CONTRACEPTION

Contraception

DEFINITION:

The intentional prevention of conception through the use of various

devices, sexual practices, chemicals, drugs, or surgical procedures. Thus,
any device or act whose purpose is to prevent a woman from becoming
pregnant can be considered as a contraceptive.
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NEED FOR CONTRACEPTION

• To avoid unwanted pregnancies

• To regulate the timing of pregnancy
• To regulate the interval between pregnancy
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IDEAL CONTRACEPTION
• Highly efficient
• Free from unwanted side effect
• Absolute safety
• Simplicity of use
• Reversible
• Well tolerated
• Inexpensive
• Long lasting
• Requires less or no medical supervision
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METHODS OF CONTRACEPTION
Temporary Permanent
• Barrier • Female
• Natural (Tubectomy)

• IUDs • Male

• Hormonal (Vasectomy)

• Emergency
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TEMPORARY
A: BARRIER

• Male condoms
• Female condoms
• Diaphragm
• Spermicides
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SIDE EFFECT
1. MALE CONDOM
Condoms have no side
• Most commonly known
effects.
contraceptive.
Rarely, latex (rubber)
• Made of very thin latex (rubber),
condoms can cause
polyurethane or polyisoprene.
irritation for people with
• Can also protect against STIs if
latex allergies or
used correctly during vaginal, anal
sensitivities. And sometimes
and oral sex.
the lube on certain types of
• They're 98 to 87 % effective at condoms may be irritating.
preventing pregnancy. 13 out of If you're allergic to latex, try
100 who use condoms as their switching brands or using
only birth control method will get plastic condoms.
pregnant each year.
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2. FEMALE CONDOM SIDE EFFECT

• A barrier method of Female condoms do not have any
side effects except to individuals
contraception worn inside the
who are allergic to latex.
vagina.
• Made from thin, soft plastic
called polyurethane.
• When used correctly, it is 95%
effective.
• They help to protect against
pregnancy and sexually
transmitted infections (STIs),
including HIV.
HOW TO USE
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3. DIAPHRAGM SIDE EFFECT

• These are soft silicone caps
• The materials in the diaphragm and
worn inside the vagina to cover
the chemicals in the spermicide may
the cervix (the entrance to the
lead to skin irritation if you’re allergic.
uterus). They prevent the
• Spermicide may damage the lining of
sperm entering the uterus.
your vagina, causing vaginal irritation
• When used with spermicide, it
or burning. The damage may put you
prevents pregnancy by blocking
at increased risk of contracting an STI.
sperm from reaching your
• Vaginal diaphragms may increase
uterus.
your risk of urinary tract infections
• It has an 87% effectiveness
(UTIs).
rate.
• Wearing diaphragms beyond 24 hours
• Diaphragms don’t protect
without washing them can put you at
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4. SPERMICIDES SIDE EFFECT

• A kind of birth control that • Vaginal discharge
has chemicals that stop (temporary)—with use of
sperm from reaching an egg. creams, foams, and
• You put it in your vagina suppositories
before sex to prevent • vaginal dryness or odor
pregnancy.
• You don't need a prescription
to get spermicide — you can
buy it over-the-counter
• It is 79% effective at
preventing pregnancy.
How to use:
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B: NATURAL
• Total abstinence
• Coitus Iterruptus  Basal body temperature method
• Lactational amenorrhea method (BBT)
(LAM)  Cervical Mucus method (Billing’s
• Methods based on fertility method)
awareness:  Symptothermal method
 Calendar method or rhythym  Hi-tech hormonal monitoring
method
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1. TOTAL ABSTINENCE
• Avoiding all types of intimate genital contact.
• Someone practicing complete abstinence does not have any type of intimate sexual contact, including
oral sex.
• There is no risk of getting pregnant or an STD.

