The document outlines various contraceptive methods, categorized into spacing and terminal methods, with a focus on barrier methods, intrauterine devices (IUDs), hormonal contraceptives, and emergency contraception. It discusses advantages and disadvantages, failure rates, and guidelines for use, emphasizing the importance of informed choice in family planning. Additionally, it covers specific devices such as condoms, diaphragms, copper IUDs, and hormonal IUDs, detailing their mechanisms of action and related health considerations.

1. CONTRACEPTIVE
METHODS

2. CONTRACEPTIVE
METHODS
• Contraceptive methods are, by definition, preventive methods to help
women avoid unwanted pregnancies.
• The present approach in family planning programmes is to provide a
"cafeteria choice" that is to offer all methods from which an
individual can choose according to his needs and wishes and to promote
family planning as a way of life.

3. I. Spacing methods
1. Barrier methods
(a) Physical methods
(b) Chemical methods
(c) Combined methods
2. Intra-uterine devices
3. Hormonal methods
4. Post-conceptional methods
5. Miscellaneous.
II. Terminal methods
1. Male sterilization
2. Female sterilization.

4. PHYSICAL
METHODS
COMBINED
METHODS
CHEMICAL
METHODS
1. Condoms
2.Diaphragm
3.Vaginal
sponge
1. Foams :- tablets,
aerosols
2.Creams, jellies
and pastes
3.Suppositories
4.Soluble films
SPACING METHODS
BARRIER METHODS

5. PHYSICAL METHODS

6. CONDOM
• Condom is the most widely known and used barrier device by the males
around the world.
• In India, it is better known by its trade name NIRODH, a Sanskrit word,
meaning prevention.
• Made up of Latex.
• Available for both male and female.
Advantage- 1. Easily available , safe & inexpensive
2. Easy to use, no medical supervision
3. Provide protection not only against
pregnancy but also against STD’s.
4. For one who have contraindications to the use
of oral contraceptive and IUD’S

7. Disadvantage- 1. May slip or tear off during coitus
2. Allergic reaction
3. To discard after one coital act
Failure rate- 2-3/100 - 14/100 women/year
Most failure rates are due to incorrect use.

8. FEMALE CONDOM (FEMIDOME)
• The female condom is a pouch made of polIyurethane, which lines the vagina.
• An internal ring in the close end of the pouch covers the cervix and an external
ring remains outside the vagina.
• It is prelubricated with silicon, and a spermicide need not be used.
• It is an effective barrier to STD infection. However, high cost and acceptability
are major problems.
• Failure rate- 5/100 - 21/100 women/year

9. Diaphragm (Dutch cap)
• It is a Reusable shallow cup made up of synthetic rubber or plastic material
which act as a vaginal barrier.
• It ranges in diameter from 5-10 cm (2-4 inches).
• It has a flexible rim made of spring or metal.
• The diaphragm is inserted before sexual intercourse and must remain in place
for not less than 6 hours after sexual intercourse.
• A spermicidal jelly is always used along with the diaphragm.
• The diaphragm holds the spermicide over the cervix.
• Failure rate- 6-12/100 women/year

10. Diaphragm conte…
Advantage:- no risk or medical
contradiction
Disadvantage:- 1.Require a trained person
to demonstrate.
2.If left for beyond 24hrs. there is a possibility
of developing a toxic shock syndrome.
Relative Contraindications : Latex
allergy, Uterine prolapse, Repeated UTIs

11. Diaphragm conte…
• Variations of the diaphragm include the
Cervical cap, Vault cap and the Vimule
cap.
• The cervical cap is smaller than the
diaphragm and can be left in place
longer.
• The cervical cap is more difficult for
women to learn to insert and remove
than the diaphragm. Mild allergic
reactions to the silicone or spermicide
occasionally occur.
• These devices are not recommended in
the National Family Welfare Programme.

