WAJIHA SAJID

BATCH L

• Contraception, birth control or fertility control refers to the methods or devices used to prevent pregnancy.

• Planning and provision of birth control is called family planning.

Reversible methods– Barrier Methods– Hormonal Methods 1. Oral Contraceptive Pills2. Injectable

Contraceptives3. Contraceptive patch4. Vaginal Ring– Intrauterine Devices– Emergency methods– Miscellaneous methods

Irreversible/permanent methods/sterilization

• Tubal ligation

• Vasectomy

Aim of the method is to prevent the sperm from meeting the ovum.

• Condoms

• Female Condoms

• Cervical Cap

• Diaphragm

• Vaginal sponge

• Spermicides

prevent the deposition of semen into vagina

• Advantages

• Protect against STDs

• Readily available

• Inexpensive

• Allow male partner to be involved in contraception

• Disadvantages

• Failure rate is 2% with perfect use

• Require responsible attitude on the part of male

• Polyurethane sheath intended for one-time use with two flexible rings.

• Acts as a barrier to passage of semen into vagina

Advantages

• Protects against STDs

• Can be inserted up to 8 hrs before intercourse

• Sheath coated on inside with silicone based lubricant

Disadvantages• More expensive than

condoms• Low acceptability,

difficult to place• Failure rate: 5% perfect

use21% typical use

• Cup-shaped latex device fits 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.

• Shallow cap with spring mechanism in rim to hold in place in vagina

• Spermicide required

• Must be left in place 6hrs following intercourse

Advantages

• Non-hormonal contraception controlled by woman

Disadvantages

• High failure rate: perfect use 6%, typical use 16%

• Prolonged use can increase risk of UTIs

• Requires professional fitting and training

• Can develop odor if not properly cleaned

• Can cause vaginal erosions

• Toxic shock syndrome

• Requires additional spermicide for repeated use in case of diaphragm

Foam

• Surface active agents

• 80-85% effective

• Works immediately

• Effective for an hour

• 20% have burning (reaction)

Vaginal Sponge

• Combined Oral Contraceptive Pills

• Progestin-Only Contraceptive Pills

• Extended cycle combined oral contraceptive pills

• Post coital pills for Emergency Contraception

• Once a month pills (quinestrol+progestogen)

• Contain estrogen(30-35mcg)

• and progestin(0.5-1mg)

• Block ovulation, alter cervical mucus, stimulate atrophic change in endometrium

• 21 days of hormone followed by 7 days of placebo to allow withdrawal bleeding

Advantages:

• Failure rate less than 0.3% with perfect use (8% typical use)

• Fertility returns rapidly

• Bleeding is decreased

• Greater cycle predictability

• Decreased risk of benign breast disease, PID, ovarian and endometrial cancers, ectopic pregnancy

Disadvantages:

• Increased risk of stroke, acute MI, venous thromboembolic disease

• Increased risk of hepatic adenoma, cervical cancer, breast cancer

• Do not protect against STDs

• When used with antibiotics or anticonvulsants, efficacy may be decreased

• Nausea

• Headache

• Weight gain

• Suppress lactation

• Vomiting

• Dizziness

• Mastalgia

• Hypertension

• Mood changes

• Decreased libido

• Increased triglycerides

• Severe depression

• Spotting, breakthrough bleeding

• Abnormal vaginal bleeding of unknown etiology

• Cerebrovascular disease• Congenital hyperlipidemia• History of breast cancer• Ischemic heart disease• Migraine• Active viral hepatitis• Diabetes >20 years OR

with severe vascular disease, nephropathy, retinopathy, neuropathy

• Severe hypertension• Hepatic neoplasm• Thrombophlebitis,

thromboembolic disease, known thrombogenicmutations

• Suppresses ovulation, has variable dampening effect on mid cycle 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:

• Risk of serious complications to which estrogen contributes is greatly reduced

• Decreased dysmenorrhea, menstrual blood loss

• Fertility returns immediately after cessation

Disadvantages:

• Does not protect against STDs

• these are COCPs packaged to reduce or eliminate the withdrawal bleeding that occurs once every 28 days in traditionally packaged COCPs. Extended cycle use of COCPs may also be called menstrual suppression

• vaginal ring and the contraceptive patch have been studied for extended cycle use, and the monthly combined injectable contraceptive may similarly eliminate bleeding

• Menorrhagia• Dysmenorrhea• Endometriosis• Menstrual migraines• Irregular periods • Iron-deficiency anemia

• Some seizure disorders• Menstrual flares of rheumatoid arthritis• Coagulation defects • Vasomotor symptoms of perimenopause• Acne • Hirsutism• Polycystic ovary syndrome

