METHODS OF CONTRACEPTION

1. CONTRACEPTION
PREPARED BY: DR. NEENUMOL K JOSE
ASSOCIATE PROFESSOR

2. Contraception, also known as birth control or family planning, refers to
the methods and techniques used to prevent pregnancy by either
preventing the fertilization of an egg by sperm or inhibiting the
implantation of a fertilized egg in the uterus.
Contraception allows individuals and couples to make informed
decisions about when and if they want to have children, helping them to
control their reproductive health and manage their family size.
There are various methods of contraception available, each with its own
mechanisms, effectiveness rates, advantages, and disadvantages.

3. ABSTINENCE
Abstinence is a contraceptive method that involves refraining from any sexual activity that
could lead to pregnancy.
It is the only contraceptive method that guarantees 100% effectiveness in preventing pregnancy
and the transmission of sexually transmitted infections (STIs), including HIV.
Abstinence can be practiced in different ways:
• Complete Abstinence: This involves avoiding all forms of sexual activity that could result in
pregnancy, including vaginal, anal, and oral sex. Complete abstinence is most effective in
preventing both pregnancy and STIs.
• Periodic Abstinence: Also known as "natural family planning" or "fertility awareness," this
method involves tracking a person's menstrual cycle to identify fertile days (when pregnancy
is possible) and abstaining from intercourse during those times. This method requires careful
monitoring of physical signs such as basal body temperature, cervical mucus consistency, and
other changes in the body.

4. Advantages of Abstinence:
• High Effectiveness: Abstinence is the only contraceptive method that provides 100%
protection against both pregnancy and sexually transmitted infections (STIs) when practiced
consistently and correctly.
• No Side Effects: Unlike hormonal methods or certain barrier methods, abstinence doesn't
involve using drugs, hormones, or devices that could potentially cause side effects.
• Cultural and Religious Beliefs: Abstinence aligns with cultural, religious, and personal
beliefs that discourage premarital or non-procreative sexual activity.
• Cost-Effective: Abstinence doesn't require purchasing contraceptives, making it a
financially economical option.
• Emotional and Psychological Well-being: Abstinence can help avoid emotional and
psychological consequences that might arise from unintended pregnancies, STIs, or
regrettable sexual experiences.
• Delaying Parenthood: For individuals who are not ready for parenthood, abstinence can
provide a means of preventing unintended pregnancies until they are prepared for the
responsibilities of raising a child.

5. Disadvantages of Abstinence:
• Requires Strong Willpower: Practicing abstinence necessitates self-discipline and the
ability to resist sexual urges, which can be difficult for many individuals, especially in the
context of intimate relationships.
• Peer and Societal Pressure: Societal and peer pressures to engage in sexual activity might
conflict with a person's decision to practice abstinence.
• Lack of Intimacy: For individuals in sexual relationships, abstaining from sexual activity
could result in a lack of intimacy and physical closeness, which are important components of
many relationships.
• Misunderstandings and Miscommunications: Misunderstandings or miscommunications
about abstinence within relationships could lead to trust issues or conflict.
• Limited Knowledge About Fertility: In the case of periodic abstinence (fertility
awareness), accurately tracking fertility signs and cycles requires education and monitoring,
which might not be foolproof and can result in unintended pregnancies.
• Unrealistic for Some Relationships: In certain long-term relationships, maintaining
abstinence might be unrealistic or might cause strain if both partners do not share the same
views.

6. STERILIZATION
➡After abstinence, sterilization by bilateral tubal occlusion or vasectomy is
the most effective means of contraception.
➡Both procedures must be considered permanent because neither is easily
reversible.
➡Women and men who choose these methods should be certain that they
no longer wish to have children, no matter how the circumstances in their
life may change.
➡Often, decisions made hastily may be regretted later.
➡Some gynecologists suggest a waiting period to ensure that patients are
certain about a potentially irreversible decision.

7. Tubal Ligation
Sterilization by tubal ligation is one of the most common surgical procedures
performed on women.
Tubal ligation, also known as tubal sterilization or getting one's "tubes tied," is a
surgical procedure for permanent female contraception.
It involves the blocking, cutting, or sealing of the fallopian tubes, which are the
structures that carry eggs from the ovaries to the uterus.
By blocking or interrupting the fallopian tubes, the procedure prevents the sperm
from reaching the egg, thereby preventing fertilization.

