Contraceptive Methods

1. Barrier Methods:2. a. Natural methods

b. Physical methodsc. Chemical methodsd. Combined Methods

2. Intra-Uterine Devices3. Hormonal Methods4. Post-Conceptional Methods5. Miscellaneous

Coitus interruptus Rhythm method or safe period

methods This method is to abstain from sex during

fertile period. Temperature change method The basal body temp in a fertile women

rises by 0.4 to 1.0 F during ovulation. Lactation Ammenorrhea method Exclusive breast feeding in Lactation

Ammenorrhea offers saves from pregnancy

Advantages:a. Easily available b. Safe and inexpensivec. Easy to used. No side effectse. Light, compact and disposable f. Provides protection against STDs &

cervical cancer Disadvantages:a. It may slip off or tear during coitus due to

incorrect use, b. Interferes with sex sensation locallyc. Can cause irritation or allergic reaction.

Vaginal spermicidal agentsFailure rate of spermicides when

used alone is 10 to 20 percent. Vaginal contraceptive sponge

‘Today’ is the name given to vaginal contraceptive sponge available in USA and UK.

IUD is a device based on spacing method of contraception , requiring one time insertion procedure and is effective for long duration

( 3-10 yrs depending on the type of IUD used).

Types of IUCDNon-medicated:

Lippies loop, spirals, coils, ringsMedicated:

Copper, silver core, Multi load Devices Release of hormones▪ Progestasert▪ Levonorgestril

Foreign body, cellular and biochemical changes in endometrium - impair viability of gametes

Hormone releasing devices increase viscosity of the cervical mucus

High level of progesterone – unfavorable for implantation.

Most effective methodSimple, in a few minutes Long acting, may be for 5-10

yearsInexpensiveReversible Lower incidence of side-effects,

free of metabolic side effects

Highest continuation rateNo need for continued motivation

Easier to fit even in nulli parous women

Better tolerated by nulli para Effective as post-coital contraceptive

At present, the most widely accepted view is that the IUCD causes a foreign-body reaction in the uterus causing cellular and biochemical changes in the endometrium and uterine fluids, and it is believed that these changes impair the viability of the gamete and thus reduce its chances of fertilization, rather than its implantation.

Suspected pregnancy Pelvic inflammatory diseasesVaginal bleeding of undiagnosed

aetiologyCancer of the cervix, uterus or

adnexiaPrevious Ectopic pregnancy

AnaemiaMenorrhagia H / O PID since last pregnancyPurulent cervical dischargeMalformations,FibroidsUnmotivated client or person

Who has borne at least one child

Has no history of pelvic disease Has normal menstrual periods Is willing to check the IUD tail Has access to follow-up and

treatment of potential problems

Any time during reproductive ageDuring menstruation or within 10

days of the beginning of menstrual cycle

First week after delivery-immediate postpartum insertion

Better time is at 6-8 weeks after delivery-post puerperal insertion

1. Bleeding, greater loss, prolonged period 2. Pain 3. Pelvic infection 4. Uterine perforation 5. Pregnancy 6. Ectopic pregnancy 7. Expulsion 8. Fertility after removal 9. Cancer and teratogenesis 10. Mortality

Most effective spacing method 100% effectiveSynthetic estrogens

▪ Ethinyl oestradiol▪ Mestranol

Synthetic progesterone▪ Pregnanes▪ Oestranes▪ Gonanes

A. Oral Pills1. Combined pill2. Progestogen only pills (POP)3. Post-coital pills4. Once-a-month (long-acting) pill5. Male pills

B. Depot (slow release) formulations1. Injectables2. Subcutaneous implants3. Vaginal rings

Major spacing method 30-35 microgram of synthetic

estrogen0.5-1.0 microgram of progestogen.Pill is given orally for 21 consec.

Days, starting on 5th day of menstrual cycle

Pill is taken every day at a fixed time

Contains only progesteroneSmall doses throughout the cycleFor those women- c/I combined pills

Morning afterWithin 48 hours of unprotected

intercourse IUCDHormonal: high doses of estrogen

and progesterone2 pills immediately & 2 pills after 12

hours

Long acting estrogenShort acting progesterone

Prevents the release of ovum from ovary by locking pituitary secretion of gonadotropin.

Progesterone only pills renders the mucus thick, scanty that inhibits sperm penetration.

Progesterone also inhibits tubal motility

OCP are 100 % effective if taken regularly

Certain drugs affects the effect of OCP

100 % effective contraceptionProtection against

Benign breast disorders Ovarian cysts Iron deficiency anaemia PID Ectopic pregnancy Ovarian cancer

Cardiovascular effects Carcinogens Metabolic effects

▪ Elevation of BP, decrease in high density lipoprot.▪ Blood clotting, increase sugar level▪ Increase in atherogenesis▪ Increase in myocardial infarction & stroke

Others: Liver disorder, lactation, fertility, ectopic preg. Breast tenderness, weight gain, headache, Bleeding disturbances , Foetal development

Cancer of breast & genitals Liver disease Cardiac diseases, DVT Congenital hyperlipideamia Undiagnosed abnormal uterine bleeding Age above 40 & smoker at age 35 Hypertension, migraine, headache,

epilepsy, diabetes, gall bladder disease Nursing mother in first 6 months

Above 40 years of ageAbove 35 years of age & heavy

smokerH / O SeizuresSevere pain in the calves or thighsSymptomatic varicose veins in the

legsSevere chest pains, shortness of

breathSevere headacheVisual problems

Lactating less than 6 months Inter menstrual bleeding Bleeding after sexual intercourseAmenorrhoeaAbnormally yellow skin & eyesHigh Blood pressureMass in the breastOedema - legs

Injectables: DMPA 150 mg every 3 months 99%, safe, effective, acceptable during

lactation Wt. gain, irregular menstrual bleeding prolonged infertility NET-EN 300 mg 2 months Inj. During first 5 days of menstruation Deep intramuscular into gluteus maximus. Never massage ± 2 weeks

Sub dermal implants Norplant ▪ 6 silicone rubber capsules containing 35 mg

of Levonorgestril▪ Implanted under the skin of left upper arm

Permanent methods1.Male sterilization2.Female sterilization

Females 90 – 95%Males 5 – 10%One time method, no sustained

motivationRisk of complications is rare

Post-operative advice1. Patient is not sterile immediately after the operation2. At least 30 ejaculations may be necessary before the

seminal examination is negative3. To use contraceptives until aspermia has been

established 4. To avoid taking bath for at least 24 hours after the

operation.5. To wear a T-bandage or scrotal support for 15 days

and to keep the site clean and dry6. To avoid cycling or lifting heavy weights for 15 days7. Remove stitches on the 5th day after the operation.

a. Operative b. Sperm granulesc. Spontaneous reorganizationd. Autoimmune response e. Psychological

It is the most widely used contraceptive method. The procedure can be carried out in the immediate post menstrual and post partum period.

Laparoscopic sterilization is most commonly employed method.

Failure and complications only due to surgical skills.

Thread attached with IUCD is meant for Anti inflammatory effect Device can be pulled out when needed Shape of loop Assurance of loop’s presence Blocking of sperm penetration

Multi load contains Copper Zinc Silver Gold Progesterone

OCP is not c/I in Pregnancy Lactation Fibroid Overweight A woman having 2-3 children

Most effective contraceptive method for spacing between pregnancies is IUCD Oral pills Condom Vasectomy Abstinence from sexual intercourse

Estrogen content of OCP causes all except: Myocardial infarction Venous thrombo - embolism Decreased quantity of breast milk Increased blood sugar Breast tenderness