DEPARTMENT OF PHYSIOLOGY

TURFLOOP CAMPUS
UNIVERSITY OF LIMPOPO 2022
SHEL 011
Ms L TLADI
 Defne contraceptives
 Explain the aim of contraception use

 Discuss the mode of action of diferent

contraceptives
 Explain the criteria for an ideal

contraceptive
 Compare & contrast between the diferent

types of contraceptives & natural family

planning methods
 Discussthe advantages, disadvantages, side
efects and contraindications of the diferent
contraceptive methods:

Explain how the method works (and if it

protects against STDs)
Describe how to switch methods
Discuss side efects
 Definitnioi o contraception
Delniberate prevention of conception or
impregnation.
 Purpose

Contraception as a means of Birth control,

is designed to interfere with the normal
processes of conception and
prevent the pregnancy that could result
 Safe & Efective
 Acceptable to all
 Inexpensive & easy access
 Reversible
 Simple to administer
 Quick onset of action
 Should not act on libido
 Require little or no medical supervision
 Contraceptives act at diferent points in the
process: from ovulation, through fertilization,
to implantation.
 They either suppress ovulation, blocks sperm,
disables / destroys sperm
 There are diferent types of contraceptives
 Each method has its own efects & side
efects.
 Some methods are more reliable than others.
 ABOUT 80% of all pregnancies in the
MZANSI are unintended
 Among women who had an unintended
pregnancy in previous years, 52% had not
been using a method of contraception
during the month of conception
 MOST unintended pregnancies ended in
abortion, unnecessarily
 Combined Oral Contraceptive Pills
Extended-cycle/continuous Oral Contraceptive Pills
Progestin-Only Contraceptive Pills
Emergency Contraception
ADVANTAGES DISADVANTAGES

 Fertility returns rapidly  Increased risk of stroke,

 Bleeding is decreased acute MI, venous
thromboembolic disease
 Greater cycle predictability
 Increased risk of hepatic
 Decreased risk of benign
adenoma, cervical cancer,
breast disease, PID, ovarian
breast cancer
and endometrial cancers
 Do not protect against STDs
 When used with antibiotics
or anticonvulsants, efcacy
may be decreased
 Nausea, vomiting  Mood changes
 Headache  Decreased libido
 Weight gain  Increased
 Dizziness triglycerides
 Mastalgia  Severe depression
 Melasma  Spotting,
breakthrough
 Hypertension
bleeding
 Smoker of age > 35
 Dniabetes >20 years
OR wnith severe
 History of breast vascular dnisease,
cancer iephropathy,
 Abnormal vaginal retniiopathy,
bleeding of unknown ieuropathy
etiology  Major surgery with
 Cerebrovascular prolonged
disease immobilization
 Congenital  Severe hypertension
hyperlipidemia  Thrombophlebitis,
 Ischemic heart disease thromboembolic
disease, known
 Migraine thrombogenic
mutations
 Liver disease
 Suppresses ovulation, has variable
dampening efect on midcycle peaks of
LH and FSH, increases cervical mucus
viscosity, leads to atrophic
endometrium, reduces cilia motility in
the fallopian tube

**MUST BE TAKEN AT THE SAME

TIME EVERY DAY**
ADVANTAGES DISADVANTAGES

 **requires compliance**
 Does not protect
against STDs
 Risk of serious
complications to which
estrogen contributes is
greatly reduced
 Decreased
dysmenorrhea,
menstrual blood loss,
PMS symptoms
 Fertility returns rapidly
 Menstrual  Adverse impact on
irregularities lipids
 Spotting,  Mood changes
breakthrough  Severe depression
bleeding  Acne
 Amenorrhea  Hypoestrogenism
 Weight gain  Hair loss
 Headache
 Contraindications: pregnancy, current
breast cancer, vaginal bleeding
 Caution: breastfeeding < 6 weeks
postpartum, active viral hepatitis,
hypertension >160/100, current
ischemic heart disease, h/o stroke,
current DVT or pulmonary embolism,
diabetes w/ vascular disease, severe
decompensated cirrhosis
 Ovrette (0.075 mg Norgestrel)
 Micronor or Nor-QD (0.35 mg
norethindrone)
 First pill is taken on day 1 of
menstruation
Progestin-only:
 Plan B (levonorgestrel 0.75 mg)
 Norgestrel 1.5 mg
Combined:
 Norgestrel 100 mg, ethinyl estradiol 100
mcg
 Levonorgestrel 50 mg, ethinyl estradiol 100
mcg
First dose < 72 hours after unprotected
intercourse, second dose 12 hours later
Depo-Provera
 Progestin-only: Depo-
medroxyprogesterone acetate (DMPA)
150 mg IM every 12 weeks
 Alters endometrial lining, thickens
cervical mucus and blocks LH surge
preventing ovulation
 Failure rate 0.3% with perfect use, 3% with
typical use.
ADVANTAGES DISADVANTAGES

