This document provides an overview of various contraceptive methods. It begins with objectives and an introduction on contraception. The methods are then classified as temporary or permanent. The summary includes details on barrier methods, IUDs, hormonal contraceptives, emergency contraceptives, and natural family planning. Side effects and effectiveness rates are provided for each method. The document aims to educate students on the types and mechanisms of different contraception options.

1. Addis Ababa UniversityCollege Of Health Science Department Of Medical Physiology Presentation on contraception By Girmay F. 7/14/2011 1 contraception

2. Presentation out line Objectives Introduction Classification Barrier method IUCD Hormonal contraceptives Emergency contraceptives Natural family planning Coituis interrupts Permanent contraceptives Summery References 7/14/2011 2 contraception

4. Mention the types of barrier methods.

5. explain The mechanism of hormonal contraceptives.

6. Know the permanent type of contraception and their advantages.7/14/2011 3 contraception

7. INTRODUCTION Contraception deliberate prevention of pregnancy using any of Several methods. Birth control prevents a female sex cell (egg) from being fertilized by a male sex cell (sperm) and implanting in the uterus. variety of birth control methods to choose from, although most options are for women. Selecting a method is a personal decision that involves consideration of many factors including convenience ,reliability, side effects, and reversibility. 7/14/2011 4 contraception

8. Cont’d EFFECTIVENESS No birth control method, is 100 percent effective in preventing pregnancy. two types of pregnancy rates when describing effectiveness. Method effectiveness ( perfect use) The percentage of pregnancies that occur when a particular method is used correctly and consistently with each act of sexual intercourse. b. User effectiveness( typical use) The percentage of pregnancies that result from average use of the method, which accounts for improper or inconsistent use. 7/14/2011 5 contraception

9. classification Broadly can be classified:- Temporary Permanent Temporary: Reversible, includes the natural family planning,coitus interrupts, barrier methods,IUCD and hormonal contraceptives. Permanent: vasectomy and tubal ligation. Most contraceptive methods are reversible—they do not affect a person’s ability to reproduce once the method is halted. 7/14/2011 6 contraception

11. Others affect a woman’s hormones, altering her reproductive cycle.

12. Other birth control methods involve behaviors that alter sexual activity in ways that lessen the chance for pregnancy.7/14/2011 7 contraception

14. Barrier methods must be used with each act of sexual intercourse. While they are easy to use, some people feel barrier methods are inconvenient because they interfere with sexual spontaneity.

15. Barrier methods include male and female condoms, the diaphragm, the cervical cap, and spermicides.7/14/2011 8 contraception

16. A1.Male Condom MOA:- During ejaculation (when semen ejects from the penis), the condom catches and holds sperm before it can travel into a woman’s uterus. Male condoms made of latex or polyurethane also protect users against many STIs, including HIV , 86 % effective in preventing pregnancy. Condom + spermicide / with coituis interaptius greatly improves condom effectiveness. 7/14/2011 9 contraception

18. A woman inserts the closed end of the sac into the vagina to cover the cervix and prevent sperm from entering the uterus.

19. The open end of the sac remains outside the vagina for the penis to enter.

20. 79 % effective in preventing pregnancy.

21. S/E :- genital irritation It also reduces the risk of many STIs. 7/14/2011 10 contraception

23. Before intercourse, spermicide must be placed inside the cup and around the inside of the rim of the diaphragm.

24. MOA :- Inserts the diaphragm into the vagina so that it covers the cervix, preventing the passage of sperm from the vagina to the uterus.

25. The spermicide kills any sperm that are able to pass by the diaphragm.

26. Various sizes to fit the cervix.

27. 80 % effective in preventing pregnancy.7/14/2011 11 contraception

28. .A2.FC cont’d B. The diaphragm is in proper position, fitting snugly between the posterior aspect of the pubic bone and the posterior vaginal fornix, completely covering the cervix. C.The diaphragm is removed by hooking a finger under the forward rim (the edge behind the pubic bone). 12 contraception 7/14/2011

29. A4 .Cervical Cap The cervical cap is a small silicone cup that blocks the cervix and held in place by suction. It should be used with a spermicide. It must be left in place at least 8 h after coitus and must be removed within 48 hr. 80 % effective in preventing pregnancy in women who have not given birth. 60 % effective in those who have given birth. 7/14/2011 13 contraception

31. Spermicides used alone must be inserted deep into the vagina before each act of intercourse and a woman should not douche for six to eight hours after intercourse.

