Download What is emergency contraception?

Family planning
Xiaoying Yao
MD, PhD
Department of family planning
Obstetrics & Gynecology Hospital, Fudan University
•Contraception
•Induced abortion
How Pregnancy (Conception) Occurs
Contraception mechanism
• Prevents ovulation
• Thickens mucus at the cervix so
sperm cannot pass through
• Changes the environment of the
uterus and fallopian tubes to prevent
fertilization and to prevent
implantation if fertilization occurs
• Block sperm from reaching the egg
Contraception
mechanism
controception methods
• female
– IUD
– Hormonal contraception
– Emergency
contraceptive
– External contraception
• femshield
• spermicide
– Safe period
contraception
– Contraceptive vaccines
– sterilization
• male
– condom
– sterilization
So many……
Contraceptive
methods
Map of the use of various of contraception in China & developed countries
口服避孕药
1.69%
Oral contraceptive
Subcutaneous
implantation
皮下埋置剂
0.36%
IUD
宫内节育器
49.79%
杀精剂
避孕套 Spermicide
5.72% 0.26%
Condom
Others
其他
Male sterilization
0.17% 男性绝育
7.39%
女性绝育
34.62%
Female sterilization
阴道屏障避孕
4.20%
Vaginal barrier
IUD
宫内节育器
14.60%
避孕套
23.70%
Condom
注射/皮埋
1.30%
Injection/subcutaneo
us implantation
其他Others
0.10%
口服避孕药
28.40%
Oral contraceptive
绝育
27.70%
Sterilization
United Nations Department of Economic and Social Affairs Population Division: World contraceptive Use 2003
IUD（intrauterine device
）
•
Types of IUD
•
Inertia IUD（first generation）
•
Active IUD（second generation）
– Copper-containing IUD（include nonsupport IUD）
– Medicine-containing IUD
• LNG-IUD
• Indomethacin-IUD
IUD mechanism of action
• Killing sperm & embryo poison
• Interference implantation
• LNG mechanism
The active ingredient: Levonorgestrel
Intrauterine Contraception
Thickening of the cervical mucus
It prevents thickening of the womb lining
Prevent ovulation
Mirena®
Heavy Menstrual Bleeding
insert
•Time
•Contraindication:
•genital tract inflammation
Follow-up
1,3,6,12 month after the IUD insertion, to make sure it is in place.
Once a year.
Useful life
The copper IUD is approved for use for up to 10 years.
The hormonal IUD is approved for use for up to 5 years.
IUD side effect and complication
• Side effect
–
–
–
–
–
Heavy bleeding
Prolonged menstruation
Spotting
Discharge increasing
Abdominal pain
• Complication
–
–
–
–
–
–
Ectopic prognancy
Embedment
Crack
Down
Fall off
Pregnancy with IUD
Takeout
Contraception methods
– IUD
– Hormonal
– Others
• Emergency contraception
• External use contraceptive
Hormonal contraception
• Contraceptive mechanism
– Suppression of ovulation
– Changes in the cervical mucus properties
– Morphologic and functional changes of
endometrial
– Change the function of fallopian tube
Hormonal contraception -Types
• Oral contraceptives
• long-acting reversible contraceptives (LARC)
– Long-acting contraceptive injection (DMPA)
– Sustained release contraceptives (Norplant、Implanol)
You will be given a local anesthetic and asked to lie on back, with non-dominant
arm slightly bent at the elbow and turned outwards. The skin is stretched and a
needle containing the implant is inserted directly under, and parallel to, the skin
on the inside of upper arm. The implant will then remain under the skin when the
needle is withdrawn
Available options for LARC
Injection, effective up to 12 weeks
Levonorgestrel (LNG) intrauterine
system, effective for up to 5 years
Copper intrauterine device (IUD),
effective for up to 10 years
Implants, effective for up to 3-7 years
Hormonal contraception –Oral
contraceptives
– Ingredient: estrogen +
progesterone
– Short-acting
– long-term
– combination oral contraceptive
– Three-phase pills
– Four-phase pills
Development trend of OC
 Gradually reduce the dose of estrogen
200
150
•
Reduce the chances of coagulation system
–
•
•
100
To reduce the incidence of thrombosis
To reduce the subjective side effects
50
–
nausea
–
Vomiting
0
–
breast tenderness
1960
1970
1980
1990
Increased tolerance
The lowest estrogen content of oral contraceptives
Mercilon®
Contraindications to hormone
contraception
• Cardiovascular disease, thrombosis
• Acute / chronic hepatitis / nephritis
• Malignant neoplasms, precancerous
lesions
• Endocrine disease
• Smoking
• Mental disease
• Recurrent severe migraine
Side effects of hormonal contraception
•
•
•
•
•
Early pregnancy reaction
Menstrual disorders
Body weight change
Skin problems
Headache, diplopia, breast swelling
Non contraceptive benefits of hormonal contraception
•Treatment of bleeding and control cycle
•The treatment of endometriosis
•Improvement of premenstrual syndrome
•Reducing osteoporosis
Contraception methods
– IUD
– Hormonal
– Others
• Emergency contraception
• External use contraceptive
What is emergency
contraception?
