This document provides an outline for a presentation on family planning methods. It defines family planning and discusses the benefits, such as preventing unintended pregnancies and empowering women. It then describes several contraceptive methods, including hormonal methods like pills, injections, implants and IUDs; barrier methods like condoms; and surgical sterilization methods like tubal ligation and vasectomy. For each method, it explains how the method works, proper use, effectiveness, benefits and disadvantages. It provides information on who should not use certain methods due to health risks. The goal is to educate about contraception options and their effects.

1. Assistant lecturer of Obst. & Gyn.
FOM - SCU

2. Outline
Definitions
Benefits of family planning
How contraception works.
Individual methods:
Hormonal methods.
Intrauterine devices.
Barrier methods.
Surgical methods.
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3. Introduction
Family planning helps women to:
Have their desired number of children &
Determine the spaces between pregnancies.
This is achieved by:
Use of contraceptive methods &
Treatment of infertility.
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4. Benefits of family planning
1. Prevent unintended pregnancies.
2. Decrease maternal & infant morbidity & mortality.
3. Decrease unsafe abortions & miscarriages.
4. Decrease adolescent pregnancy (higher risk of
medical complications).
5. Empowering women: allowing their education &
employment.
6. Prevention of sexually transmitted diseases
(condoms)
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5. How contraceptives work?
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−Prevention of ovulation
“OCP – lactational amenor.”
− Avoiding time of ovulation
“Fertility awareness”
−Cutting or clipping
of the tube
e.g., Tubal ligation
− Damage of sperms in
uterine cavity → prevent
fertilization
e.g., Copper IUD
−Thickening of cervical mucus
→ prevent sperm passage.
e.g., POP.
−Covering the cervix.
e.g., diaphragm, cervical cap
−Barrier in the vagina:
e.g., female condom
−Absorption of hormones
released from a vaginal ring.
−Killing sperms in vagina by
spermicides.

6. Contraceptive methods
Contraception
Hormonal Intrauterine
devices
Barrier
methods
Fertility
awareness
methods
Sterilization Emergency
contraception
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Pills
Injections
Implants
Patches
Vag. Rings
Copper IUD
Hormonal IUD
♂ Condom
♀ Condom
Diaphragm
Cerv. Cap
+
Spermicides
Natural
- Abstinence
- Lactational
amenorrhea
Tubal ligation
Vasectomy
Pills
Copper IUD

7. Hormonal Methods
Combined Oral Contraceptive Pills (COCP)
COCP:
• Pills contain 2 hormones: estrogen & progesterone.
Mechanism of action:
• Prevent pregnancy by:
1. Inhibition of ovulation (↓ FSh & LH)
2. Thickening of cervical mucus → prevent sperm passage.
3. Cause endometrial changes → affect implantation.
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8. Hormonal Methods
Combined Oral Contraceptive Pills (COCP)
Use:
• Start: between days 1-5 of cycle.
• Duration: 21 pills taken daily for 3 weeks followed by 1 free
week then start the next packet.
• During the free week most women have withdrawal bleeding.
• NOT given in 1st 6 months postpartum:  breast milk.
Effectiveness:
• Risk of pregnancy 3/1000
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9. Hormonal Methods
Combined Oral Contraceptive Pills (COCP)
Disadvantages:
• Minor: Nausea – vomiting – breast pain – dysmenorrhea –
mood changes – irregular bleeding.
• Increased risk of:
–Blood clot formation in legs or lungs.
–Hearts attacks and strokes.
Benefits:
• Decrease menstrual pain & amount of bleeding.
• Decrease risk of uterine and ovarian cancers.
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10. Hormonal Methods
Combined Oral Contraceptive Pills (COCP)
Who should NOT use COCP:
• Heavy smokers >35 years old.
• Uncontrolled hypertension.
• Heart disease (heart attacks), stroke, blood clots.
• Breast cancer.
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11. Hormonal Methods
Progesterone only Pills (POP)
POP:
• Contain only a synthetic progesterone – No estrogen
Mechanism of action: Prevent pregnancy by:
1. Thickening of cervical mucus → prevent sperm
passage.
2. Cause endometrial changes → affect implantation.
3. Less effective in preventing ovulation.
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12. Hormonal Methods
Progesterone only Pills (POP)
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Use:
• Start: - between days 1-5 of cycle
- Postpartum: 21 days after delivery.
- post-abortion: within 1-5 days
• MUST be taken at same time every day
• Continuous use: NOT stopped during menstruation.
Benefits:
• Decrease menstrual pain.

13. Hormonal Methods
Progesterone only Pills (POP)
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Disadvantages:
• Minor: - Depression & mood changes.
- Irregular, infrequent bleeding or amenorrhea.
• Increased risk of ectopic pregnancy if the patient got pregnant
on the POP.
Who should NOT use POP:
• Breast cancer.
• Severe liver disease.