 Involves injections and

 Efcacy is not altered by remembering to visit MD
varying weight nor use of every 3 months
concurrent medications nor
sickness/diarrhea
 Persistent irregular bleeding
 Decreased anemia,
 Delayed return to fertility
dysmenorrhea  Weight gain-about 5 lbs in
 Decreased risk of frst year.
endometrial and ovarian  Depression
ca, PID, ectopics
 Safe for use in breast-
feeding mothers
 Does not produce serious
side efects of estrogen
 Edema,
 Nausea, vomiting, diarrhea, abdominal pain
 Hot fashes, decreased libido, menstrual changes,
breast tenderness, galactorrhea
 Weight gain
 Headache, insomnia, dizziness, depression, fatigue,
nervousness
 Rashes, alopecia, acne, urticaria, pruritus
 Injection site reactions
 Can cause decreased bone mineral density, but this
is not associated with increased fracture risk, is
transient and reversible upon discontinuation.
 Known or suspected pregnancy
 Undiagnosed vaginal bleeding or missed
abortion
 Known or suspected malignancy of the breast
 Liver dysfunction or disease
Ortho Evra
 Apply once weekly
for 3 weeks. Placebo
is one patch-free
week during which
withdrawal bleeding
occurs
 Blocks LH surge
(preventing
ovulation), thickens
cervical mucus,
alters endometrial
lining
NuvaRing
 Ethylvinyl acetate ring
 Ethinyl estradiol 0.015
mg/day +etonogestrel
0.12 mg/day
 Inserted intravaginally
for three weeks
 Thickens cervical mucus,
alters endometrial lining,
blocks LH surge
preventing ovulation
 Failure rate 0.3-1%
perfect use, 8% typical
use
 Advantages compared to other methods:
 Each ring releases ½ level of hormones as
average OCP
 Weight does not efect efcacy
 Enough hormone to be efective for 4-5 weeks
 Side efects, contraindications similar to
combined OCPs. Ring specifc:
 2.5% of women will have 1 event/year where
ring falls out
 Leukorrhea/vaginitis
Copper T 380A
Mirena
Copper T IUD Mirena
 Causes migration of WBCs  Releases 20 mcg LNG per day
into the uterine cavity into uterine cavity for 5 years
resulting in phagocytosis of  Inhibits fertilization:
spermatozoa anovulation, thickens cervical
 Copper ions seem to have mucus, inhibits sperm and
direct toxic efect on ovum motility and function
spermatozoa  Can be left in place for 5 years
 Can be left in place for 10 yrs  Bleeding: Decreases fow 90%,
 Bleeding: Increases fow 50%, irregular periods w/ spotting,
regular periods, 7-12% 20% amenorrheic at 1 year,
remove for bleeding and/or 7% remove for bleeding within
pain at 1 year 1 year
 Failure rate w/ perfect use  Failure rate w/ perfect use 0.1-
0.1-0.6%, typical use 0.1- 0.6%, typical use 0.1-0.8%
0.8%
ADVANTAGES DISADVANTAGES

 Long-term  Increased risk of PID (only at

 Reversible insertion-1/100)
 Most cost-efective
 Risk of perforation with
insertion (1/1000)
 No systemic side efects  Cramping and pain at
 Mirena only: decreased insertion
menorrhagia, dysmenorrhea,
anemia
 May be expelled unnoticed
 Decreased rate of ectopic
 No STD protection
pregnancies overall*  REQUIRES COUNSELING,
HISTORY, PELVIC EXAM,
SCREEN FOR
GONORRHEA/CHLAMYDIA and
PAP SMEAR**
 Mood changes
 Acne
 Headache
 Breast tenderness
 Nausea
 With Copper T: cramping, increased
bleeding
 High risk for STDs
 Current cervicitis or PID
 Known or suspected pregnancy
 Uterine anatomy interfering w/ placement
 AIDS, not doing well on ARV therapy
 Mirena only: Current DVT
 Copper only: Allergy to copper or Wilson’s dz
 Gynecologic or breast malignancy
 Unexplained vaginal bleeding
Implanon
 Progestin-only
(etonogestrel) implanted
contraceptive rod
 Implanted subdermally
in upper arm
 Lasts 3 years
 Blocks LH surge,
preventing ovulation.
Thickens cervical mucus.
Alters endometrial lining.
 Failure rate 0.1%
ADVANTAGES DISADVANTAGES