2. COITUS ITERRUPTUS
• Also known as withdrawal, is a traditional family planning method in which the man completely
removes his penis from the vagina, and away from the external genitalia of the female partner before
he ejaculates.
• The pull out method has no side effects.
• Withdrawal works about 78% of the time overall. But the odds of pregnancy are always higher during
the 5 days leading up to, and during,
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3. LACTATIONAL AMENORRHEA METHOD

• Lactation amenorrhea method (LAM) is a way for breastfeeding to temporarily help prevent pregnancy.
It must be used correctly to work.
• Lactation means your body is making breastmilk and amenorrhea means you aren't having a monthly
period. Breastfeeding hormones may stop your body from releasing eggs.

3 conditions must be met when using the lactational amenorrhea method

These guidelines include the following three criteria, all of which must be met to ensure adequate
protection from an unplanned pregnancy:
1) amenorrhea
2) fully or nearly fully breastfeeding (no interval of >4–6 hours between breastfeeds)
3) <6 months postpartum
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4. METHODS BASED ON FERTILITY AWARENESS:

Calendar method or rhythym method
• To use the rhythm method, you track your
menstrual history to predict when you'll
ovulate. This helps you determine when
you're most likely to conceive.
• It is not the most reliable way of preventing
pregnancy. With typical use, the traditional
rhythm method, which only involves
counting days on a calendar, has a failure
rate of 8–25%. With perfect use, the failure
rate is less than 5%.
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Basal body temperature method (BBT)

• Defined as the lowest natural, non-pathologic body
temperature recorded after a period of rest. Women
have used charting average basal body temperatures
over the length of a menstrual period has been a
tool to determine if ovulation has occurred or not.
• You can use a regular digital thermometer or buy a
basal thermometer. A basal thermometer shows you
the temperature in tenths of a degree. This allows
you to note tiny changes in body heat. Many
wearable devices, such as activity trackers, can
measure temperature.
• It has been predicted in some studies to be only
approximately 22% accurate in detecting ovulation.
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Cervical Mucus method (Billing’s method)

• A type of natural family planning in which a person
learns to track the changing features of their
cervical mucus to predict ovulation. This can be
used to help prevent pregnancy and to predict
ovulation when someone wishes to conceive.
• It's estimated that as many as 23 out of 100 women
practicing the cervical mucus method for birth
control will get pregnant in the first year of typical
use. With perfect use, the pregnancy rate may be as
low as 3 out of 100 women a year. Formal training
is usually needed to master the cervical mucus
method.
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Symptothermal method
• is a combination of methods. The two most
commonly used are the BBT method and
the cervical mucus method.
• BBT and cervical mucus tracking with use of
an electronic hormonal fertility monitor.
The monitor detects hormones in urine to
confirm fertile days.
• The effectiveness rate of using the
symptothermal method as a means of
preventing unplanned pregnancy is
controversial and highly debated. Multiple
sources and studies report differing results.
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Hi-tech hormonal monitoring

• Personal hormone monitoring consists of a hand held
monitor and disposable test sticks which measure
changes in urinary concentrations of oestrone-3-
glucuronide and luteinising hormone. An algorithm
estimated the fertile days which were displayed by a red
light.
• High-tech fertility tracking devices, including wearables
and apps, use various parameters such as basal body
temperature, hormone levels, and menstrual cycle data
to predict fertility. While some users have reported
success in using these devices for natural family planning
or conception, the effectiveness may vary, and they may
not be suitable for everyone.
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C: IUD (INTRA UTERINE DEVICE)

• An intra uterine device (IUD or coil) is a small
contraceptive device, often T-shaped and
containing either copper or levonorgestrel,
which is inserted into the uterus. They are one
form of long-acting reversible contraception
which are the most effective types of reversible
birth control.
• Failure rates with copper IUD is about 0.8%
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TYPES OF IUD
1st Generation
• Inert/non-medicated devices
• Ex. Lippes loop (left as long as required)

2nd Generation
• Metallic IUD
• Cu-T380 A (10 years)
• Nova T (5 years)
• Multiloaded devices