14. Hormonal Methods
Injectable Contraception
Injection contraception: 2 types
 Progesterone only injection.
− Most common type contain depot medroxyprogesterone
acetate (DMPA: a progesterone)
Combined injection: estrogen & progesterone (Monthly)
Mechanism of action:
• Prevent pregnancy mainly by inhibition of ovulation.
• Also cause thickening of cervical mucus → prevent sperm
passage.
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15. Hormonal Methods
Injectable Contraception
Use:
• Intramuscular injections given every 3 months. The hormone is
then released slowly into the bloodstream.
• Start: between days 1-5 of cycle.
• During the free week most women have withdrawal bleeding.
Effectiveness: Very effective
• Risk of pregnancy 2/1000
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16. Hormonal Methods
Injectable Contraception
Disadvantages:
• Minor: hair loss - headache - mood changes.
• Weight gain
• Amenorrhea, infrequent or prolonged bleeding.
• Loss of bone density (weaker bones).
• Return of fertility after stopping it: Up to 1 year.
Benefits:
• Decrease menstrual bleeding (amenorrhea) & pain.
• Decrease risk of uterine and ovarian cancers.
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17. Hormonal Methods
Injectable Contraception
Who should NOT use injection contraception:
• Breast cancer.
• Heart disease (heart attacks), stroke, uncontrolled hypertension.
• Unexplained vaginal bleeding.
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18. Hormonal Methods
Progesterone only implant
Progesterone only implant: (Nexplanon: 1 rod)
• Small plastic flexible rods that release progesterone.
Use:
• The implant (1 rod) is inserted by minor surgical procedure
under skin of inside of upper arm.
+ local anaesthesia.
• Start: - days 1-5 of cycle.
- 21 days postpartum
• Duration: 3-5 years.
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19. Mechanism of action: Prevent pregnancy by:
1. Inhibition of ovulation
2. Thickening of cervical mucus → prevent sperm passage.
3. Thinning of endometrium → prevent implantation.
Effectiveness: Very effective
• Risk of pregnancy with <1/1000.
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Hormonal Methods
Progesterone only implant

20. Disadvantages:
• Minor: headache– mood changes – weight gain - acne.
• Irregular or infrequent bleeding
• Insertion complications:
–Infection.
–Difficult removal.
Benefits:
• Decrease menstrual pain (Dysmenorrhea).
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Hormonal Methods
Progesterone only implant

21. Who should NOT use implants:
• Breast cancer.
• Unexplained vaginal bleeding.
• Heart disease (heart attacks), stroke.
• Severe liver disease.
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Hormonal Methods
Progesterone only implant

22. Intrauterine devices (IUD)
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Intrauterine contraception: 2 types
1. Non hormonal (Copper IUD)
Small flexible plastic frame with copper wire around it
1. Hormonal IUD
Mechanism of action (Cu-IUD):
• Prevent pregnancy by:
1. Chemical changes causing damage to sperm & ovum.
2. Inflammation of endometrium → prevents implantation.

23. Use:
• Insertion: into uterus through vagina & cervix, leaving two
threads passing outside the cervix.
• Start: between days 1-7 of cycle.
• Duration: 5-10 years.
Effectiveness:
• Risk of pregnancy < 1/100.
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Intrauterine devices (IUD)

24. Disadvantages:
• Irregular, heavy periods.
• Increased risk of ectopic pregnancy if pregnant on the IUD.
• Complications of insertion:
– Expulsion – Infection – uterine perforation.
• Pregnancy on with IUD in the uterus: abortion – infection –
preterm labour.
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Intrauterine devices (IUD)

25. Benefits:
• Avoids complications of hormones.
• Can be used as emergency contraception.
Who should NOT use COCP:
• Post-partum & post abortion sepsis – Pelvic infection
• Unexplained vaginal bleeding.
• Cervical cancer - endometrial cancer
• Molar pregnancy (high B-HCG).
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Intrauterine devices (IUD)

26. Barrier methods
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Male barriers Female barriers
Male condom Female condom
Diaphragm
Cervical cap
+ Spermicide
Male Condom:
• A thin sheath of rubber put on man’s erect penis before
intercourse to collect semen  preventing sperms from
entering the woman’s vagina.
• A new condom is used each time.

27. Benefits:
• Protects against sexually transmitted diseases: HIV –
gonorrhea – chlamydia – syphilis.
• Protect against human papilloma virus  decrease cervical
pre-cancers & cancers.
• Risk of pregnancy: 2/100  less effective than hormonal
methods.
Disadvantages:
• Allergic reaction to latex.
• May tear: risk of pregnancy…
• May interfere with sexual pleasure.
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Barrier methods

28. Surgical methods (sterilization)
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Tubal ligation (female sterilization)
• A surgery involving cutting or blocking the two fallopian
tubes  prevent meeting of the ovum & sperms.
• Through laparotomy (open) or laparoscopy.
• Risk of failure (pregnancy): 5/1000
Disadvantages:
• Complications of surgery and anaesthesia.
• Permanent: can not be reversed.

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Surgical methods (sterilization)
Tubal ligation (female sterilization)

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Surgical methods (sterilization)
Laparoscopic tubal ligation

31. Surgical methods (sterilization)
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Vasectomy (male sterilization)
• A surgery involving cutting or blocking the vas deferens
(the tubes that carry sperms from the testes).
• Through a small incision in the scrotum under local
anaesthesia.
• Risk of failure (pregnancy): < 2/1000
Disadvantages:
• Complications of surgery: pain - infection
• Permanent: can not be reversed.

32. Surgical methods (sterilization)
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Vasectomy
(male sterilization)
Vas deferens

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