CONTRACEPTION

Chapter 6

CONTRACEPTIVES

Definition:

Conception: the fusion of an ovum and

sperm creating a fertilized egg (zygote)

Contraception: preventing conception by

blocking the female’s egg from uniting

with the male’s sperm

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PRINCIPLES OF CONTRACEPTION

Based on the physiology of reproduction

Types of contraception:

Barrier

Hormonal

Natural methods

Surgical

Factors affecting choice

Advantages and disadvantages

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Effectiveness

Contraceptive failure rate- % of women

experiencing an unintended pregnancy in the

1st yr. of contraceptive use

Continuation rate- % of people who continue to

use the method after a specified period of time

PRINCIPLES OF CONTRACEPTION

ORAL CONTRACEPTIVES: THE PILL

Estrogen and progesterone taken orally Mimics the corpus luteum

Secretes progesterone & estrogen to suppress ovulation

Combination pill Most common

Advantages : Easy to use, effective, fertility returns after use

Disadvantages : exp. symptoms of pregnancy, no protection against STD’s; stroke, blood clots in older women who smoke

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CONTRACEPTIVE SKIN PATCH

Thin , tiny square patch

Releases estrogen and progestin slowly into the bloodstream

Prevents the same way as OCs

Worn for 1 week, replaced on the same day for 3 consecutive weeks. 4th wk. no patch

Advantages: as effective as OCs

Disadvantages: similar to OCs

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VAGINAL CONTRACEPTIVE RING

The NuvaRing

2 inch flexible vaginal ring molded w/ progestin and estrogen

Slowly releases hormones into bloodstream

Inserted during cycle, kept in for 3 wks., removed during 4th wk. (ring free) new ring inserted at next menstrual

Advantages : 1 month of protection, no daily/weekly action required

Disadvantages : similar to OCs and patch

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CONTRACEPTIVE IMPLANTS Placed under skin of upper arm/leg

Delivers progesterone over a period

of years

May inhibit ovulation & affect development

of the uterine lining

Advantages: Highly effective, no further action required after insertion, contain no estrogen, so lower risk of estrogen related side effects

Disadvantages: no protection against STDs, menstrual irregularities, uncomfortable appearance

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INJECTABLE CONTRACEPTIVES

Depo-Provera

Injectable progestin every 12 weeks

Provides protection like implants

Advantages Highly effective, requires

little action on part of user ; No estrogen-

related side effects, minor injection

Disadvantages: visit to health care

facility every 3 months, side effects

similar to Norplant, weight gain,

infertility after stopping use

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EMERGENCY CONTRACEPTION

“Morning-after Pill”, Plan B

Most common is the two dose regimen

May inhibit/delay ovulation or altering

the transport of sperm/egg; do not affect

a fertilized, implanted egg

Needs to be taken within 72 hours. Best

used within 24 hours

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THE INTRAUTERINE DEVICE (IUD)

Small plastic device placed in the uterus ParaGard (copper;protects 10 yrs.)

Mirena (protects 5 yrs.) Releases small amounts of progestin

May work by preventing fertilization

Advantages: highly reliable, once inserted a simple check of string is all that’s needed; reduce risk of endometrial cancer; fertility restored after use

Disadvantages: limited to genital tract: heavy menstrual flow, uterine cramping, backache, spontaneous expulsion, may puncture uterine wall

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FIGURE 6.1 AN IUD PROPERLY POSITIONED

IN THE UTERUS

BARRIER METHODS

MALE CONDOMS

Thin latex, or polyurethane

Most widely used barrier method

Advantages: Protect against pregnancy and

STD’s, easy to purchase, no prescription

Disadvantages: Most common complaints are

reduced sensitivity and interfering with sexual

intercourse

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FEMALE CONDOMS

Polyurethane sheath with two flexible

rings

Advantages: offers potentially more

protection against genital warts and

herpes b/c it covers base of penis as well

Disadvantage: more expensive, more

difficult to use

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FIGURE 6.3 THE FEMALE CONDOM

PROPERLY POSITIONED

ABSTINENCE

Abstinence

Without sexual intercourse for a chosen

period of time

Benefits

More self respect and respect for

others

Security that you are not being

pursued for sexual reasons.

Less worry about STDs and

Pregnancy.

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THE FERTILITY AWARENESS METHOD

Only one egg released each month

Lives for ~ 24 hrs. unless fertilized

Sperm can live in the body for 6-7 days

Only 8 days/month when conception can

happen

FAM

Calendar method

A woman releases an egg 14-16 days before her next

period

Temperature method

A woman’s BT drops slightly before ovulation and

rises slightly after

Withdrawal

Coitus interruptus

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MALE STERILIZATION: VASECTOMY

Severing of the vas deferens

May return to work in 2 days

Reversal varies between 80% to 50%

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FIGURE 6.7 VASECTOMY

FEMALE STERILIZATION

Tubal sterilization (laparoscopy) is most

commonly known as tubal ligation

Hysterectomy

Complication rate: 6-11%

Reversibility: Low

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FIGURE 6.8 TUBAL STERILIZATION

WHICH CONTRACEPTIVE METHOD IS

RIGHT FOR YOU?

Key considerations include:

1. Health risks

2. Implications of unplanned pregnancy

3. STD risk

4. Convenience and comfort level

5. Type of relationship

6. Ease and cost of obtaining and

maintaining each method

7. Religious or philosophical beliefs

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CONTRACEPTIVE EFFECTIVENESS

Most Effective (Perfect Use)

Pill, Patch, Ring, Injectiable = 0.3%

Implant =0.05%

ParaGard = 0.6%

Mirena = 0.1%

Male Condom =2.0%

Female Condom = 5.0%

Withdrawal = 4.0 %

Vasectomy = 0.1%

Tubal sterilization = 0.5%