Download Contraceptive Methods

Contraceptive
Methods
Contraception
 There are many types of contraception widely used now
days for family planning purposes.
 Each method has its advantages and suits special cases
and not necessarily suits others and the choice of
contraception depends on different needs of the patients
like the period of contraception and also doctor should
decide which method suits needs more.
 No method of contraception is completely effective and
failure rates for most reversible methods are strongly
influenced by compliance.
 Types:1.
2.
3.
4.
Natural contraception
Mechanical contraception
Hormonal contraception
Surgical contraception
Characteristics of ideal contraceptive:
 Safe
 100% effective
 Free of side effects
 Easily obtainable
 Affordable
 Acceptable to the user and sexual
partner
 Free of effects on future pregnancies
Conditions of family planning
 Pregnancy
 Lactation
 Before puberty
 After menopause
 Abstinence
Natural Family planning methods
 These methods involve finding out when a woman is
at her most fertile, so that
she can be extra careful or avoid sex altogether
during these times. This can be done by using
techniques such as the woman keeping a daily
record of her body temperature using a special
fertility thermometer.
 A combination of techniques is recommended to
increase the effectiveness of these methods.
 These are a natural alternative to hormonal and
barrier methods but the
techniques used require a significant level of
motivation and a clear understanding of how to
monitor fertility. Natural methods of contraception
also do not take into account fluctuations in the
menstrual cycle.
Natural Family planning methods
 They include:







Calendar (Rhythm) method
Basal body temperature
Cervical mucous method
Symptothermal method
Ovulation awareness method
Lactational amenorrhea method
Withdrawal ( Coitus interruption )
Rhythm method
 This method can be used for patients with regular cycles
only.
 This is done depending on the exact knowledge of
ovulation day and avoiding intercourse during the days
before and after ovulation;
 for example in a regular period that occurs every 28 days
the exact day of ovulation should be the day 14 so
intercourse should be avoided 4-5 days before and after
this days.
 There are many methods to detect ovulation days;
1- Increase in body temperature by about o.5 C.
2- Change in type cervical mucous
3- Ovulation kits nowadays are available for ovulation day
detection by measuring LH surge
Palm leaf pattern
Withdrawal
 When having sex, the man has to take his penis




out of the vagina before ejaculation.
This is intended to stop sperm from entering the
woman.
This method frequently fails as drops of sperm
can already escape from the penis into the
vagina before the man ejaculates.
Effectiveness: Failure rate can be as high as
15% (15 pregnancies per 100 women).
More reliable methods are advised.
Mechanical family planning methods
 Male condoms
 Female condoms
 Diaphragms
 Spermicidal
 Intrauterine devices (IUD)
 Sponge
Male condom
 It's a thin latex or plastic sheath placed over a man's
erect penis during sex to trap
sperm at the point of ejaculation. It must be put on the
penis as soon as it becomes erect and
before any contact takes place with the vagina. Men
should withdraw as soon as they have
ejaculated and take care not to spill any semen.
 Condoms must be used with care as they can slip off or
split. They should never be used with oil-based products
such as petroleum jelly or suntan oil as these will damage
the rubber.
 Advantages: easily available; offers protection against
sexually transmitted infections including
HIV/AIDS.
 Effectiveness: 94%-98% depending on correct use. Only
use condoms that have been
manufactured.
Female condom (Femidom)
 It's a thin polyurethane sheath placed inside the
vagina (also covering the cervix and the area
outside) to stop sperm from entering. It can be
put in at any time before sex and is
actually stronger than the male condom.
 It need to be sure that the penis enters the
condom
and is not inserted between the condom and
the vaginal wall.
 Advantages: offers protection against sexually
transmitted infections, including HIV/AIDS.
 Effectiveness: 95% if used correctly.
Diaphragms/cervical cap
 A diaphragm or cap is a dome of rubber which




