Contraception
Contraception
Contraception
WHAT is CONTRACEPTION?
the prevention of unwanted pregnancy
Prevent ovulation Prevent fertilization of ovum Prevent implantation of fertilized ovum
- To avoid hereditary disorders (e.g.: Thalassemia) - For spacing of children - Not ready (financial / mental / physical)
Oral Contraceptive Pills 25% Male/Female Sterilization 23% Male Condoms 20%
TYPES of CONTRACEPTION
Prevent ovulation
Oral / Hormonal Contraceptives
(COCP, POP, IM Depot)
Misc
Rhythm method
EFFICACY of CONTRACEPTION
Method of Contraception
IUCD
Female Sterilization Male Sterilization
*within FIRST year of use
0.15%
1:700 lifetime
0.10%
1:1000 lifetime
WHICH CONTRACEPTION?
Highly effective No side effects Independent of intercourse Rapidly reversible Cheap Widespread availability Acceptable to all cultures & religions Administration by healthcare personnel not required Easily distributed
COCP - Introduction
Synthetic ESTROGEN + PROGESTERONE
Estrogen : usually ethinylestradiol Progesterone : 2nd gen levonorgestrel, norethisterone 3rd gen desogestrel, gestodene > 99% effective if used correctly
COCP - Method
May be used from menarche menopause Start on day 1 of menses Take everyday for 21 days, within 12 hours of the same time everyday Pill-free for 7 days (allow menses) Missed pill: emergency contraception needed only if no previous 7-day protection
COCP - Advantages
Highly effective Reversible Menstrual pain & blood loss
(Lyer et al 2003, Proctor et al 2003, Moore et al 2003)
COCP - Disadvantages
Breast tenderness Acne Mood changes
Irritability, emotionally unstable
Weight gain risk of Venous thromboembolism (5X), Myocardial infarction (HPT, smoking = 3-10X) Stroke (2-3X) Cervical CA (< 5 years = 10%) ( 10 years = 100%) Breast CA (small risk) Liver CA (small risk)
COCP - Contraindications
< 6 weeks postpartum
Risk to neonate due to steroid exposure
Aged > 35 years + smoking History of HPT, CVS d/o, CVA, Liver d/o, Breast d/o, Migraine
POP - Introduction
Contains low-doses of:
Norethisterone Etynodiol diacetate Levonorgestrel Desogestrel
Alternative for women who cannot take estrogen due to CVA, CVS, Migraine
POP - Method
Started on 1st day of period Taken continuously everyday WITHOUT BREAK Taken within 3 hours of the same time everyday Missed pill: added contraceptive for 2 days
POP - Advantages
Reliable Reversible Can be used by women who cannot use estrogen
POP - Disadvantages
Menstrual irregularities Strict time window Development of functional ovarian cysts risk of breast CA
POP - Contraindications
Breastfeeding < 6 weeks postpartum History of breast CA History of liver d/o
IM Depo - Introduction
Progesterone-only injection Commonest: Medroxyprogesterone acetate (Depo Provera) Provides contraception for 12 weeks
IM Depo - Method
IM injection by a trained medical staff
IM Depo - Advantages
Highly effective Ensured compliance Protect against functional ovarian cysts
IM Depo - Disadvantages
Must be given as a deep IM injection Delay in return to fertility Irregular menstrual cycles after withdrawal Weight gain Reduction in bone mineral density
(reversible)
risk of breast CA
IM Depo - Contraindications
History of breast CA Breastfeeding < 6 weeks postpartum History of liver d/o
IUCD Introduction
Polyethylene + Copper With monofilament thread to check that the IUCD is still in place & for removal Usually left in situ for 3 years
IUCD - Method
Inserted after confirming there is no pregnancy Can be inserted anytime Usually inserted:
Within 7 days of start of menses Within 4 weeks postpartum if non-lactating Within 6 months postpartum if lactating
(reduced risk of uterine perforation d/t oxytocin)
IUCD - Advantages
Highly effective Reversible Immediate No drugs can affect its efficacy
IUCD - Disadvantages
Menstrual abnormalities
1st 3-6 months
Unacceptable bleeding, dysmennorrhoea leading to IUCD removal Small risk of pelvic infection (post 20 days) IUCD expulsion (1:20) Uterine perforation (< 1:1000)
IUCD - Contraindications
Pregnancy Breastfeeding Anatomical abnormalities Cervical / Endometrial / Ovarian d/o PID STDs