12. VAGINAL SPONGE
• It is a small polyurethane foam sponge measuring 5 cm x 2.5 cm,
saturated with spermicide(Nonoxynol-9) commercially marketed
in USA under the trade name TODAY .
• The sponge is far less effective than the diaphragm, but it is better
than nothing.
Failure rate-
In parous women :- 20-40/100women/year
In nulliparous women:- 9-20/100women/year

13. CHEMICAL METHODS
• Spermicides (vaginal chemical contraceptives) are “Surface
Active Agents” which attach themselves to spermatozoa and
inhibit oxygen uptake and kill sperms.
Drawbacks:- 1. High failure rate
2. Require training
3. Mild burning and irritation.
• No spermicide is safe to use has yet been found to be really
effective in preventing pregnancy when used alone .
• Therefore, spermicides are not recommended by
professional advisers.

14. COMBINED DEVICES
• Using chemical contraceptives with condoms is known as combined
devices or method.
• It provides deep and double protection against pregnancy.

15. INTRA-UTERINE
DEVICES

16. INTRA-UTERINE DEVICES
• LIPPES LOOP
FIRST
GENERATION
• COPPER IUD’S
SECOND
GENERATION
• HORMONE RELEASING
THIRD
GENERATION

17. • It is a non medicated (inert) device, usually made of
polyethylene, to be inserted in the uterus.
• They are available in different shape and sizes-loops ,
coils, rings and spirals.
LIPPES LOOP
FIRST GENERATION IUD’S
• It is a double S shaped device made of polyethylene,
with a tail of nylon thread which projects into vagina
after insertion, and can be easily felt to reassurance
by the user.

18. SECOND
GENERATION
NEWER
DEVICES
Variants of T
devices
T CU 220 C
T CU 380 A/AG
MULTI LOAD
DEVICES
ML CU 250
ML CU 375
NOVA T
EARLIER
DEVICES
CU-7
CU-T 200

19. • It was found that metallic copper had a strong anti-fertility effect.
• The addition of copper has made it possible to develop smaller devices
which are easier to fit.
• The numbers included in the names of the devices refer to the surface area
(in sq. mm) of the copper on the device.
• Nova T and Cu-T- 380 Ag are distinguished by a silver core over which the
copper wire is wrapped.
• Advantages of copper devices
• Low expulsion rate
• Lower incidence of side-effects, e.g., pain and bleeding
• Easier to fit even in nulliparous women
• Increased contraceptive effectiveness
• Effective as post-coital contraceptives, if inserted within 3-5 days of
unprotected intercourse.
SECOND GENERATION CONTE..

21. • CuT 380A - It is a T shaped device with a polyethylene frame holding
380 mm2 of exposed surface area of copper. The IUD frame contains
barium sulfate thus making it radio-opaque.
• CuT-380Ag - It is identical to 380 A except that the copper wire on the
stem has a silver core to prevent fragmentation and extend the life span of
the copper.
• No Touch Withdrawal Technique is used for insertion.
CuT 380A CuT-380Ag

22. Levonorgestrel IUD releases the hormone at an approximate rate
of 20 micrograms per day and effective for five years.