8. Despite a very high rate of effectiveness, all women who have undergone
tubal ligation but miss a period should be tested for pregnancy because ectopic
and intrauterine pregnancies, although rare, may occur.

9. There are a few different methods of performing tubal ligation:
• Laparoscopic Tubal Ligation: This is the most common method. It involves making
small incisions near the navel and lower abdomen, through which a tiny camera
(laparoscope) and surgical instruments are inserted. The surgeon then blocks, cuts, or
seals the fallopian tubes using clips, rings, or by cauterizing (burning) a small section
of the tube.
• Mini-Laparotomy: This method involves making a slightly larger incision in the
abdomen, usually near the navel. The fallopian tubes are accessed through this
incision and treated in a similar manner to laparoscopic tubal ligation.
• Hysteroscopic Tubal Ligation: This method involves accessing the fallopian tubes
through the cervix, without making any external incisions. A hysteroscope (a thin,
lighted tube) is used to guide the placement of small implants or coils inside the
fallopian tubes, causing scar tissue to form and block the tubes.
The use of spring clips is associated with the highest rate of pregnancy following
sterilization.

10. ➡Before undergoing tubal ligation, the patient should be informed that
an IUD, if present, will be removed.
➡If the patient is taking oral contraceptives, she usually continues them
up to the time of the procedure.
➡If a laparoscopic procedure is performed, the patient may experience
postoperative abdominal or shoulder discomfort for a few days, related
to the carbon dioxide gas and the manipulation of organs.
➡The patient is instructed to report heavy bleeding, fever, or pain that
persists or increases.
➡She should avoid intercourse, strenuous exercise, and lifting for 2
weeks.

11. Advantages of tubal ligation:
• Highly Effective: Tubal ligation is very effective in preventing pregnancy, with a failure rate
of less than 1%.
• Permanent: It provides long-lasting contraception without the need for ongoing
maintenance or remembering to use contraceptives.
• Doesn't Affect Hormones: Unlike some hormonal contraceptive methods, tubal ligation
does not involve altering hormone levels.
Disadvantages of tubal ligation:
• Irreversible: Reversal is not always successful, and the chances of conceiving again after
reversal are not guaranteed.
• Surgical Procedure: Tubal ligation requires a surgical procedure, which carries risks
associated with anesthesia and surgery.
• No Protection Against STIs: Tubal ligation does not protect against sexually transmitted
infections (STIs).
• Personal Decision: The decision to undergo tubal ligation should be carefully considered, as
it is intended to be a permanent choice.

12. Transcervical tubal occlusion (TCTO)
➡Transcervical tubal occlusion (TCTO) is a minimally invasive method of
permanent female contraception that involves blocking the fallopian tubes
without the need for an abdominal incision or general anesthesia.
➡This procedure is also known as “Essure procedure” and “Adiana."
➡TCTO is designed to create scar tissue within the fallopian tubes, which
eventually blocks the tubes and prevents sperm from reaching the eggs.
➡Women who have had this procedure should abstain from unprotected
intercourse for 3 months to avoid pregnancy until the scar tissue develops and
the effectiveness of the procedure is verified by HSG.

13. • Placement of Devices: Small, flexible devices (such as coils or inserts) are
inserted through the cervix and into the openings of the fallopian tubes. These
devices are usually made of materials that promote the growth of scar tissue.
• Stimulation of Scar Tissue Formation: Over time, the presence of the devices
triggers an inflammatory response within the fallopian tubes. Scar tissue gradually
forms around the devices, causing the tubes to become blocked. This process
typically takes a few months.
• Confirmation of Tubal Occlusion: To ensure that the fallopian tubes are
effectively blocked, follow-up tests are conducted. These tests might include
hysterosalpingography (HSG), where a contrast dye is injected into the uterus and
an X-ray is taken to confirm that the tubes are blocked.

14. Advantages of Transcervical Tubal Occlusion:
• Minimally Invasive: TCTO is a relatively non-surgical procedure that doesn't
require abdominal incisions.
• Local Anesthesia: The procedure is often performed under local anesthesia,
which reduces the risks associated with general anesthesia.
• Quick Recovery: Recovery time is typically shorter compared to traditional
surgical methods like laparoscopic tubal ligation.
• No Hormones: TCTO doesn't involve the use of hormones, making it a
hormone-free contraceptive option.
• Permanent Contraception: Once the fallopian tubes are blocked, the
contraceptive effect is intended to be permanent.

