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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!