This document discusses various contraceptive methods including oral contraceptives, implants, injectables, IUDs, barriers, fertility awareness, sterilization, and emergency contraception. It describes how each method works, effectiveness, side effects, advantages, disadvantages, proper usage, and contraindications. Common contraceptives discussed in detail are combined and progestin-only oral contraceptives, transdermal patch, implants such as Norplant, injectables like Depo-Provera, copper and hormonal IUDs, and emergency contraception pills.

1. Contraception
Dr.Muhabat Salih Saeid MRCOG

2. Learning Objectives
 Recognize common adverse effects
of estrogen and progestin
 In a patient case be able to provide
a recommendation for symptom
management
 Identify contraindications to
contraceptive options

3. Contraception Definition
 Contraception generally implies the
prevention of pregnancy following
sexual intercourse by
 inhibiting viable sperm from coming
into contact with a mature ovum
 by preventing a fertilized ovum from
successfully implanting in the
endometrium.

4. Commonly used methods
 Reversible contraception
 Oral contraceptives
 Long acting injectable or implantable
progestins
 Combined estrogen patch
 Condoms, spermicides, diaphragms,
withdrawal, periodic abstinence, and
IUD’s

5. Properties of Contraceptive
Desired by Patients
 Highly effective
 Prolonged duration of action
 Rapidly reversible
 Privacy of Use
 Protection against STD’s
 Easily accessible

6. Oral Contraceptives
 Introduced to the US in 1960
 Works through the manipulation of
normal physiologic feedback
mechanisms of the menstrual cycle
by varying amounts of estrogen
and/or progestin.
 Proven to be a very effective and
popular method of birth control.

7. The Pill
Advantages
 Easy to use
 Dependable
 No additional appliances
 Can regulate menstrual flow and
decrease cramps and other symptoms
of menses

8. Missed pills
 Missed 1 day:ASAP and next pill
at regular time
 Missed 2 days: 2 when she
remembers, 2 the next day, use
back up until her next period
 More than 2 days: Restart and
use a back up method

9. Contraindications
 History of cerebrovascular disease
 Uncontrolled hypertension
 DVT or PE
 Migraines worsened by estrogen
 Estrogen dependent neoplasm
 Ischemic heart disease
 IDDM w/ complications
 Breast Cancer
 Impaired liver function
 Smokers>35y/o

10. Estrogen
 Inhibits ovulation by suppressing of
pituitary release of FSH/LH (negative
feedback)
 Inhibits implantation by altering
secretions within the uterus
 Accelerates ovum transport
 Induction of luteolysis: degeneration of
corpus luteum prevents normal
implantation and placental attachment

11. Estrogenic Side Effects
 Nausea
 Weight gain
 Fluid retention
 Pulmonary emboli
 Hypertension
 Thromboembolic complications
 Stroke
 Increase in bile cholesterol

12. Progesterone
 Inhibits ovulation by disruption of
HPO function and by modification of
mid-cycle FSH/LH surge
 Inhibits implantation by suppressing
the endometrium
 Production of thick cervical mucus
 Prevention of sperm penetration
 Slows ovum transport

13. Progestin Side Effects
 Increased appetite
 Depression, fatigue, lethargy
 Acne, oily skin
 Hirsutism
 Headache
 Weight gain
 Decreased libido
 Increased LDL, decreased HDL
 Hypertension

14. Noncontraceptive benefits
 Relief from
menstruation-
related problems
 Decreased cramps
 Decreased
ovulatory pain
 Decreased
menstrual blood
loss
 Disease prevention
 Ovarian and
endometrial cancer
 Ovarian cysts
 Ectopic pregnancy
 Pelvic inflammatory
disease
 Benign breast
disease

15. Contraindications
 History of cerebrovascular disease
 Uncontrolled hypertension
 DVT or PE
 Migraines worsened by estrogen
 Estrogen dependent neoplasm
 Ischemic heart disease
 IDDM w/ complications
 Breast Cancer
 Impaired liver function
 Smokers>35y/o

16. Transdermal Contraception
 Ortho Evra
 Norelgestromin and Ethinyl
Estradiol
 Similar to OC’s
 Not recommended in patients
>198lbs, less effective
 Applied every 7 days for 3
weeks followed by patch free
week
 Convenience, increased
compliance

17. Ortho Evra
 If a patch comes
off????
 <24 hours
 Reapply
 use a new patch
 >24 hours
 apply a new patch
 use this day as the new
patch change day
 use a back up method
until 7 consecutive
days
 Patient Education
 Similar side effects to
OC’s
 Same incidence of
drug interactions
 Apply to abdomen,
buttock, upper outer
arm, and upper torso
 Back up method
should be used until
after the first 7 days
of consecutive
administration