15. Disadvantages of Transcervical Tubal Occlusion:
• Effectiveness Takes Time: It takes several months for the scar tissue to form and
effectively block the fallopian tubes. During this time, alternative contraception
must be used.
• Potential Complications: While the procedure is minimally invasive, there can
still be risks, including pain, discomfort, and potential device-related issues.
• Not Immediately Effective: TCTO is not immediately effective as a
contraceptive method; other contraception must be used until confirmation of
successful tubal occlusion.
• Limited Reversibility: Reversing the procedure might be challenging, and
successful reversal is not guaranteed.
• Follow-Up Required: Follow-up tests are necessary to confirm that the fallopian
tubes are properly blocked.

16. Vasectomy
Vasectomy is a surgical procedure for
permanent male contraception.
It involves cutting or blocking the vas
deferens, the tubes that carry sperm from the
testicles to the urethra.
By interrupting the flow of sperm, vasectomy
prevents the sperm from reaching the semen
that is ejaculated during sexual activity.
This makes it highly effective in preventing
pregnancy.

17. Advantages
• Highly effective
• Relieves female of contraceptive
burden
• Inexpensive in long run
• Permanent
• Highly acceptable procedure to
most patients
• Very safe
• Quickly performed
Disadvantages
• Expensive in short term
• Serious long-term effects suggested (although
currently unproved)
• Permanent (although reversal is possible, it is
expensive and requires highly technical and major
surgery, and results cannot be guaranteed)
• Regret in 5%–10% of patients
• No protection against STDs, including HIV
• Not effective until sperm remaining in
reproductive system are ejaculated

18. HORMONAL CONTRACEPTION
➡Oral contraceptives block ovarian stimulation by preventing the release of FSH from the
anterior pituitary gland.
➡In the absence of FSH, a follicle does not ripen, and ovulation does not occur.
➡Progestins (synthetic forms of progesterone) suppress the LH surge, prevent ovulation, and also
render the cervical mucus impenetrable to sperm.
➡Hormonal contraceptive agents may be oral, transdermal, vaginal, or injectable.
➡Combined oral contraceptives that contain both estrogens and progestins are currently used by
many women to prevent pregnancy.

19. Benefits and Risks of Combination Hormonal Contraceptives
Benefits
• Decreased cramps and bleeding
• Regular bleeding cycle
• Decreased incidence of anemia
• Decrease in acne with some formulations
• Protection from uterine and ovarian cancer
• Decreased incidence of ectopic pregnancy
• Protection from benign breast disease
• Decreased incidence of pelvic infection
Risks
•Rare in healthy women
•Bothersome side effects (eg, breakthrough
bleeding, breast tenderness)
•Nausea, weight gain, mood changes
•Small increased risk of developing blood clots,
stroke, or heart attack, related more to smoking
than to oral contraceptive use alone
•Possible increased incidence of benign liver
tumors and gallbladder disorders
•No protection from STDs/STIs (possible
increased risk with unsafe sex)

20. Contraindications
Absolute contraindications to hormonal contraceptives include
•Current Or Past Thromboembolic Disorder
•Cerebrovascular Disease, Or Artery Disease
•Migraine Headaches With Visual Auras
•Suspected Breast Cancer
•Known Or Suspected Current Or Past Estrogen-Dependent Neoplasia
•Pregnancy
•Current Or Past Benign Or Malignant Liver Tumors
•Liver Dysfunction
•Clotting Disorders
•Congenital Hyperlipidemia
•Abnormal Vaginal Bleeding.
Relative contraindications include hypertension, bile induced jaundice, acute phase of
mononucleosis, and sickle cell disease.

21. Methods of Hormonal Contraception
Combination methods include the combination of oral contraceptive
pills, vaginal ring (NuvaRing), and transdermal patch (Ortho Evra).
Progestin-only methods include the progestin-only pills or minipills,
progestin-only emergency contraception (Plan B), once-every-3-month
injection (Depo-Provera), levonorgestrel-releasing intrauterine system
(Mirena), and single-rod subdermal implant (Implanon).

22. Oral contraceptives
Oral contraceptives, commonly referred to as birth control pills or simply
"the pill," are a type of hormonal contraception taken orally by individuals
who want to prevent pregnancy.
These pills contain synthetic hormones that mimic the effects of natural
hormones in the body to prevent ovulation (the release of an egg from the
ovaries) and create an environment that is less conducive to fertilization
and implantation.