• Emergency contraception is a way to prevent pregnancy if:
– Sex without using birth control
– Birth control method failed
• forgot to take pill or get shot
• the condom broke or came off
• diaphragm slipped
– Be raped
What are the types of emergency contraception?
• Pills
– work well
– don't cost a lot
– usually easy to get
• Copper intrauterine device (IUD).
– works very well
– but it has to be inserted by a doctor
How does it work?
• Emergency contraception pills work by
– preventing ovulation
– preventing fertilization
– preventing implantation
– 96% effective
• The copper IUD may work by
– killing sperm
– preventing fertilization
– preventing implantation
– 99% effective
Does it cause side effects?
• Emergency contraception may cause some side effects
– spotting or mild symptoms like those of birth control pills
– nausea or vomiting
– sore breasts, fatigue, headache, belly pain, or dizziness
– An IUD may cause cramping and bleeding during the first few
days after insertion
What else should you think about?
• Emergency contraception pills won't protect you for the rest of your cycle.
Use your regular method of birth control, or use condoms.
• Unless you get an IUD, emergency contraception does not take the place
of regular birth control. Find a good method of birth control you can use
every time you have sex.
• Emergency contraception does not prevent sexually transmitted infections
(STIs).
Method
Barrier
methods
Fertility awareness
(natural family
planning)
Permanent birth
control (sterilization)
How it prevents pregnancy
•Block sperm from reaching the egg
•Some are used with spermicides, which kill sperm.
•Identifies the time during a woman's cycle when she is most likely to
become pregnant (fertile). An additional method or abstinence should be
used during this time of fertility.
•Men: Vasectomy blocks the release of sperm.
•Women: Tubal ligation surgery or tubal implants block the movement of
an egg through the fallopian tube, preventing fertilization.
Tubal sterilization operation
•
Ligation method
– The proximal embedding
method
– Madlener
电绝育法
– Pomeroy
– Falope ring
– Hulka clip
Madlener
Pomeroy
The choice of family planning
methods
•The wedding
•Lactation
•After birth
•Menopausal transition
period
• Contraception
• Induced abortion
• Termination of early pregnancy---- Artificial
abortion
– Surgical abortion
• Vacuum aspiration<10w
– Medical abortion
• <7w
Common complications
Uterine perforation and visceral
injury
Incomplete abortion
Uterine
hemorrhage
Bleeding in
operation
Complication
Induced Abortion
syndrome
Cervical and intrauterine
adhesions
Infection
Miss-suction or leakage
Regret syndrome
(long-term)
Medical abortion
Overview and history
Medical abortion
Mechanism of action
Mifepristone: blocks the action of progesterone
causes the cervix to soften
Misoprostol: causes the uterus to contract
causes the cervix to soften
Medical abortion
•
Is a kind of non operation of artificial
abortion
•
Could reduce the fear and pain on the
operation of women
•
Long bleeding time and the potential risk
of major bleeding
•
Is the only remedy for contraception
failure
•
Not a contraceptive method
vaginal bleeding
Vacuum
abortion
<7 days
Medical
abortion
14-15 days
19.2%
complete abortion >21 days
1.5%
0.16%
emergency curettage
blood transfusion
Medical contraindications
• Mifepristone:
–
–
–
–
endocrine disease
history of ICP
blood disease
history of thrombosis
• Prostaglandin
contraindications:
–
–
–
–
–
cardiovascular disease
Glaucoma
Asthma
Epilepsy
colitis
• Other:
– allergic constitution
– IUD with pregnancy
– ectopic pregnancy
– hyperemesis gravidarum
– medication (anti tuberculosis,
epilepsy, anti depression, anti
prostaglandin drug)
Questions?