23. Copper IUDs
Copper wire or copper sleeves are put on the plastic frame (polyethylene frame). Examples include Copper T, CuT380
A, Multiload 375 etc.
The various types of Copper IUDs differ from each other by the amount of copper. The initial Copper IUDs were
wound with 200-250 mm2 wire (CopperT 200). The modern copper containing devices contain more copper and a
part of copper in the form of solid tubal sleeves rather than wire. This increases the efficacy and lifespan (Cu T-380 A).
• CuT 380A - It is a T shaped device with a polyethylene frame holding 380 mm2 of exposed surface area of copper.
The IUD frame contains barium sulfate thus making it radio-opaque.
• CuT-380Ag - It is identical to 380 A except that the copper wire on the stem has a silver core to prevent
fragmentation and extend the life span of the copper.
• CuT 380 slimline - It has copper sleeves flushed at the ends of horizontal arms to facilitate easier loading and
insertion. The performance of CuT-380 Ag and the CuT-380 slimline is equal to that of CuT-380 A.
• Multiload 375 - It has 375 mm2 of copper wire wound around its stem. The flexible arms are designed to minimize
expulsions. The multiload 375 and T cu-380 A are similar in their efficacy and performance.
• Nova T - It is similar to the CuT-200, containing 200 mm2 of copper. However, the Nova T has a silver core to the
copper wire, flexible arms, and a large flexible loop at the bottom to prevent cervical perforation.
Hormone-Releasing IUDs
• Progestasert - It is a T shaped IUD made of ethylene and vinyl acetate copolymer containing titanium dioxide. The
vertical stem contains a reservoir of 38 mg progesterone together with barium sulfate dispersed in silicone fluid. The
progesterone is released at the rate of 65 µg per day.
• LNG - 20 (Mirena) - This T shape & device has a collar attached to vertical arm containing 52 mg of levonorgestrel
dispersed in poly dimethyl siloxane. It releases 15µg of levonorgestrel per day in vivo and is effective for 7-10 years..

25. THIRD GENERATION
(Hormone releasing iuds)
Progestasert:
• most widely used hormonal device.
• T shaped device with 38mg of progesterone the natural hormone.
• hormone is released slowly in the uterus at the rate of 65 mcg
daily.
• It has a direct local effect on the uterine lining, on the cervical
mucus and possibly on the sperms.
• Because the hormone supply is gradually depleted, regular
replacement of the device is necessary.
LNG-20
T shaped device releasing 52 mg of Levonorgestrel
Advantage:- 1. Low mentural blood loss.
2. Fewer days of bleeding.
3. Effective life of
10 year.

26. MECHANISM OF ACTION OF
IUD’S
a)Cause cellular and biochemical changes in the
endometrium and cervical mucus.
b)Impair the viability of gamete thus reduce the chances of
fertilization.
c)Cu ions affect sperm motility,capacitation and survival.
d)Hormonal releasing devices increases viscosity of the
cervical mucus thus prevent sperm from entering the cervix
and make endometrium unfavourable for implantation.

27. Change of IUD’S
Lippes loop as long as required if there is no side effect
Tcu 380A 10 years
T Cu 200 12 years
Progestasert 1 year
LNG 20 10 years
Cu devices cannot be used indeginitely because copper corrodes
and mineral deposits build up on the copper affecting the release
of copper ions.

28. ADVANTAGES:-
1. Simple , short procedure , no hospitalization required.
2. Inexpensive
3. Contraceptive effect is reversible by removal of IUD
4. Free of systemic metabolic side effects
5. Effective as post coital contraceptives if inserted with
in 3-5days of unprotected intercourse
TIMING OF INSERTION:-
•With in 10days of beginning of menstrual period or
•First week after delivery or
•6-8 weeks after delivery in puerperal period
Because diameter of :- 1. Cervical canal is greater,
2. Uterus is relaxed,
3. And myometrium is contracted.

29. CONTRAINDICATIONS:-
ABSOLUTE
I.Suspected pregnancy
II.PID
III.Abnormal Vaginal bleeding
IV.Cancer of uterus, cervix or adnexa
RELATIVE
V.Anemia
VI.Menorrhagia
VII.History of PID
VIII.Purulent cervical discharge
IX.Uterine fibroid

30. IDEAL CANDIDATE FOR IUD’S
a)Women who has borne at least one child
b)Has no history of PID
c)Has normal menstural periods
d)Is willing to check the IUD tail
e)Has access to follow up and tratment of potential problems
f)Is in a monogamous relationship
FOLLOW UP
To ensure presence
of IUD’S
To diagnose and treat
any complications
To provide motivational and
emotional support

