Download Contraception and Birth Control

Contraception and Birth Control
Lecture
Petrenko N., MD, PhD
Risk and Responsibility
 If
intercourse occurs the day before ovulation, the
chance of pregnancy is about 30%.
 If intercourse occurs the day of ovulation, the
chance of pregnancy is about 15%.
 Over the course of one year, couples who do not
use contraception have a 90% chance of
pregnancy.
Contraception
We use our knowledge of
reproductive physiology to
promote or avoid pregnancy.
Preventing Sexually Transmitted
Diseases (STD’S)
 Most
STD’s are treatable if diagnosed early.
 AIDS is one exception> AIDS is FATAL.
 Some contraceptive methods work to help prevent
disease and pregnancy.
 Latex and polyurethane condoms provide barrier
protection against virus and bacterial infection:
such as Herpes virus, chlamydia, gonococcus, and
HIV.
Preventing Sexually Transmitted
Diseases (STD’S)
 Not
100% effective at preventing infection or
pregnancy.
 Spermicides - Chemicals that kill sperm offer
protection against some STD’s, foam or film can
provide extra protection.
 Use of spermicides with barrier methods increase
the effectiveness of both the infection and
pregnancy protection of the method.
Contraception
 Three
general strategies:
 Prevent
ovulation;
 Prevent fertilization;
 Keep
 Prevent
sperm & oocyte away from each other.
implantation.
Contraceptive methods
 Hormonal
methods
 Barrier methods
 Intrauterine devices
 Natural methods
 Permanent methods
Birth Control and Contraception
 What
is the difference
 Birth
Control: Preventing birth from taking place
 IUD
 Emergency
contraceptive pills
 RU-486
 Surgical Abortion
Birth Control and Contraception
 Contraception:
Preventing conception (preventing the
sperm and the egg from uniting)
 Barrier

methods
Condoms, diaphragms
 Spermicides
 Hormonal
methods
Pill
 Shot (depo)
 Implants

Methods of Contraception and Birth
Control
 Choosing
 The
a Method
best method is the one you will use consistently
and correctly
 Know the reliability of method
 Know the advantages and disadvantages
 Side effects
 Risks
Methods of Contraception and Birth
Control
 Hormonal
 The
Methods
pill
 Implants
 Injections
Hormonal Contraception:
Combination OCP’s
 Contain
Synthetic Estrogen/Progestin
 Modern E2 Dosage ≤ 50 Mcg
 99.5 % effective (if used correctly) 92 %
The Pill

Combination of estrogen and progestin (some progestin only)
 Prevents ovulation
 Thickens
mucus at the cervix so sperm cannot
pass through
 Changes the environment of the uterus and
fallopian tubes to prevent fertilization or
implantation should fertilization occur
Combination OCP’s:
Mechanism of Action
 Suppresses
LH / FSH Release
(E2
FSH, P
LH)
 Progestin Thickens Cervical Mucus and Alters
Endometrium
 Major Effect Is Anovulation and Impairment of
Sperm Transport and Oöcyte Implantation
The Pill
Advantages
 Easy
to use
 Dependable
 No additional appliances
 Can regulate menstrual flow and decrease cramps and
other symptoms of menses
Combination OCP’s:
Additional Benefits
 Menstrual
Regulation
 Decreased Risk of Anemia
 Ovarian, Endometrial CA:
Risk
 Lower PID Risk
 Prevention of Benign Breast Disease
The Pill
 Problems
 Side
effects
 Changes
in menstrual flow
 Breast tenderness
 Nausea
 Vomiting
 Wt. gain or loss
The Pill

Contraindications
Heart disease
 Kidney disease
 Asthma
 High blood pressure
 Diabetes
 Epilepsy
 Gall bladder disease
 Sickle-cell anemia
 Migraine headaches
 depression,

The Pill
 ACHES
 Abdominal
pain
 Chest pain or shortness of breath
 Headaches (severe)
 Eye problems (blurred vision, flashing lights and
blindness)
 Severe leg pain
The Pill
 Smoking
and the Pill
 DO NOT TAKE THE PILL IF YOU SMOKE
Implants
 Progestin
only (Norplant)
 Prevents ovulation
 More effective than the Pill
Norplant:
 Implantable
for ≤ 5 Years
 Similar Side Effects as Depo-Provera
 Avg. Yearly Failure Rate: 0.8/100 (Increases : >
2/100 after 5 years)
 Occasionally Difficult to Remove
Implant
 Advantages
 Convenience
 Eliminate
user error
 No menses or very light
 Decreased cramping
Implant
 Problems
 Difficulty
 Side
 Side
in removing
effects
Similar to the pill
Changes in
menstrual bleeding
Headaches
effects
wt.
gain
Acne
breast tenderness
hair growth
ovarian cysts
Implant
 Contraindications
 Liver
disease
 Breast cancer
 Cardiovascular disease
 Unexplained vaginal bleeding
 Pregnant
 Smokers
Injectable Contraceptives
 Depo-Provera
(DMPA) Progesterone
 Can
stop menses
 Side effects include
 Spotting,
wt. gain, headaches, breast tenderness, dizziness,
loss of libido and depression
 Lunelle
Progestin and estrogen
 Similar
to the pill in all aspects
Barrier Methods
 The
condom
 Female condom
 Diaphragm
 Cervical cap
 Sponge
Barrier methods
Male / Female
 Diaphragm
Block sperm from
condom reaching the egg
Some are used
with spermicides,
which kill sperm.
Barrier
Methods:
 Diaphragm: High Failure Rates
– Must Remain in ~6 Hrs post-coitus
– Best if Combined with Spermicide
– UTI Potential
 Condom: STD Protection, Inconsistent Use
by Men
 Female Condom: Cumbersome, Learning
Curve
Spermicides
 Nonoxynol-9
 Use
in combination with barrier methods of
contraception
 Foam
 gel
 Film
 Creams,
jellies and suppositories
IUD
 Intrauterine
device
 Copper and plastic (Copper T-380A) 10 years
 Plastic and Progesterone (progestasert IUD) 1 year
 90-96 % effective in use
 Increased risk of PID
IUD:
Mechanisms of Action
 NOT ABORTIFACIENT!!!!!!!!
 Prevents
Conception:
– Sperm Transport Inhibited
– Sperm Survival / Capacitation
Diminished
 Prevents Implantation: hCG Levels = 0
 PID:
IUD:
Complications
0
Usually 2 Insertional Contamination
– Unproven Role for Prophylactic ABx
 Hypermenorrhea
 Expulsion
 Perforation (< 0.1%)
 Failure: IUD Should be Removed
 ??Ectopic
Fertility Awareness Methods
 Calendar
or rhythm method
 Midway
 Basal
in cycle
body temperature (BBT) method
 Increase
 Cervical
 Clear
in body temperature
Mucous Method
slippery mucous
 Symptothermal
 Combination
method
of BBT and Cervical Mucous methods
Fertility
awareness
(natural family
planning)
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.
Fertility Awareness Methods
Basal Body Temperature Method
(BBT)
The lowest body temperature of a
healthy person during awaking hours
OVULATORY
CYCLE
BBT IS
BIPHASIC
Sterilization
 For
Women
 Tubal
 Cut
ligations
and seal the fallopian tubes
 Hysterectomy
 Removal
of the uterus
 For
Men
 Vasectomy
 Vas
deferens are cut and sealed
Emergency Contraception
 Emergency
Contraception Pill (ECP)
 Copper IUD
Thank you!