is fitted by the woman over her cervix before
sex. It acts as a barrier to stop sperm getting
through to the uterus. It should be used with a
spermicidal cream, jelly or pessaries that
contain a chemical that kills sperm.
The diaphragm must stay in place for six hours
after sex.
Advantages: only needs to be used when the
couple has sex
Spermicides may cause irritation or an allergic
reaction.
Effectiveness: 92%-96% if used correctly.
Spermicides
 These are creams, gels, sponges or
pessaries that contain a chemical that
kills sperm.
 They can increase the effectiveness of
certain barrier methods of contraception
such as a diaphragm.
 However, they don't provide reliable
contraception when used alone.
The IUD
 An IUD - also known as a Coil - is a small




plastic and copper device, usually shaped like a
'T', which is fitted into the woman's uterus by a
doctor using a simple procedure.
It works by preventing an egg from settling in
the womb. An IUD can stay in place for five
years - sometimes for 10. It can also be used
as an emergency method of contraception
within five days of unprotected intercourse.
Advantages: no need to think about it once it is
in place and it last for a long time.
Considerations: There is a higher risk of
infection for women with more than one partner.
It may cause heavier, more painful periods.
Effectiveness: 98%-99%.
IUD’s
Copper -T
VAGINAL SPONGE
 Vaginal contraceptive sponges are soft
synthetic sponges saturated with a spermicide.
Prior to intercourse, the sponge is moistened,
inserted into the vagina, and placed over the
cervix . After intercourse, the sponge is left in
place for 6 to 8 hours.
 It is quite similar to the diaphragm as a barrier
mechanism.
 About 18 to 28 pregnancies occur over one
year for every 100 women using this method.
The sponge may be more effective in women
who have not previously delivered a baby.
 This method was removed from the U.S.
market, but plans are underway to re-introduce
it in the near future.
Hormonal family planning methods
 Skin patch
 Vaginal ring
 Pills ( Combined & Minipill )
 Injection
 Implant
Contraceptive skin patch
 The Contraceptive Patch looks like a square
band-aid. It is applied to the abdomen,
buttocks, upper arm, or upper torso. The Patch
is changed each week for a schedule of 3
weeks on and 1 week off.
 It works by slowly releasing a combination of
estrogen and progestin hormones through the
skin. These hormones prevent ovulation
(release of an egg from the ovary) and thicken
the cervical mucus, creating a barrier to prevent
sperm from entering the uterus.
 Effectiveness: When used correctly, it’s about
99% effective as birth control except for women
weighing 198 pounds or more when it is only
about 92% effective.
Vaginal Ring
 A soft, flexible vaginal ring, which is about 2
inches in diameter, delivers low doses of
estrogen and progestin into the body. This helps
prevent pregnancy by suppressing ovulation and
thickening the cervical mucus, which helps block
sperm from entering the uterus. The ring is
inserted into the vagina and left for 3 weeks. It is
then removed for 1 week, during which a woman
menstruates, and a new ring is inserted after the
1-week "break."
 The vaginal ring is at least 98 percent effective
with perfect use, which refers to always correct
and consistent use.
Combined pill
 This is the most common type. It contains two hormones estrogen and Progesterone which prevent an egg from being





