This document discusses various methods of family planning, including injections, implants, patches, IUDs, and sterilization. It provides details on the mechanisms of action, efficacy, benefits, procedures, side effects, return to fertility, and contraindications for each method. The injections discussed are progestin-only and combined methods administered monthly or every 2-3 months via intramuscular injection. Implants and IUDs are long-acting reversible options placed surgically or inserted into the uterus. Sterilization methods include vasectomy for men and tubal ligation for women. Comparative information is also provided to help evaluate the options.

1. Family Planning-Part 2
By: Ismah Haron

2. Injections
Implant
Patch IUD
Surgical
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3. INJECTIONS
Progestin
only
DMPA NET-EN
Monthly
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4. Progestin only injectable
• Mechanism: preventing ovulation
• Efficacy: 3 per 100 women
• Benefits:
- Don’t require daily action
- Cause no monthly bleeding
- Can be used throughout breastfeeding
- Help protect against endometrial ca, uterine fibroids, IDA
- May help to gain weight
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5. • Method:
- IM
- Repeat in 3 months (DMPA) and 2 months (NET-EN)
• Side effects:
- Bleeding changes
- Headaches
- Dizziness
- Increased blood pressure
- Mood changes
- Loss of bone density
• Return of fertility: DMPA 4 months longer, NET-EN 1 month
longer
06/08/2014 5Picture from: Family Planning; A Global Handbook For Providers WHO 2011 Update

6. • Contraindications:
- Serious active liver disease
- High blood pressure (≥160/100 mmHg)
- Diabetes more than 20 years or with complications (arteries,
vision, kidneys, nervous system)
- Stroke, DVT, heart attack
- Breast ca
- Migraine aura
• Can come 2 weeks early for injections
• DMPA: can come up to 4 weeks late
• NET-EN: can come up to 2 weeks late
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7. Monthly injectable
• Contains progestin + estrogen
• Mechanism: preventing ovulation
• Efficacy: 3 per 100 women
• Benefits:
- Don’t require daily action
- Cause no monthly bleeding
- May help to gain weight
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8. • Method:
- IM
- Repeat every 4 weeks
• Side effects:
- Bleeding changes
- Headaches
- Dizziness
- Increase blood pressure
- Breast tenderness
• Return of fertility: about 1 month longer
06/08/2014 8Picture from: Family Planning; A Global Handbook For Providers WHO 2011 Update

9. • Contraindications:
- Serious active liver disease
- High blood pressure (≥140/90 mmHg)
- Diabetes more than 20 years or with complications (arteries,
vision, kidneys, nervous system)
- Stroke, DVT, heart attack
- Breast ca
- Migraine aura
- Fully breastfeeding
- ≥ 35 years old and smokes >15 cigarettes/day
- Taking lamotrigine/ritonavir
• Can come 7 days early or late for injections
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10. Combined patch
• Contains progestin + estrogen
• Mechanism: preventing ovulation
• Method:
- Worn on body every day and night
- Can be worn on arm, back, abdomen or buttock
- New patch every week for 3 weeks followed by a week
with no patch
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11. • Side effects:
- Bleeding changes
- Headaches
- Dizziness
- Skin irritation
- URTI
• Return of fertility: immediately
• Can apply it up to 48 hours late
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12. Implants
• Small plastic rods/capsule that contains progestin
• Mechanism:
- Thickening cervical mucus
- Preventing ovulation
• Efficacy: 5 per 10 000 women
• Benefits:
- Don’t require daily action
- Can be used during breastfeeding
- Cause no monthly bleeding
- Protect against PID, IDA
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13. TYPES OF
IMPLANTS
Implanon
– 3 years
Jadelle
– 5 years
Norplant
– 7 years
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The effectiveness
will be lose earlier in
heavier women

14. • Method:
- Minor surgical procedure
- Placed under the skin
06/08/2014 14Picture from: Family Planning; A Global Handbook For Providers WHO 2011 Update