32. Spermicides used alone are 74 % effective in preventing pregnancy.

33. S/E:- An allergic reaction such as irritation of the vagina or penis. 7/14/2011 14 contraception

34. B .Intrauterine Device(IUD) IUDis a small plastic device consists of a T-shaped piece of flexible placed through the cervical canal into the uterine cavity. Some IUDs have a wrapping of copper wire around the plastic or contain a progestogen. A plastic string attached to the IUD hangs down through the cervix, enabling a woman to check regularly that the IUD is properly positioned. MOA:- 1.They interfere with the movement of sperm and egg. 2. They decrease the ability of sperm to fertilize an egg. 3.Rarely, they prevent a fertilized egg from implanting in the lining of the uterus. Depending on the device, it must be replaced every one to ten years. 96 % effective in preventing pregnancy. 7/14/2011 15 contraception

36. making the mov’t of sperm difficult.

37. Prevent implantationInflammatory r xn :- create hostile environment for sperm motility/transport + spermicidal and for implantation of blastocyst. 7/14/2011 16 contraception

38. Contains a hormone called progestin 99% effective in presenting pregnancy. Long acting contraceptive. Hormone acts on the lining of the uterus and thickens. the cervical mucus making it difficult for sperm to reach the egg. May prevent ovulation Decrease in menstrual blood loss by 74-97%. Progesterone releasing IUDs Affects tubal motility & interferes with ovum transport Cause atrophic change to the endometrial lining Thicken cervical mucus & prevent sperm transportation 7/14/2011 17 contraception

39. Side effects increase menstrual bleeding , irregular bleeding or cramping. It has an increased risk for PID . perforation of the uterus and embedding of the IUD in the uterus. In rare cases an ectopic pregnancy occurs. Parts of IUCDs Arms (Rt./Lt.) Stem Copper sleeve (33mm×2=66mm2 String/Thread Copper wire (314mm2 7/14/2011 18 contraception

41. Hormonal contraceptivescont’d Two types:-1.the combination pill 2.the progestin only pill The combination pill MOA:-prevents conception by inhibiting ovulation. The combination of estrogen and progestogen inhibits ovarian follicle growth and prevents the FSH and surge LH secretion . In essence, this pill mimics the negative feedback effects of estrogen and progestogen present during the luteal phase of the menstrual cycle and in pregnancy. Renders the cervical mucus hostile to sperm transport. Even if some sperm reach the egg and fertilization occurs, the pill causes the uterine endometrium to be unreceptive to the embryo because the estrogen: progestogen ratio. 7/14/2011 20 contraception

42. Hormonal contraceptivesCont’d Draw backs Reduced effectiveness when used in conjunction with some medications . Lack of protection against STIs. Hormonal contraceptives may be administered by pill form, implant, injection, or through vaginal rings or skin patches. 7/14/2011 contraception 21

43. 1 . oral contraceptive MOA:- To prevent pregnancy a woman takes one birth control pill each day for 21 days, after which she takes no pill or a placebo (a pill containing no active ingredients) for 7 days. 95 % effective in preventing pregnancy. Relieve menstrual pain and reduce menstrual bleeding. It may also offer some protection against PID, endometrial and ovarian cancer, endometriosis and uterine fibroid tumors . S/E - breakthrough bleeding (bleeding between periods), headache, hypertension, weight gain, mood change, decreased sexual desire, blood clotting disorders, cardiac complications, breast tenderness, and galactorrhea . 7/14/2011 contraception 22

45. Inserted under the skin of the woman’s arm by the bicep muscle.

46. Implanted in the arm for 3 years.

47. The most highly effective form of birth control.

48. S/E - irregular intervals between menstrual periods, breakthrough bleeding, headache, acne, weight gain or loss, depression, breast tenderness, and infection or skin discoloration at the implant insertion point. 7/14/2011 23 contraception

50. Lunelle contains a combination of estrogen and progestin and must be injected once a month.

51. S/E :- irregular bleeding is the most common. Other includes breakthrough bleeding, weight gain, headache, sore breasts, depression, nausea, vaginal dryness, and acne.

52. 99 % effective in preventing pregnancy. 7/14/2011 24 contraception

54. vaginal irritation or infection. 7/14/2011 25 contraception

55. 5 .Contraceptive Patch It is a thin, plastic patch containing a combination of estrogen and progestin. MOA:- applies to the skin of the buttocks, stomach, upper arm, or upper torso once a week for three out of four weeks. The skin absorbs the hormones, which alter the woman’s reproductive cycle to prevent pregnancy. S/E:- skin reaction at the application site. 95 to 99 % effective in prevent pregnancy. Women who smoke should not use the patch because of increased risk of stroke and heart attack. 7/14/2011 26 contraception

56. D .Emergency Contraception It refers to methods that a woman can use after unprotected intercourse to prevent fertilization or implantation of the fertilized egg. Two methods are available:- 1.emergency contraceptive pills 2. emergency insertion of an IUD. Emergency contraceptive pills(morning-after pills) are similar to birth control pills but they contain a higher dose of hormones. The pills are usually taken in two doses, 12 hours apart. 79 to 85 % effective when a woman takes the pills within 72 hours of unprotected intercourse. 7/14/2011 27 contraception