31. SIDE EFFECT
1.BLEEDING
2. PAIN
3.PERFORATION
4.PELVIC INFETION
5.ECTOPIC PREGNANCY
6.EXPULSION

32. HORMONAL CONTRACEPTIVE
• COMBINED PILL
• PROGESTERONE ONLY PILL
• POST COITAL PILL
• ONCE A MONTH PILL
• MALE PILL
ORAL
PILLS
• INJECTABLES
• SUBCUTANEOUS IMPLANTS
• VAGINAL RINGS
DEPOT
FORMULATIO
N

33. COMBINED PILLS
Contain combination of oestrogen and progesterone.
Commonly used are :- MALA N and MALA D
They contain Levonorgestrel 0.15mg and
Ethinil oestradiol 0.03mg.
MALA D is in a package of 28 pills and is of 3/-
MALA N is supplied free of cost through all PHCs
Action:-Prevent release of ovum from ovary by blocking pituitary secretion
METHOD OF INTAKE
Beginning on 5th
day of menstural cycle 21 pills are to be
taken at fixed time.
Followed by a break of 7 days during which menstural period
known as withdrawl bleeding occur.
In these 7 days rest of the pills coated with ferrous fumarate is to be taken

34. PROGESTERONE ONLY PILLS
MINIPILL or MICROPILL
•It contain small amount of progesterone
which is to be given in small amount
through out the cycle.
•They render the cervical mucus thick and
scanty and thereby inhibit sperm penetration.
•Inhibit tubal motility and delay transport of sperm
•Commonly used are NORETHISTERONE and LEVONORGESTEROL.
ONCE A MONTH PILL
Combination of a long acting estrogen- QUINESTROL and a short acting
progesterone
Disadvantage:- High failure rate
Abnormal irregular bleeding

35. POST COITAL PILL
(MORNING AFTER PILL)
Two methods:-
a)IUD :-Insert with in 5 days.
b)Hormonal:- Levonorgesterol 0.75mg tablet within 72hrs of unprotected
intercourse and 2nd
tablet after 12hrs of the first
or
Two pills containing 30 or 35mcg of ethinyl estradiol within 72hrs and
4 tablets after 12hrs
or
4pills containing 50mcg of ethinyl estradiol within 72hrs after intercourse
and a same dose after 12hrs
Failure rate is > 1%

36. MALE PILL
•Made of Gossypol from cotton seed oil
•It is effective in producing azoospermia or severe
oligospermia but 10% of men may become permanently
azoospermic after taking it for 6 months.
ACTION:-1.Prevent spermatogenesis
2.Affect sperm storage and maturation.
3.Prevent sperm transport in vas
4.Affect constituent of seminal fluid
Side effect:- Hormones tend to lower down testosterone
production affect potency and libido.

37. ADVERSE EFFECT OF ORAL PILLS
1.CVS
2.Carcinogenesis
3.Metabolic disoder
4.Liver disorder

38. Beneficial effect
100% effective in preventing pregnancy
Provide protection against 6 disease
• Benign breast disorder
•Ovarian cysts
•Iron deficiency disorder
•PID
•Ectopic pregnancy
•Ovarian cancer
Pill should be used primarily for spacing pregnancies in
younger women,should not be prescribed after 35-40yr
because of sharp increase in the risk of CVS complication.

39. CONTRAINDICATION
ABSOLUTE:-

C ancer of breast and genitals

Liver disease

History of thromboembolism

Cardiac abnormalities

Congenital hyperlipidaemia

Undiagnosed uterine bleeding
RELATIVE:-
a)
Age over 40yrs
b)
Smoking and age 35yrs
c)
Hypertension
d)
Chronic renal disease
e)
Epilepsy
f)
Migraine

40. DEPOT FORMULATIONS
INJECTABLE
CONTRACEPTIVE
•Progesterone only
injectables :-1.DMPA
2.NET-
EN
3.DMPA-SC
•Combined injectable
contraceptive
SUBDERMAL
IMPLANTS
VAGINAL
RINGS