3rd Generation
• Hormonal IUD
• Progestasert ( 2 years)
• Minera (LNG-20) (10 years)
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CONTRAINDICATION TIME OF INSERTION

• Pelvic inflammation current or within 3 months • Preserable to insert 2-3 days after the period is
• Undiagnosed genital tract bleeding over. But it can be inserted any time during
menstrual phase and during lactation
• Suspected pregnancy
amenorrhea.
• Congenital uterine malformation
• Immediate after termination of pregnancy by
• Severe dysmenorrhea
suction evacuation or D and E or following
• Past history of ectopic pregnancy
spontaneous abortion.
• STIs current or within 3 months • t can inserted after delivery when patient are to
• Significant immunosuppression be discharged from hospital.
• Dabetes • Insertion immediately following delivery of
• Copper allergy for Cu-T placenta could be done, but the expulsion rate
is high
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INDICATION FOR REMOVAL COMPLICATION

• Persistent excessive regular or irregular uterine Immediate:
bleeding • Cramp like pain- Transient but at times, severe
• Flaring up of salpingitis. and usually lasts for 1/2 to 1 hr. It is relieved by

• Perforation of the uterus analgesic or antipasmodic drugs.

• IUD has come out of the place (partial expulsion) • Syncopal attack- more often found in
nulliparous or when the device is large enough
• Pregnancy occuring with the device
to distend the uterine cavity.
• Woman desirous of a baby
• Partial or complete perforation- due to faulty
• Missing thread
technique of insertion.
• One year after menopause
• When effective lifespan of the device is over
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ADVANTAGE DISADVANTAGE
• Simple to use • Side effects and complications

• Immediate return of fertility on removal of • Does not prevent HIV/STDs

device • Can’t use on her own or stop on her own
• Cheap • Some medical help required for insertion and
• No systemic side effects removal

• Effective in long term • May come out without woman’s knowledge

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D: HORMONAL/STEROIDAL
They contain synthetic female hormones (estrogen and
progesterone) which are steroid in nature.
Types:
Oral- Commonly known as pills or OC pills
• Combined Oral pills
• Phasic pills
• Mini pills
• Newer pills

Injectable- Intramuscular Newer sustained release systems

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ORAL PILLS BENEFIAL SIDE EFFECT

• Regularlization of cycles • Menstrual comfort- regularization of cycle and
• In cases of DUB blood loss is controlled

• Endometriosis ( taken continously for 6-9 • Prevents PID- cervical mucous is thickened,

months and not in cyclic manner as in other mentrual blood loss is reduced, uterine
indications) contractions are inhibited. Thus spread of
infection to tubes is prevented.
• Postponement of menstrual period
• Prevents ectopic pregnancy- lowers rish of
• Suppression of functional ovarian cysts
endometrial cancer: Because of progesterone
component.
• Lowers risk of ovarian cancer- Because of
suppression of pituitary secretion of
Gonadotropins and pvulation
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CONTRAINDICATION SIDE EFFECT

• Thrombo embolic disease • Nausea and Vomiting
• Acute or chronic disease of liver • Breakthrough bleeding
• Cancer of breasts or genitals • Absence of withdrawal bleeding
• Known or suspected pregnancy • Hypertension
• Hypertension and Diabetes • Cardiovascular disease
• Valvular heart disease • Weight gain and fluid retention
• Epilepsy • Pain, tenderness and engorgement of breasts
• Smokers over 35 years • Glucose tolerance is impaired
• Sickle cel anemia and Thalassemia • Higher rish of breast and cervical carcinoma
• Asthma and allergic disorders • Teratogenicity
• Varicous veins, Obesity and Elective surgeries
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INJECTABLES
Long acting progestins
• every 2 to 3 months

Combined Injectables
• monthly
• failure rate is 1 in every 100 women per year
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E: EMERGENCY CONTRACEPTIVE PILLS