23. Transdermal contraceptives
‣ Transdermal contraceptives, also known as contraceptive patches, are a form of
hormonal contraception that delivers synthetic hormones through the skin to prevent
pregnancy.
‣ Similar to oral contraceptives, these patches release hormones into the bloodstream to
inhibit ovulation, thicken cervical mucus, and alter the uterine lining to make it less
receptive to implantation.
‣ The primary difference is the method of delivery: patches are applied directly to the
skin rather than being taken orally.
‣ It is changed every week for 3 weeks, and no patch is used dur- ing the fourth week,
resulting in withdrawal bleeding.
‣ The patch may be applied to the torso, chest, arms, or thighs; it should not be applied to
the breasts.
‣ It irritate skin conditions (eg, psoriasis) in some women and results in higher blood
estrogen levels than oral contraceptives.

24. Vaginal Contraceptives
• NuvaRing (etonogestrel/ethinyl estradiol vaginal ring) is a combination hormonal
contraceptive that releases estrogen and progestin.
• It is inserted in the vagina for 3 weeks and then removed, resulting in withdrawal
bleeding. It is as effective as oral contraceptives and results in lower hormone blood
levels than oral contraceptives.
• NuvaRing is flexible, does not require sizing or fitting, and is effective when placed
anywhere in the vagina.
Injectable Contraceptives
• An intramuscular injection of Depo-Provera (a long-acting progestin) every 3 months
inhibits ovulation and provides a reliable, private, and convenient contraceptive
method.
• A subcutaneous formulation is also available.
• It can be used by lactating women and those with hypertension, liver disease, migraine
headaches, heart disease, and hemoglobinopathies.

25. • Injectable contraceptives are a form of hormonal birth control that involves receiving
injections of synthetic hormones to prevent pregnancy.
• These hormones are usually similar to those found in combination birth control pills
(estrogen and progestin) or, in some cases, only progestin.
• Injectable contraceptives offer a longer-lasting alternative to daily pill use and are available
in two main types: the combination injectable and the progestin-only injectable.
Implants
• Implanon is a single-rod subdermal implant that is usually placed inside the upper arm via
a small incision.
• It is effective for 3 years.
• Implanon may cause irregular bleeding but may improve dysmenorrhea, and it does not
affect bone density. This contraceptive can be used by lactating women.
•

26. INTRAUTERINE DEVICE
‣An IUD is a small plastic device, usually T-shaped, that is inserted into the
uterine cavity to prevent pregnancy.
‣A string attached to the IUD is visible and palpable at the cervical os.
‣An IUD prevents conception by causing a local inflammatory reaction that is
toxic to spermatozoa and blastocysts, thus preventing fertilization.
‣The IUD does not work by causing abortion.

27. Hormonal IUD:
• Mechanism of Action: Hormonal IUDs release synthetic progestin hormone
into the uterus. This hormone thickens cervical mucus, making it harder for
sperm to reach the egg, and it can also inhibit ovulation in some cases.
• Usage: Hormonal IUDs are typically effective for 3 to 5 years, depending on
the specific brand and formulation.
Non-Hormonal (Copper) IUD:
• Mechanism of Action: Copper IUDs are wrapped with a copper wire, which
creates an environment that is toxic to sperm, preventing fertilization. They do
not release hormones.
• Usage: Copper IUDs can be effective for up to 10 years, depending on the type.

28. Advantages
•Effectiveness over a long period of time.
•This reversible method of birth control is as effective as sterilization and more effective than
barrier methods.
Disadvantages
•Possible excessive bleeding, cramps, and backaches; a slight risk of tubal pregnancy; slight risk
of pelvic infection on insertion; displacement of the device; and, rarely, perforation of the cervix
and uterus.
•If a pregnancy occurs with an IUD in place, the device is removed immediately to avoid
infection.
•Spontaneous abortion (miscarriage) may occur on removal. An IUD is not usually used in
women who have not had children because a small nulliparous uterus may not tolerate it
•Women with multiple partners, women with heavy or crampy periods, or those with a history of
ectopic pregnancy or pelvic infection should be encouraged to use other methods of
contraception.