18. Implants
 Progestin only (Norplant)
 Prevents ovulation
 More effective than the Pill

19. Implant
 Advantages
 Convenience
 Eliminate user error
 No menses or very light
 Decreased cramping

20. Implant
 Problems
• Difficulty in
removing
 Side effects
•Similar to the
pill
•Changes in
menstrual
bleeding
•Headaches
 Side effects
•wt. gain
•Acne
•breast
tenderness
•hair growth
•ovarian cysts

21. Implant
 Contraindications
 Liver disease
 Breast cancer
 Cardiovascular disease
 Unexplained vaginal bleeding
 Pregnant
 Smokers

22. Injectable Contraceptives
 Depo-Provera
 Medroxyprogesterone acetate
 150mg/ml
 Progestin only
 Inhibits ovulation for 3
months
 IM injection 5 days w/in
onset of menstrual bleeding
and Q12 weeks

23. Depo-Provera
 Advantages
 Highly effective
99.7%
 Increased compliance
 Amennorrhea
 Reduced risk of anemia
 Decreased menstrual
cramps/pain
 No drug interactions
w/ anticonvulsants
 Disadvantages
 Break through
bleeding
 Weight gain
 Headache
 Depression
 Decreased HDL
 Risk of ectopic
pregnancy
 Contraception
reversible in 4-
13months

24. Barrier Methods
 The condom
 Female condom
 Diaphragm
 Cervical cap
 Sponge

25. IUD
 Intrauterine device
 Copper and plastic (Copper T-380A)
10 years
 Plastic and Progesterone
(progestasert IUD) 1 year
 90-96 % effective in use
 Increased risk of PID

26. Spermicides
 Nonoxynol-9
 Use in combination with barrier
methods of contraception
 Foam
 gel
 Film
 Creams, jellies and suppositories

27. Fertility Awareness Methods
 Calendar or rhythm method
 Midway in cycle
 Basal body temperature (BBT)
method
 Increase in body temperature
 Cervical Mucous Method
 Clear slippery mucous
 Symptothermal method
 Combination of BBT and Cervical
Mucous methods

28. Sterilization
 For Women
 Tubal ligations
• Cut and seal the fallopian tubes
 Hysterectomy
• Removal of the uterus
 For Men
 Vasectomy
 Vas deferens are cut and sealed

29. Emergency Contraception
 Emergency Contraception Pill (ECP)
 Copper IUD

30. Emergency Contraception
 Indications:
 Unprotected
intercourse
 Condom
slipped/broke
 Missed pills
 Sexual assault
 Preven
 50µg EE and
0.25mg
levonorgestrel
 Plan B
 0.75mg
levonorgestrel

31. Patient Education
 Prescribing Info.
 First dose must be
taken within 72 hours
of unprotected
intercourse
 Second dose is 12
hours later
 Side Effects
 Nausea
 Vomiting
 Breast Tenderness
 Reglan(metoclopramide)
1 hour prior can
reduce n/v
 Repeat dose if
vomiting occurs w/in
1 hr of admin.

32. Abortion
 Spontaneous abortion
(miscarriages)
 Induced abortion

33. Injectable Contraceptives
 Depo-Provera
 Medroxyprogesterone acetate
 150mg/ml
 Progestin only
 Inhibits ovulation for 3
months
 IM injection 5 days w/in
onset of menstrual bleeding
and Q12 weeks

34. Depo-Provera
 Advantages
 Highly effective
99.7%
 Increased compliance
 Amennorrhea
 Reduced risk of anemia
 Decreased menstrual
cramps/pain
 No drug interactions
w/ anticonvulsants
 Disadvantages
 Break through
bleeding
 Weight gain
 Headache
 Depression
 Decreased HDL
 Risk of ectopic
pregnancy
 Contraception
reversible in 4-
13months

35. Implantable Contraception
 Norplant
 Subdermal progestin implant
 6 implantable capsules filled
w/ levonorgestrol
 Requires physician
administration
 Effective for 5 years
 Every 3 yrs for women
weighing >154lbs

36. Norplant
 Advantages
 Convenience
 Highly effective
 Decreased
menstrual cramps
 Fertility rapidly
returns
 Disadvantages
 Irregular period
 Headache
 Depression
 Weight gain
 Pain/itching @ site
 Site infection
 Ectopic pregnancy
 Removal
difficulties

37. TTTTT