CONTRACEPTIONWe use our knowledge of reproductive

physiology to promote or avoid pregnancy

Lecture 7N.Petrenko, MD, PhD

HISTORY

• China - quicksilver (mercury) was heated in oil and swallowed by women

• Persia - sponges soakedin quinine, iodine, carbolic acid (phenol) and alcohol were

inserted in vagina before intercourse

• 1850 B.C. Egyptians used crocodile dung mixed with honey as vaginal pessary

History of contraceptives An oral birth control pill was

tested on 6,000 women from Puerto Rico and Haiti.

– In 1960, the first oral contraceptive (Enovid-10) was launched in the US market.

– The ‘Pill’ heralded a revolution in birth control.

incidence

Methods of Contraception• Natural family planning methods And Fertility Awareness Methods

Coitus interruptus Calendar metods Basal body temperature Ovulation-detection method Symptothermal method (cervical mucus+BBT) Predictor test for ovulation

• Barrier Methods Chemical male (condom) Mechanical female (condom, cervical diaphragm, cervical cap)

• Hormonal Methods Combined (oral, injection, transdermal, vaginal ring) Pogestin only (oral, injection, implantable)

• Intrauterine Device

• Emergency Contraception

Natural family planning methodsBasal Body Temperature Method (BBT)

Natural family planning methodsBasal Body Temperature Method (BBT)

Natural family planning methodsCervical mucus Ovulation-Detection

Method• requires that the woman recognize and

interpret the cyclic changes in the amount and consistency of cervical mucus that characterize her own unique pattern of changes

• cervical mucus should be free from semen, contraceptive gels or foams, and blood or discharge from vaginal infections, douches and vaginal deodorants, medications such as antihistamines for at least one full cycle

Natural family planning methodsCervical mucus Ovulation-Detection

Method

Natural family planning methodsCervical mucus Ovulation-Detection

Method

Natural family planning methodsCervical mucus Ovulation-Detection

Method

Natural family planning methodsPredictor test for ovulation

• detects the sudden surge of luteinizing hormone (LH) that occurs approximately 12 to 24 hours before ovulation. Unlike BBT, the test is not affected by illness, emotional upset, or physical activity

Methods of Contraception• Natural family planning methods And Fertility

Awareness Methods

• Barrier MethodsChemical male (condom)Mechanical female (condom, cervical diaphragm,

cervical cap)

• Hormonal Methods• Intrauterine Device• Emergency Contraception

Barrier MethodsSpermicides

• Nonoxynol-9 is a surfactant that destroy the sperm sell membrane,

• Mode of action• Provide a physical and chemical barrier that prevent viable

sperm from entering the cervix• frequent using increase the transmission of HIV, • can cause genital lesion• aerosol foams, foaming tablets, suppositories, creams, films,

gels, and sponges• Should be inserted no longer than 1 hour before intercose • Effectiveness depends on consistent and accurate use• Typical failure rate in the first year of use is 29%

Barrier MethodsSpermicides

• Advantages• Easy to apply• Safe• Low cost• Available without a prescription or previous medical examination• Aids in lumbricate of the vagina• Alternative to lacting woman and premenopausal, foget oral

contraceptive• Disadvantages

• Maximall effectiveness lasts no longer 1 hour• Repeated intercourse need additional spermicides• Alergic reaction and irritation of vaginal and penile tissue• Decrease sensation• Increase STI

Barrier MethodsSpermicides

Barrier Methodsmale condom

• prevent sperm from entering the cervix • FAILURE RATE

• Typical users, 14%• Correct and consistent users, 3%

• ADVANTAGES• Safe• No side effects Readily available• Premalignant changes in cervix can be prevented or ame liorated in women

whose partners use condoms Method of male nonsurgical contraception• DISADVANTAGES

• Must interrupt lovemaking to apply sheath. Sensation may be altered.• If used improperly, spillage of sperm can result in preg nancy. Occasionally,

condoms may tear during intercourse.• STI PROTECTION

• If a condom is used throughout the act of intercourse and there is no unprotected contact with female genitals, a latex rubber condom, which is impermeable to viruses, can act as a protective measure against STIs. The addi tion of nonoxynol-9 increases protection against trans mission of STIs.

Barrier Methodsfemale condom

• is made of polyure-thane and has flexible rings at both ends

• The closed end of the pouch is inserted into the vagina and is anchored around the cervix, and the open ring covers the labia.

• The female condom can be inserted up to 8 hours be fore intercourse and is intended for one-time use.