29. MECHANICAL BARRIERS
Diaphragm
•The diaphragm is an effective contraceptive device that consists of a round, flexible
spring (50 to 90 mm wide) covered with a domelike latex rubber cup.
•A spermicidal (contraceptive) jelly or cream is used to coat the concave side of the
diaphragm before it is inserted deep into the vagina, covering the cervix completely.
•The spermicide inhibits spermatozoa from entering the cervical canal.
•The diaphragm is not felt by the user or her partner when properly fitted and inserted.
•Because women vary in size, the diaphragm must be sized and fitted by an
experienced clini- cian.
•The woman is instructed in using and caring for the device. A return demonstration
ensures that the woman can insert the diaphragm correctly and that it covers the
cervix.

31. • Spermicide: To enhance its effectiveness, the diaphragm is often used in
conjunction with spermicide, a chemical substance that immobilizes or kills
sperm. Spermicide is applied to the diaphragm before insertion. It helps to further
prevent sperm from moving past the barrier.
• Correct Usage: It's important to use the diaphragm correctly for it to be effective.
This involves ensuring proper insertion and making sure it remains in place
during intercourse. After intercourse, the diaphragm should be left in place for a
few hours to ensure that any remaining sperm are immobilized by the spermicide.
• Reusability: Diaphragms are reusable and can be washed and stored for future
use.

32. ➡Each time the woman uses the diaphragm, she should examine it carefully.
➡By holding it up to a bright light, she should ensure that it has no pinpoint holes,
cracks, or tears. She then applies spermicidal jelly or cream and inserts the diaphragm.
➡The diaphragm should remain in place at least 6 hours after coitus (no more than 12
hours).
➡Additional spermicide is necessary if more than 6 hours have passed before
intercourse occurs and before each act of repeated intercourse.
➡On removal, the diaphragm should be cleansed thoroughly with mild soap and water,
rinsed, and dried before being stored in its original container.
➡Disadvantages include allergic reactions in those who are sensitive to latex and an
increased incidence of urinary tract infections. Toxic shock syndrome has been
reported in some diaphragm users but is rare.

33. CONTRACEPTIVE SPONGE
➡The contraceptive sponge is another form of barrier contraception, similar in
principle to the diaphragm.
➡It is a small, round, soft device made of polyurethane foam that is designed to be
inserted into the vagina before sexual intercourse to prevent pregnancy.
➡The contraceptive sponge combines both a physical barrier and a chemical
component to provide contraception.
➡It contains and releases a spermicide (eg, nonoxynol-9) that is continuously
released into the vagina in small amounts through a 24-hour wear time.
➡The sponge is left in place in the vagina for at least 6 hours after intercourse and
can be kept in place for up to 24 additional hours without the need to replace it
with repeated acts of intercourse during that period of time

35. Female Condom
➡The female condom was developed to give control
of barrier protection to women to provide them with
protection from STDs and HIV as well as pregnancy.
➡The female condom (Reality) consists of a cylinder
of polyurethane enclosed at one end by a closed ring
that covers the cervix and at the other end by an open
ring that covers the perineum.
➡Advantages include some degree of protection from
STDs (HPV, herpes simplex virus, and HIV).
➡Disadvantages include the inability to use the
female condom with some positions (ie, standing).
Women have found that it can be noisy and slippery.

36. Spermicides
Spermicides are chemical substances designed to immobilize or kill sperm, providing an
additional layer of contraception when used in combination with barrier methods like
diaphragms, contraceptive sponges, cervical caps, or even condoms.
They work by disrupting the structure and function of sperm cells, thus preventing them
from successfully fertilizing an egg.
• Forms: Spermicides come in various forms, including creams, gels, foams, films,
suppositories, and lubricants. These formulations are designed for vaginal use and are
inserted into the vagina before intercourse. Some condoms also come pre-lubricated
with spermicide.
• Active Ingredients: The active ingredient in most spermicides is a chemical called
nonoxynol-9. This compound attacks the sperm's cell membrane, rendering the sperm
unable to swim effectively and reducing their ability to penetrate the cervical mucus
and reach the egg.