released from a woman's ovary each month.
The combined pill can reduce pre-menstrual syndrome (PMS) and
period pain. There is evidence that it also offers some protection
against cancer of the uterus and ovaries.
Advantages: the pill does not interfere with the spontaneity of sex.
A full medical history is essential as this pill is not suitable for
women who have certain conditions such as high blood pressure,
circulatory disease or diabetes. Women over 35
who smoke or are very overweight may be advised to choose
another method of contraception.
There are several different types of pill so if one does not suit then
another might.
The combined pill is not reliable if taken over 12 hours late or if
have vomiting and diarrhea, when extra protection is required.
Some drugs like antibiotics can also affect its reliability.
Effectiveness: 99% if taken correctly.
Progesterone-only pill (mini pill)
 Unlike the combined pill, this only contains the hormone
Progesterone. It works by thickening the cervical mucus, which
acts as a barrier to stop sperm entering the womb. It also
makes the lining of the womb thinner, to prevent it accepting
a fertilised egg. This type of pill is good for women who are
breast-feeding, older women, smokers and others who
cannot use the combined pill. It can also help with premenstrual syndrome (PMS) and painful periods.
 Advantages: the pill does not interfere with the spontaneity
of sex.
 It must be taken at the same time each day or at most within
three hours of that time. It will not work if taken over three
hours late, or if have vomiting and diarrhea, in these
cases extra protection is needed. It can cause irregular
bleeding and periods may stop altogether while are taking it.
 Effectiveness: 98% if taken correctly.
Contraceptive injection
 It's an injection of hormones that provides a longer-acting
alternative to the pill. It
works by slowly releasing the hormone progesterone into
the body to stop ovulation. Each injection lasts for 8-12
weeks. Injections may reduce heavy or painful periods and
may give some protection against cancer of the uterus.
 Advantages: unlike the pill don’t need to remember to take
a tablet every day.
 Periods can become irregular or stop altogether. It can take
over a year for fertility to return to normal after stopping
contraceptive injections, so if patient is planning to start a
family in the near future, it may not be suitable.
 Effectiveness: 99%.
Contraceptive implant
 It's a small stick containing the hormone
progesterone which is inserted under the skin in
the arm. The hormone is slowly released into
the body, preventing eggs from being released
from the ovaries, sperm from reaching an egg
or an egg settling in the womb.
 Advantages: implants are a good method for
women who want a long-term contraceptive, as
each implant lasts for three years.
 Periods can become irregular or stop
altogether.
 Effectiveness: 99%.
Side effects of Hormonal family
planning methods
 Nausea
 Weight gain
 Headache
 Breast tenderness
 Breakthrough bleeding
 Vaginal infections
 Mild hypertension
 Depression
Absolute Contraindications of
Hormonal family planning methods
 Breast feeding
 Family history of CVA or CAD
 History of thromboembolic disease
 History of liver disease
 Undiagnosed vaginal bleeding
Possible Contraindications of
Hormonal family planning methods
 Age > 40 years
 Breast or reproductive tract malignancy
 DM
 Elevated cholesterol and triglyceride
 High blood pressure
 Mental depression
 Migraine and other types of vascular
headache
Cont. Possible Contraindications of
Hormonal family planning methods
 Obesity
 Pregnancy
 Seizure disorders
 Sickle cell and or other
hemoglobinopathies
 Smoking
 Use of medication or drug with drug
interaction effect
Surgical family planning methods
(Sterilization)
 Vasectomy (Male)
 Tubal ligation (Female)


Minilaprotomy
Laparoscopy
 Essure
Male sterilization
 Vasectomy:-division or occlusion of the vas deference
prevents the passage of sperms.
 Methods:1- Clips
2- Diathermy
3- Percutaneous injection of sclerosing agents or
occlusive substances.
 The success of the procedure is verified by the absence
of sperms from two consecutive samples of ejaculate
collected at least 4 weeks apart.
 Contraception must be continued until confirmation of two
negative semen results has been achieved and this is
achieved after 16-18 weeks of performing the vasectomy.
Female sterilization
 Female sterilization is done surgically by blocking
both fallopian tubes by three ways:
Laparotomy minilaparatomy laparoscopy
 Laparotomy: Bilateral salpingectomy or
hysterectomy may be preferable when there is a
coexistent pathology while the other two ways are
more preferable, safe and effective
 A number of chemical agents have been tested
for their ability to occlude the fallopian tube when
installed into the tube either directly or
transcervically via the uterus. Inflammation and
fibrosis result and occlude the tubes. However,
safety of quinacrine sterilization has not yet been
determined so surgical method is safer
Female sterilization
 Methods of tubal occlusions:




Ligation by absorbable or non-absorbable sutures the
ends left free or buried in the broad ligament or uterine
cornue.
Electrocautery:-Bipolar diathermy allows only the tissue
held between the jaws of the forceps to be cauterized.
Falope ring:- ring of silicone or rubber is placed over a
loop of the tube with a specially designed applicator.
This destroys 2-3 cm of tube.
Clips: - a variety of clips are available tlulka-clemens clip
(stainless steel and polycarbonal and filshie clip)
(titanium lined with silicon rubber). Smaller length of the
tube is destroyed via this method.
Laser; CO2 laser divides tube very cleanly but may allow
a high incidence of recanalization.
Tubal rings
Tubectomy