15. • Side effects:
- Bleeding changes
- Headaches
- Dizziness
- Weight gain
- Breast tenderness
- Abdominal pain
- Can either improve/worsen acne
- Infections at site of implant
- Expulsion of the implant
- Enlarged ovarian follicles
• Return of fertility: immediately
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16. • Contraindications:
- Serious active liver disease
- DVT
- Breast ca
06/08/2014 16Picture from: Family Planning; A Global Handbook For Providers WHO 2011 Update

17. IUD
Copper bearing Levonorgestrel
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18. Copper-bearing IUD
• Mechanism: causing chemical change 
damage sperm
• Efficacy: 6 to 8 per 1000 women
• Benefits:
- Don’t require daily action
- Can be used throughout breastfeeding
- Help protect against endometrial ca
- Long lasting
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19. • Method:
- Effective up to 12 years
- Determine the uterus size and
anatomical position
• Side effects:
- Bleeding changes
- More cramps and pain during monthly bleeding
- Perforation of the IUD
• Return of fertility: immediately
06/08/2014 19Picture from: Family Planning; A Global Handbook For Providers WHO 2011 Update

20. • Contraindications:
- Gynecological/obstetric problems e.g. cervical
ca
- AIDS
- STD
- Pregnant
- Anatomical abnormality of uterine cavity
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21. Levonorgestrel IUD
• Contains progestin
• Mechanism: suppress endometrium
growth
• Efficacy: 2 per 1000 women
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22. • Benefits:
- Don’t require daily action
- No monthly bleeding
- Can be used throughout breastfeeding
- Protect against IDA, PID
- Reduces menstrual cramps
• Method:
- Effective up to 5 years
- Determine the uterus size and
anatomical position
06/08/2014 22Picture from: Family Planning; A Global Handbook For Providers WHO 2011 Update

23. • Side effects:
- Bleeding changes
- Acne
- Headaches
- Breast tenderness
- Ovarian cyst
- Perforation
• Return of fertility: immediately
• Contraindications:
- DVT, severe liver disease, breast ca
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24. STERILIZATIO
N
Male Female
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25. Vasectomy
• Mechanism: closing off vas deferens
• Efficacy: 2 per 1000 women
• Benefits:
- Permanent
- Fewer side effects and complications
06/08/2014 25Picture from: Decision-making tool for family planning clients and providers WHO 2005

26. • Complication (rare):
- Severe scrotal/testicular pain
- Infections at the incision sit
• 3 months delay in taking effect
• Return of fertility: None
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27. Caution, delay & special arrangement for
vasectomy
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CAUTION DELAY SPECIAL
ARRANGEMENT
Previous scrotal injury Active STD Hernia in groin
Large
varicocele/hydrocele
Both sides
undescended testicle
One side undescended
testicle
AIDS
Diabetes, depression Coagulations disorder
Young age

28. Female sterilization
• Mechanism: blocked fallopian tubes
• Efficacy: 5 per 1000 women
• Benefits:
- No side effects
- Easy to use
- Protect against PID, ovarian ca
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29. • Method:
- Tubal ligation
- Minilaparotomy or laparoscopy
• Return of fertility: none
06/08/2014 29Picture from: Decision-making tool for family planning clients and providers WHO 2005

30. Caution, delay & special arrangement for
female sterilization
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CAUTION DELAY SPECIAL
ARRANGEMENT
Breast ca Currently pregnant AIDS
Uterine fibroids PID Endometriosis
Previous
abdominal/pelvic
surgery
STD Abdominal wall/
umbilical hernia
Controlled hypertension DVT ≥ 160/100 mmHg
Kidney disease Severe IDA (Hb <7
g/dL)
Hyperthyroidism

31. Comparing methods
06/08/2014 31Source: Decision-making tool for family planning clients and providers WHO 2005

32. THANK YOU
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References:
1. Family Planning; A Global Handbook For Providers WHO 2011 Update
2. Medical Eligibility Criteria For Contraceptive Use 4th Edition WHO 2009
3. Selected Practice Recommendation For Contraceptive Use WHO 2008
Update
4. Decision-making Tool For Family Planning Clients And Providers WHO
2005