37. • Usage: Spermicides need to be applied deep into the vagina before sexual
intercourse. The specific instructions for use can vary based on the product, so it's
important to carefully read and follow the manufacturer's guidelines.
• Time Frame: Spermicides typically need some time to become effective.
Depending on the product, you might need to wait for a certain period (usually
around 10 to 15 minutes) after application before engaging in sexual activity. This
allows the spermicide to disperse and take effect.
• Reapplication: If additional rounds of intercourse are planned within a certain time
frame (usually within a few hours), it's often recommended to reapply more
spermicide before each subsequent act.
• Effectiveness: Spermicides are generally less effective on their own compared to
some other forms of contraception. They are more effective when used in
combination with other barrier methods like diaphragms or condoms. The typical
failure rate for spermicides is around 28% with typical use

38. Male Condom
➡The male condom is an impermeable, snug-
fitting cover applied to the erect penis before it
enters the vaginal canal.
➡The tip of the condom is pinched while being
applied to leave space for ejaculate.
➡If no space is left, ejaculation may cause a tear or
hole in the condom and reduce its effectiveness.
➡The penis, with the condom held in place, is
removed from the vagina while still erect to
prevent the ejaculate from leaking.
➡Condoms are now available in large and small
sizes.
➡They are a protective sheath typically made of
latex or polyurethane that is worn over the penis
during sexual intercourse

39. Coitus Interruptus Or Withdrawal
Coitus interruptus (removing the penis from the vagina before ejaculation) requires
careful control by the male partner. Although it is a frequently used method of
preventing pregnancy and better than no method, it is considered an unreliable
method of contraception.

40. RHYTHM AND NATURAL METHODS
Methods
Calendar method
Basal body temperature method
Ovulation method
Symptothermal method
➡Combinations of these methods are often used.
➡The fertile phase (in which sexual abstinence is required) is estimated to occur
about 14 days before menstruation, although it may occur between the 10th and 17th
days.
➡Spermatozoa can fertilize an ovum up to 72 hours after intercourse, and the ovum
can be fertilized for 24 hours after leaving the ovary.
➡The pregnancy rate with the rhythm (ie, calendar) method is about 40% yearly.

41. CALENDAR METHOD
The calendar method, also known as the rhythm method or fertility awareness method, is a natural
family planning technique used to predict a woman's fertile and non-fertile days in her menstrual
cycle. This method is based on tracking the menstrual cycle to identify the days when pregnancy is
most likely to occur and avoiding unprotected sexual intercourse during those times if the goal is to
prevent pregnancy.
• Understanding the Menstrual Cycle: The menstrual cycle consists of different phases,
including the follicular phase (before ovulation), ovulation (when an egg is released from the
ovary), and the luteal phase (after ovulation). Ovulation is the most fertile phase, as an egg can
be fertilized by sperm during this time.
• Tracking Menstrual Cycles: To use the calendar method, a woman needs to track her
menstrual cycles over a period of several months to identify patterns and average cycle
lengths.
• Determining Fertile Days: The fertile days are calculated by estimating the time of ovulation.
This is typically done by identifying the shortest and longest menstrual cycles and then using
these values to calculate a fertile window. The fertile window usually includes a few days
before and after the estimated day of ovulation.

42. Avoiding Unprotected Intercourse:
During the fertile window, couples
using the calendar method for
contraception should avoid unprotected
sexual intercourse if they want to
prevent pregnancy.
This can be achieved by using other
forms of contraception or by abstaining
from intercourse during these days.

43. The basal body temperature (BBT) method is a natural family planning technique that
involves tracking a woman's basal body temperature throughout her menstrual cycle to identify
the fertile and non-fertile days.
This method relies on the fact that a woman's body temperature slightly increases after ovulation
due to the hormonal changes associated with the release of an egg from the ovary.
Understanding Basal Body Temperature: Basal body temperature refers to the body's resting
temperature, usually measured immediately upon waking up in the morning before any physical
activity. Ovulation causes a subtle increase in basal body temperature due to the rise in
progesterone levels after the release of an egg.
Temperature Tracking: To use the BBT method, a woman needs to track her temperature every
morning using a specialized basal body thermometer. This thermometer measures temperature in
fractions of a degree, allowing for accurate tracking of even small changes.
Creating a BBT Chart: The recorded temperatures are plotted on a graph or chart over the
course of several menstrual cycles. This helps establish a pattern and identify changes in
temperature.