41. DEPORT-MEDROXYPROGESTERONE
ACETATE
Dose:-IM injection of 150mg every 3months and initial injection to
be given in the first 5 days of the menstrual period.
Action:- 1.Suppress ovulation.
2.Decreases cervical mucus production.
DMPA-SC
It is a new lower dose formulation of DMPA,depo-subQ provera
Dose:- 104mg of DMPA,given at the interval of 3mnths
Site:- Injected under the skin in the upper anterior thigh or
abdomen

42. NORETHISTERONE ENANTATE
Dose:-IM injection into the gluteus muscle of 200mg every 60
days,initial injection to be given in the first 5days of menstrural period.
Action:- 1. Inhibition of ovulation
2. Thicken cervical mucus
Advantages:- 1.Can be use post partum,does not affect lactation.
2. Protective against endometrial cancer and ovarian
cancer
Disadvantage:- 1.Weight gain,headache
2.Irregular bleeding
3.Prolong infertility after its use

43. SIDE EFFECT
a)Disruption of the normal menstrual cycle.
b)Abnormal bleeding
c)Infertility of 5-6 months after its use
d)Some become amenorrhoeic which is alarming
CONTRAINDICATION
e)Cancer of genitals , breast.
f)Undiagnosed abnormal uterine bleeding
g)CVS disorder

44. COMBINED INJECTABLES
CONTRACEPTIVE
•Contain combination of progesterone and oestrogen
•They are given at monthly interval.
•Commonly used are:- Cyclofem/Cyclo-provera
Mesigyna
Action:- 1.Suppress ovulation
2.Cervical mucus is thickened
3.Make endometrium unfit for fertilization

45. SUBDERMAL IMPLANTS
NORPLANT
•It consist of 6 silastic capsules containing
35mg of levonorgestrel
•It is implanted beneath the skin of the
forearm or upper arm.
•Effective contraception is provided for
over 5years.
•The contraceptive effect is reversible on
removal of capsules.
Disadvantage:- 1. Irregularity of bleeding
2. Surgical process required .

46. VAGINAL RING
•It contain levonorgesterol.
•Hormone is slowly absorbed
•through the mucosa, permitting
•most of it to bypass the digestive
•system and liver and thus
•allowing a potentially lower dose.
•The ring is worm for 3weeks
•of the cycle and removed for the fourth.

47. POST CONCEPTIONAL METHODS
Menstrual regulation
Consist of aspiration of the uterine contents 6-14 days of a missed period.
Disadvantage- Uterine bleeding and trauma
MENSTRUAL INDUCTION
This is based on disturbing the normal progesterone-prostaglandin balance
by intrauterine application of 1-5mg solution of PG F2.

48. MISCELLANEOUS
ABSTINENCE
BIRTH
CONTROL
VACCINE
BREAST
FEEDING
SAFE
PERIOD
COITUS
INTERRUPTUS

49. ABSTINENCE
COITUS INTERRUPTUS
Method of voluntary fertility control.
Action:- Withdrawal before ejaculation prevent sperm deposition
in the
vagina.
ADVANTAGE :- 1.No application is required
2.No cost
DISADVANTAGE :- 1.Pre coital secretion may contain sperm
2.Women may develop anxiety
neurosis,vaginismus or pelvic congestion

50. RHYTHM METHOD
CALENDER METHOD
Based on the identification of the fertile period of cycle and to
abstain from intercourse during that period.
Method to determine:- 1.Noting of basal body temperature
2.Cervical mucus method
3.Symptothermic method
ADVANTAGE
No cost
No side effect
DISADVANTAGE
Difficult to calculate the safe
period
Menstural cycles are not
always regular
Compulsory abstinence from
intercourse during that period

51. BREAST FEEDING
Prolong and sustained breast feeding offers a natural protection of
pregnancy.
Risk of pregnancy to a women who is fully breast feeding and
amenorrhoiic is < 2% in th efirst 6months.
Once mensturation returns ,continued lactation no longer offers
any protection against pregnancy
BIRTH CONTROL VACCINE
Immunized with hCG, antibodies are produced in 4-6 weeks ,
reaching maximum in 5months and then start declining