57. Emergency contraceptives cont’d MOA:- Depending on where a woman is in her menstrual cycle at the time she takes these contraceptives:- 1. the pills will either inhibit or delay ovulation. 2.It alter the uterine lining, preventing implantation of a fertilized egg. The insertion of an IUD within seven days of unprotected intercourse is 99 % effective. The IUD interferes the ability of a fertilized egg to implant in the uterine lining. 7/14/2011 28 contraception

59. Any sperm deposited before withdrawal or left on the vulva wall during withdrawal could reach the cervix.7/14/2011 29 contraception

60. F. Natural Family Planning These methods are based on restriction of coitus to a “safe period” of the menstrual cycle. The “fertile” period of the cycle, when coitus is avoided, is determined by the number of days sperm remain capable of fertilization (6–7 days). And the time that the ovum remains capable of being fertilized (1 day). Therefore, a woman is fertile for about 5 days before ovulation, the day of ovulation, and possibly 1 day after ovulation. it requires instruction, daily monitoring, and a strong commitment from both sexual partners. 7/14/2011 30 contraception

61. NFPcont’d most reliable for women with regular menstrual cycles. As a woman becomes more familiar with the signs of ovulation and the pattern of her menstrual cycle, the method become more effective. Methods that can help predict ovulation include 1.monitoring the lengths of menstrual cycles 2.measuring basal body temperature 3. observing changes in cervical mucus. Recommend using more than one method to more accurately determine a woman’s fertile period. 80 % effective in preventing pregnancy. 7/14/2011 31 contraception

62. NFP cont’d 1.Calendar Method Based on the predicted time of ovulation . The women should record of the dates of her first day of menstruation over the period of 8 to 12 months. From this record she can calculate the average number of days in her menstrual cycle, and estimate the day in her cycle when she is most likely ovulating. 7/14/2011 32 contraception

63. How to calculate 18 days are subtracted from the shortest cycle recorded and 11 days from the longest cycle recorded. Thus, the fertile period is defined. For example, suppose a woman, after recording her cycle lengths for a year, had a longest cycle of 35 days and a shortest cycle of 25 days. Her possible fertile period then would be 35-11=24 and 25-18=7 Her possible fertile period then would be from days 7 to 24 of her cycle. 7/14/2011 33 contraception

64. NFP cont’d 2 .Basal Body Temperature Measurement The woman takes her temperature at the same time each morning before getting out of bed. In most women, body temperature rises about one degree on the day of ovulation and stays raised for several days. A woman can keep a record of her basal body temperature over a period of 8 to 12 consecutive months to determine the time in her cycle when she ovulates. Drawback :- many factors can raise body temperature . 7/14/2011 34 contraception

66. Mucus that is clear, wet, and sticky or elastic appears in the days preceding ovulation.

68. 2.Permanent methods Surgical methods 7/14/2011 36 contraception

69. 2A.Vasectomy Methods of male surgical sterilization-vasectomy permanent forms of birth control. A vasectomy is performed using local anesthesia. minor surgical procedure, each of the two vas deferens (ducts that carry sperm from the testes to the penis) is cut and the ends are tied off to prevent sperm from reaching the penis. 7/14/2011 37 contraception

70. Vasectomy cont’d Fig Distal ligation of the vas deferens and cauterization ofthe proximal lumen Fig Following a longitudinal incision of the scrotal skin along the vas deferens the vas is lifted by a small clamp 7/14/2011 38 contraception

71. Vasectomycont’d 7/14/2011 39 contraception

72. Vasectomycont’d The failure rate lies below 1% . Failure is due to recanalization of the divided duct in up to 1.5% of cases (even possible in the form of late recanalization) , or to the extremely rare occurrence of a double vas or incomplete division of the duct. 7/14/2011 40 contraception

73. 2B.Tubal Ligation the fallopian tubes are cut and tied, blocked, or sealed to prevent eggs from descending from the ovaries to encounter sperm. Tubal ligation is performed under general or spinal anesthesia . 7/14/2011 41 contraception

74. Tubal ligation cont’d There are mainly four occlusion methods for tubal ligation, typically carried out on the isthmic portion of the fallopian tube, that is, the thin portion of the tube closest to the uterus. Partial salpingectomy Clips Silicone rings: Electro coagulation (cauterization) Isthmus Ampulla Infundibulum Fimbria Anatomy 7/14/2011 42 contraception

75. summary 7/14/2011 43 contraception

76. summary 7/14/2011 contraception 44

77. References 1.human reproductive biology,3rd edition,richard E.jones,elsevier press imprint 2.Lecture note. 3.Internet websites 7/14/2011 45 contraception

78. Thank you!!! contraception 46 7/14/2011