works by inhibiting ovulation (suppresses FSH & LH), t
hickening cervical mucus
 Safe for those who can’t take estrogen (e.g. hx of DVT)
 Highly effective
 Very light to no menstrual periods (but can have irregul
ar bleeding)
 New SC formulation less painful, may be self-administer
ed

34. Hormonal contraception
 DMPA disadvantages
 Most women have irregular bleeding/spotting
 Most women gain weight
 May increase risk of depression
 May decrease bone density
 May take up to one year to reverse effects/regain fertility
 Must return for injectionsf every 3 monthly
 No protection from STI

35. Hormonal contraception
 Implanted contraception
 Implanon
 Single rod implanted under skin of upper arm
 Provides contraception for 3 years
 Releases progestin continuously
 Extremely effective
 Like all progestin-only methods, causes irregular bleeding in ma
ny women
 Must be inserted by HCP & removed later

36. Emergency contraception
 Used after unprotected sex, contraceptive failure, or unsure
protection
 Should be taken as soon as possible after incident
 No medical contraindications except established pregnanc
y
 Most effective in first 72 hours, but still somewhat effective
up to 5 days after coitus
 Providing EC is the standard of care for women who requ
est it

37. Emergency contraception
 Methods
 Combined hormonal ( estrogen & progestin)
 Progestin-only (Plan B, available OTC for those >/= 18, rx for those <
18, more effective & better tolerated )
 Copper IUD insertion (99% effective; can insert up to 7 days after co
itus)
 Not the same as abortion pill (RU486/mifepristone)!

38. Operative sterilization
 Surgical procedures that permanently prevent pregnan
cy
 Very difficult to reverse
 Vasectomy and tubal ligation
 Extremely effective and cost-effective
 Does not protect against STI

39. Operative sterilization
 Vasectomy
 Relatively minor procedure (safer and less expensive tha
n female sterilization)
 Surgical severing of vas deferens
 Takes 4-6 weeks/6-36 ejaculations to clear remaining act
ive sperm from vas
 Couple needs to use alternate method and bring in seme
n samples to verify (and recheck at 6-12 months)
 SE include pain, infection, hematoma, sperm granuloma
s, spontaneous reanastomosis

40. Operative sterilization
 Female sterilization
 May be done with repeat cesarean section or postpartum
from vaginal birth
 More serious surgery than vasectomy
 Complications include injury to bowel, bladder & adjace
nt structures, pain, infection, hemorrhage, adverse effec
ts of anesthesia
 New transcervical method (Essure) does not require ope
ning abdominal cavity, can be done under local anesthes
ia in physician’s office

41. Thank you