 Rapid return to fertility  Does not protect

 Lasts 3 years against STDs
 Safe to use during  May be less efective in
breast-feeding overweight women
 Complications at the
time of insertion or
removal, such as
scarring, bleeding,
infection
 Irregular bleeding and dysmenorrhea
 No consistent bleeding pattern-amenorrhea,
infrequent bleeding, prolonged bleeding
 Acne
 Weight gain-about 12% of patients
 Headache
 Mood swings
 Depression
 Decreased libido
 Breast/abdominal pain
 Known or suspected pregnancy
 Active venous thromboembolic disease
 Active liver disease
 Undiagnosed vaginal bleeding
 Known or suspected breast cancer
 Progesterone dependent tumors
 Allergy to any components
 Condoms
Female Condoms
Cervical Cap
Diaphragm
 Acts as barrier against
passage of semen into
vagina
 Good for individuals
who have multiple
partners, or who do
not want medical
intervention for
contraception.
 Failure rate: 2%
perfect use, 15%
typical use
ADVANTAGES DISADVANTAGES

 Protects against STDs  Requires responsible

 Readily available attitude on the part of
the male
 Inexpensive
 May decrease
 Allows male partner to
enjoyment of sex
be involved in
contraception
 Non-hormonal
 Polyurethane
sheath intended for
one-time use with
two fexible rings.
 Acts as a barrier to
passage of semen
into vagina
 Failure rate: : 5%
perfect use, 21%
typical use
ADVANTAGES DISADVANTAGES

 Protects against STDs  More expensive than

 Can be inserted up to 8 condoms
hrs before intercourse
 Awkward, difcult to
place
 Sheath coated on inside  May cause UTI
with silicone based
lubricant
 Non-hormonal method
controlled by women
 Cup-shaped latex device fts
over the base of the cervix
 Spermicide required
 May be inserted up to 8 hrs
prior to intercourse and left
in place for 48 hrs.
 Failure rate: nulliparous
women 6% with perfect
use, 16% with typical. In
parous women, 26% with
perfect use, 32% typical use
ADVANTAGES DISADVANTAGES

 Provides continuous  Requires professional

protection for duration ftting and training
of use regardless of  Can lead to cervical
number of intercourse erosions
acts, and does not  Obesity can make
require additional placement difcult
spermicide  Risk of toxic shock
 Non-hormonal syndrome of left in place
contraception controlled longer than prescribed
by women period
 Requires h/o normal PAP
smears
 Shallow cap with
spring mechanism in
rim to hold in place in
vagina
 Spermicide required
 Must be left in place
6hrs following
intercourse
 Failure rate: perfect
use 6%, typical use
16%
ADVANTAGES DISADVANTAGES

 Non-hormonal  Requires professional ftting

contraception and training
controlled by woman
 Can develop odor if not
properly cleaned
 Can cause vaginal erosions
 Requires additional
spermicide for repeated use
 Prolonged use can increase
risk of UTIs
 as the sperm pass through the vas deferens,
the positive charge on the RISUG polymer
causes the sperm cells to break apart. These
pieces still show up in the ejaculated semen,
but they cannot fertilize an egg.
 It is known that RISUG has an acidic pH
(lower pH) decreasing the sperm motility
and killing the sperm and it contains a
positive charge to disturb the negative
charge of sperm.
 Complete occlusion
 Partial occlusion
 pH lowering efect, greatly reducing the
motility of sperm
 Positive charge –negating the negative
charge on sperm that neutralizing
them.
 Duration of efect - a single dose (60 mg)
injection can be efective for at least 10
years. Reversal tried on animals.
 The safety of the use has not been
ascertained yet . Clinical trials are still
going on.
 Lohiya, N.K. Alam, I. Hussain, M. Khan, S.R.
and Ansari, A.S. 2014. RISUG: An intravasal
injectable male contraceptive. Indian
Journal of medical research 140
(Supplement), November 63-72
Draw a graph
to represent
the data on
the table
above