Progestin-only:– Levonorgestrel 0.75 mg

– Norgestrel 1.5 mg

Combined:– Norgestrel 100 mg, ethinyl estradiol 100 mcg

– Levonorgestrel 50 mg, ethinyl estradiol 100 mcg

T Cu

First dose < 72 hours after unprotected intercourse, second dose 12 hours later

Depo-Provera

• Injectable Contraceptives• Progestin-only: Depo-

medroxyprogesterone acetate (DMPA) 150 mg IM every 12 weeks

• Alters endometrial lining, thickens cervical mucus and blocks LH surge preventing ovulation

Advantages• Extremely effective. Failure rate 0.3% with perfect

use, 3% with typical use.• Efficacy is not altered by varying weight nor use of

concurrent medications nor sickness/diarrhea• Decreased anemia, dysmenorrhea• Decreased risk of endometrial and ovarian ca, PID,

ectopics• Safe for use in breast-feeding mothers

• Does not produce serious side effects of estrogen: OK to use in patients with diabetes, lipid disorders, complicated migraines, h/o cerebrovascular accidents/Coronary Artery Disease/Congestive Heart Failure, SLE, peripheral vascular disease

Disadvantages• Involves injections and remembering to visit doctor

every 3 months• Persistent irregular bleeding• Delayed return to fertility• Weight gain-about 5 lbs in first year.• Depression

• 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

• Ethyl vinyl 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

– vaginitis

• Lippes loop

• Copper T 380 A

• Multiload

• Mirena

Copper T IUD

• Causes migration of WBCs into the uterine cavity resulting in phagocytosis of spermatozoa

• Copper ions seem to have direct toxic effect on spermatozoa

• Foreign body reaction

• Can be left in place for 10 yrs

• Releases 20 mcg LNG (levonorgestrel) per day into uterine cavity for 5 years

• Inhibits fertilization: anovulation, thickens cervical mucus, inhibits sperm and ovum motility and function

• Can be left in place for 5 years

Advantages: Efficacy. Failure rate w/ perfect use 0.1-0.6%, typical

use 0.1-0.8% Long-term Reversible Most cost-effective No systemic side effects Mirena only: decreased menorrhagia, dysmenorrhea,

anemia Do not interfere with lactation

**

• Increased risk of PID (only at insertion)

• Bleeding

• Risk of perforation with insertion

• Cramping and pain at insertion

• May be expelled unnoticed

• No STD protection

• Ectopic pregnancy

• Vaginal bleeding of unknown etiology

• Current cervicitis or PID

• Known or suspected pregnancy

• Uterine anatomy interfering w/ placement

• Mirena only: Current DVT

• Copper only: Allergy to copper or Wilson’s disease

• Gynecologic or breast malignancy

• Previous ectopic pregnancy

• Within first 10 days of menstrual cycle

• Within first week after delivery

• 6 to 8 weeks after the delivery

• Coitus interruptus (literally "interrupted sexual intercourse"), is the practice of ending sexual intercourse ("pulling out") before ejaculation

• Symptothermic method

• Safe period (rhythm method)

• Basal body temperature method

• Cervical mucous method

Sterilization Sterilization :female bilateral tubal ligation and male

vasectomy are permenant method of contraception and highly effective.

• They are generally chosen by relatively older couple who are sure that they completed their family.

Also individual who carry a genetic disorder may choose to be sterlized.

Sterilization methods include:1- Vasectomy in males.

2- Tubal Ligation in females .

Bilateral Tubal Ligation

This involve mechanically blockage of both fallopian tube to prevent the sperm reaching and fertilizing the oocyte

sterilization performed by laparoscopically(under GA) or through a suprapubic “mini-laparotomy” During caesarean section

Failure rate: 0.5%

Tubal Ligation

Tubal LigationAdvantages:• intended to be

permanent• highly effective• safe• quick recovery• lack of significant long-

term side effects• cost effective

Disadvantage:

possibility of patient regret

• difficult to reverse

• future pregnancy could require assisted reproductive technology (such as InvitroFertilization)

• more expensive than vasectomy

Vasectomy

• Vasectomy involve division of the vas deferens on each side to prevent the release of sperm during ejaculation.

• Easier than tubal ligation.

• Usually done under local• anesthesia.

• Failure rate: 0.1%.

Vasectomy

• Advantages:

• permanent,effective,safe, quick recovery

• lack of significant long-term side effects

• cost effective; less expensive than tubal ligation

Disadvantages:

• reversal is difficult, often unsuccessful

• not effective until all sperm cleared from the reproductive tract (may take up to 12 w)

• no protection from STD

Cont.

Complication of vasectomy:

• Immediately bleeding, wound infection

• At the cut of vas deferns small lump will apear as a result of a local inflammation response this is called sperm granuloma it needs surgical excision.

• some men develop anti-sperm antibody following vasectomy

THANK YOU