• Also called the ‘morning after’ pill.
• Emergency contraception is not an abortive method as the pill helps avoid conception.
• Pills are high dose hormonal pills that can be taken up to 72 hours AFTER intercourse but the sooner
someone uses emergency contraception the more effective it is.
• If it contains two pills, take both at the same time.
• There are no major side effects, but some people may experience vomiting, headache or breast
tenderness.
• If the period does not start in three weeks after taking the pill, check for pregnancy.
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PERMANENT
A: FEMALE (TUBECTOMY)

• Female sterilization also known as tubal ligation or tuberctomy is a surgical procedure in which the
fallopian tubes are severed and sealed or “pinched shut” in which prevents eggs from reaching the
uterus for implantation.

• It is the highly effective, safe and simple procedure that involves cutting, tying or removing a part of
the fallopian tubes.
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METHODS OF TUBECTOMY
Occlusion method Method of tubal ligation by entry sites or routes
• Partial salpingectomy • Laparotomy method
• Tubal clip • Mini laparotomy
• Tubal rings/falope rings • Laproscopic tubal ligation
• Fibriectomy • Vaginal tubal ligation (Colpotomy)
• Epectrocoagulation or cauterization
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ADVANTAGE SIDE EFFECT

• Very effective method
• Reaction to Anesthetic drug
• Give permanent or life long protection
• Bleeding
• Nothing to remember, no supplies, and no repeated clinicasl visit required
• Perforation of major vessel
• No interference with sexual intercourse
• Abdominal pain
• No known long term side effect or health risk
• Perforation of fallopian tube
DISADVANTAGE • Ectopic pregnancy
• Pain for few days after surgery
• Infection or bleeding at the incision site
• Injury to internal organs
• Anaesthetic risk
• Allergic reaction
• Delayed recovery and side effect of general anesthesia
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CANDIDATE FOR STERILIZATION

With proper counselling and informed consent, any woman can have female sterilization safety,
including women with who:
• Have no children or few chilldren
• Are not married
• Do not have husband’s permission
• Are young
• Just gave birth (within the last 7 days)
• Are breast feeding
• Are infected with HIV whether or not on antiretroviral therapy
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B: MALE (VASECTOMY)
• Vasectomy is a surgical procedure for male sterilization and a method of permanent birth control
• During the procedure, the vasa deferentia of a man are tied and separated to prevent sperms from
entering into the seminal stream.
• Not easily reversible
• Safe and effective and is a day care procedure requiring hospitalization for a few hours only.
• Pregnancy may occur after vasectomy because of:
 Failure to use another birth control method until the sperm count is confirmed to be zero. It usually
takes 10 to 20 ejaculations to completely clear sperm from the semen.
 Make sure sperm count is zero on two different analysis before resuming unprotected sexual
intercourse
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PROCEDURE OF VASECTOMY
• The two ends of the vas deferens are tied,
cut and separated.
• The vas deferens is then replaces inside
the scrotum and the skin with stitches
that dissolve and do not have to be
removed.
• The procedure takes about 20 to 30
minutes and can be done in a clinic. It is
best done by a Urologist
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AFTER SURGERY COMPLICATION

• The scrotum will be numb for 1 to 2 hrs after a • Bleeding under the skin, which may cause swelling or
vasectomy. bruising.
• Wearing snug underwear or a jockstrap will help ease • Infection at the site of the incision
discomfort and protect the area. • Sperm leaking from the vas deferens into the tissue
• There might be some swelling and minor pain in the around it and forming a small lump (sperm
scrotum for several days after the surgery. granuloma)
• The patient can resume normal activities same day. • Inflammation of the tubes that move sperm from the

• Analgesics will be required. testicles (epididymitis)

• Bu the partner can still get pregnant until the sperm

count is zero.
RECANALIZATION
• Another method of birth control should be adopted In rare cases, the vas deferens joins back naturally
(recanalization), and the man becomes fertile again after
until the patient has a follow-up sperm count test, 6
many years.
weeks after the vasectomy or after 10 to 20
ejaculations