• Typical failure rate is 21% in the first year of use

Barrier method

Barrier Methodsdiaphragm

• is a shallow, dome-shaped rubber device with a flexible wire rim that covers the cervix

• The diaphragm is a mechanical barrier preventing the meeting of the sperm with the ovum.

• The diaphragm holds the spermicide in place against the cervix for the 6 hours it takes to destroy the sperm.

• Typical failure rate of the diaphragm alone is 20% in the first year of use.

• Effectiveness of the diaphragm can be increased when combined with a spermicide

Barrier Methodscervical cap

• soft, natural rubber dome with a firm but pliable rim. It fits snugly around the base of the cervix close to the junction of the cervix and vaginal fornices.

• It is recommended that the cap remain in place no less than 8 hours and not more than 48 hours at a time.

• It is left in place at least 6 hours after the last act of intercourse. • The seal provides a physical barrier to sperm: spermicide in side the cap adds a

chemical barrier. • The extended period of wear may be an added convenience for women.

• Contindication• abnormal Papanicolaou (Pap) test results, • those who cannot be fitted properly with the existing cap sizes, • those who find the insertion and removal of the device too difficult,• those with a history of Toxic Shock syndrome, • those with vaginal or cervical infections, • those who experience allergic responses to the latex cap or spermicide.

Barrier MethodsSponges

• is a small, round, polyurethane sponge that contains nonoxynol-9 spermicide. It is designed to fit over the cervix (one size fits all). The side that is placed next to the cervix is concave for better fit. The opposite side has a woven polyester loop to be used for removal of the sponge.

• The sponge must be moistened with water before it is inserted. It provides protection for up to 24 hours and for repeated instances of sexual intercourse. The sponges hould be left in place for at least 6 hours after the last act of intercourse. Wearing longer than 24 to 30 hours may put the woman at risk for TSS

Barrier MethodsSponges

Methods of Contraception• Natural family planning methods And Fertility Awareness

Methods

• Barrier Methods

• Hormonal MethodsCombined (oral, injection, transdermal, vaginal ring)Pogestin only (oral, injection, implantable)

• Intrauterine Device

• Emergency Contraception

Methods of Contraception• Natural family planning methods And Fertility

Awareness Methods• Barrier Methods

• Hormonal MethodsCombined (oral, injection, transdermal, vaginal ring)Pogestin only (oral, injection, implantable)• Intrauterine Device• Emergency Contraception

Hormonal MethodsCombined oral contraceptives (COCs)

• Consist of synthetic estrogen and progestin preparations • suppresses the action of the hypothalamus and anterior

pituitary, leading to inappropriate secretion of follicle-stimulating hormone (FSH) and LH; ovulation is inhibited because ovarian follicles do not mature.

• maturation of the endometrium is altered, making it a less favorable site for implantation should ovulation and fertilization occur;

• the cervical mucus remains thick as a result of the effect of the progestin and reduces the chance for sperm penetration

• Decrease tubal motility

Hormonal Methods Combined contraceptives Transdermal contraceptive patch

Hormonal MethodsCombined contraceptives

Vaginal Ring

• Etonogestrel + ethynyl estradiol• Worn for 3 weeks + 1 week without ring• Withdrawal bleeding occurs during “no ring”

week

Depot medroxyprogesterone acetate (DMPA, Depo-Provera), 150 mg

injected intramuscularly in the deltoid or gluteus maximus, don’t massage

every 3 months • Advantages.

– Rapidly and highly effective, long-acting, only 4 times a year, lacting period

• Disadvantages- Prolonged amenorhea, or uterine bleeding, increased risk of

of venous thrombosis and thrombembolism, no protection against STI

Hormonal Methods

Progestin-only injectable contraceptives

Hormonal Methods Progestin-only implants,

The Norplant system

Methods of Contraception• Natural family planning methods And Fertility

Awareness Methods

• Barrier Methods

• Hormonal Methods

• Intrauterine Device

• Emergency Contraception

Intrauterine Device (IUD)

Methods of Contraception• Natural family planning methods And Fertility

Awareness Methods

• Barrier Methods

• Hormonal Methods

• Intrauterine Device

• Emergency Contraception

Emergency contraception • used within 72 hours of unprotected intercourse to

prevent pregnancy. • High doses of oral progestins • or combined OCPs • or insertion of IUD • Before ovulation: inhibiting follicular development• After ovulation: prevent implantation• First dose within 72 hour, • second dose 12 hour later

Voluntary sterilization

female

Voluntary sterilizationmale

21 Dec. 2008 Contraception.ppt 39

& if contraception fails …

• RU-486– Blocks progesterone

receptors– Uterus & anterior

pituitary behave as if no progesterone present

– Endometrium sloughs.

THANK YOU !!!