44. • Identifying the Shift: After ovulation occurs, there is a noticeable increase in
basal body temperature, usually ranging from 0.4 to 1.0 degrees Fahrenheit (0.2
to 0.5 degrees Celsius). This temperature rise remains elevated for the remainder
of the menstrual cycle.
• Determining Fertility: The fertile window is the few days leading up to and
including the day of ovulation. By tracking the BBT shift, a woman can identify
when ovulation has likely occurred and use this information to determine her
fertile days.
• Avoiding Unprotected Intercourse: Couples using the BBT method for
contraception would avoid unprotected sexual intercourse during the fertile
window, especially on the days leading up to and immediately following the
BBT shift.
• 3-6 CYCLES

45. The "Ovulation Method," also known as the Billings Ovulation Method or the Billings Method,
is a natural family planning method used to track a woman's fertility cycle and determine the
times when she is most and least likely to conceive. It relies on observing changes in cervical
mucus to predict ovulation.
The method involves paying close attention to the changes in the consistency and appearance of
cervical mucus throughout a woman's menstrual cycle. Cervical mucus is a fluid produced by the
cervix, and its characteristics change in response to hormonal fluctuations during the menstrual
cycle.
Infertile Phase: In the days following menstruation, the cervical mucus is typically dry, sticky, or
scant. This is considered the infertile phase, as it indicates that ovulation is not imminent.
Fertile Phase: As ovulation approaches, the cervical mucus becomes more abundant, slippery,
clear, and stretchy, resembling the consistency of raw egg whites. This fertile cervical mucus
helps facilitate the movement of sperm through the reproductive tract and is a sign that ovulation
is likely to occur soon.

46. Couples using the Ovulation Method can consider themselves fertile when they observe the
presence of fertile-type cervical mucus. This is the window when conception is more likely to
occur. Once the cervical mucus returns to its less fertile characteristics, the couple can consider
themselves infertile again.

47. The Symptothermal Method is another natural family planning method
that combines the observation of multiple fertility signs to track a woman's
menstrual cycle and predict ovulation.
Unlike the Ovulation Method, which primarily relies on observing changes
in cervical mucus, the Symptothermal Method incorporates several
indicators, including basal body temperature, cervical mucus, and
optionally, changes in the cervix and secondary fertility signs.

48. ➡ Ovulation detection methods (eg, Clearblue Easy Fertility Monitor) are
available in most pharmacies. The presence of the enzyme guaiacol peroxidase
in cervical mucus signals ovulation 6 days beforehand and also affects mucosal
viscosity.
➡ Over-the-counter test kits are easy to use and reliable but can be expensive.
➡ Ovulation prediction kits are more effective for planning conception than for
avoiding it.
➡ But if they are used in combination with cervical mucus changes and the
calendar method, they may be effective; further research is needed.
➡ Douching is not a contraceptive method and may enhance rather than decrease
the chances of conception.

49. EMERGENCY CONTRACEPTION
The need for emergency contraception may arise after an episode of unprotected sexual
intercourse.Therefore, nurses need to be aware of emergency contraception as an option
for women and the indications for its use.
Hormonal methods used as emergency contraception, often referred to as "emergency
contraceptive pills" or "morning-after pills," are a type of birth control that can be taken
after unprotected intercourse or contraceptive failure to reduce the risk of pregnancy.
•These methods primarily work by preventing or delaying ovulation, which is the
release of an egg from the ovary. They may also alter the cervical mucus and the
uterine lining, making it less conducive for fertilization and implantation.
•Levonorgestrel (Progestin-only) Emergency Contraceptive Pills( can be taken up to
72 or 120 hours (depending on the specific brand) after unprotected
intercourse.These pills contain a synthetic progestin hormone called levonorgestrel.)

50. •Ulipristal Acetate Emergency
Contraceptive Pills ( This type of
emergency contraceptive pill is
available by prescription and can be
taken up to 120 hours after
unprotected intercourse)(Ulipristal
acetate is a selective progesterone
receptor modulator).

51. Postcoital Intrauterine Device Insertion
•Postcoital IUD insertion, another form of emergency contraception, involves
insertion of a copper-bearing IUD within 5 days of coitus in women who want
this method of contraception; however, it may be inappropriate for some women
or if contraindications exist.
•The mechanism of action is unknown, but it is thought that the IUD interferes
with fertilization. The patient may experience discomfort on insertion and may
have heavier menstrual periods and increased cramping.
•Contraindications include a confirmed or suspected pregnancy or any
contraindication to regular copper IUD use.
•The patient must be informed that there is a risk that insertion of an IUD may
disrupt a pregnancy that is already present.