Contraception.: Kursk State Medical University

KURSK STATE MEDICAL UNIVERSITY
DEPARMENT OF OBSTETRICS AND GYNECOLOGY

IV YEAR VII SEMESTER
CONTRACEPTION.
Профессор кафедры акушерства и гинекологии

Хурасева Анна Борисовна
KURSK 2013
CONTRACEPTION
Definition
Contraception means a sensitive decision
employed by an individual or both couples
to terminate fertility or conception.
Contraception is also defined as the
prevention of fertilization of an egg by a
sperm (conception).
Classification
1) Physiological Contraception:
 Periodic abstinence
 Coitus interruptus
 Prediction of ovulation
 Prolongation of lactation
2) Chemical:
 Spermicidal
3) Barrier:
 Male and female condom
 Vaginal diaphragm
 Vaginal contraceptive sponge
 Cervical cap
4) Intrauterine Contraception:
 Progestasert
 Paragard (Copper bearing)
 Mirena (Levonorgestrel releasing system)
5) Hormonal Contraception:
 Oral contraceptives
 Depot Progesterone
 Implants (Norplant I & II)
 Progesterone intra uterine system
6) Surgical Contraception:
 Laparotomy
 Minilaparotomy
 Vaginal Sterilization
 Endoscopic Techniques
 Hysterectomy
 Tubal Ligation
Physiological contraception
i) Periodic Abstinence:
Absolute abstinence from sexual
intercourse is the sure-fire way to prevent
conception.
ii) Coitus Interruptus:

Act of withdrawing the penis from the
vagina before ejaculation. Very unreliable
method. Requires discipline. No STD
protection
iii) Prediction Of Ovulation (Rhythm Method):
1) BBT (Basal Body Temperature) Measuring:

Body temperature rises slightly during ovulation.
2) Calendar Method:
Length of menstrual cycle is recorded.
3) Cervical Mucus Method:

Consistency of cervical mucus changes depending
on state of fertility.
Advantages Disadvantages
 No  Needs high degree of
dependence discipline.
of hormones,  Not good if cycles are
chemical or irregular.
devices.  No STD protection.
 Satisfactory
for those who
 Low effectiveness rate.
cannot use  Possibility of variable
other cycles.
methods.  Hyperthermia arising
 Inexpensive. from non-ovulatory
causes.
Cervical Mucus Or Billings
A = Intermediate type mucous B = Infertile type mucous

C = Fertile type mucous
Cervical Mucus Or Billings
iv) Prolongation of lactation (Lactation
Amenorrhea):
 Delay in ovulation during breast feeding
caused by increased prolactin levels.
 Mother must provide breast feeding as the
only form of infant nutrition.
 Amenorrhea must be maintained
 Should be maintained for period of 6
months.
BARRIER
METHODS
ADVANTAGES
 STD DISADVANTAGES
protection.  Insertion difficulty.
 Female has  High failure rate.
control of  Dislodges during
use. intercourse.
 Vaginal irritation.
Male condom
When placed correctly over the penis,
the condom acts as a
mechanical barrier that
prevents contact between
semen and the sexual partner.
Easy to use Risk of dislodging
Cheap Decreased sensation
Very reliable if used Tear,breakage risk
properly Disintegrates when
STD protection
left unpackaged
Not everyone knows
how to use it(though
they think they do)
Vaginal Diaphragm
Disadvantages
Advantages
 Dislodges during sex
 Non
hormonal
 Allergy to rubber
 Placement  Risk of bladder infection
may occur  Requires individual fitting
up to 2 hours  Reapplication of
before spermicide for repeated
ejaculation
intercourse
 Some STD
protection 
Vaginal wall irritation
 Reusable
iii) Cervical cap:
 It is a small cup
like diaphragm
placed tightly
over the cervix
and is held in
place by
suction.
 Its is smeared
with spermicidal
cream for
additional
protection.
ADVANTAGES
 Non hormonal. DISADVANTAGES
 Insertion may  Dislodges during sex.
occur from 30
minutes to 48  Allergy to rubber.
hours before  Requires fitting by
intercourse.
professional.
 May be left in
place for prolonged  Impossible to use if
period of time (1 cervix is short.
or 2 days).  Difficult insertion and
 STD protection.
 Reusable.
removal.
 Female controlled.
Chemical
contraception
Foam, Jelly, Cream, Pessaries, Gels, Aerosols.
It consists of
deposition of
spermicidal
substance in the
vagina before coitus.
This spermicidal
substance destroys
the sperm, so that
no viable sperm can
reach the ovum.
 Easy insertion. • Allergic reaction.
 Lubricating • Short duration of
properties. action.
 Possible to use • Short time to wait
with barrier
for dispersion.
methods.
 Use along or
• Inability to
with condom. correctly place.
Intrauterine devices
TYPES
 Chemical inert.
 Chemically active:-
a) hormone contained (with progesterone)
which must be replaced every year.
b) Non hormonal (copper, silver, gold
containing) which need to be replaced
every 3-5 years.
Different types of
IUD(top) with their
Introducers(bottom
)
From left to right-
1.Usual(physically
prevents
implantation
2. Nova-T
3. Multiload -375
Mechanism of action:
 Altered implantation.
 Altered tubal motility.
 Create local endometrial sterile
inflammatory reaction in response to the
presence of foreign body.
 Hormonal effects of progesterone in
progesterone IUD, causes atrophy of
endometrial and thickening of cervical
mucus.
 Spermicidal activity with copper devices.
 Highly effective, failure

 Possibility of increased
rate only 2%. menstrual flow and
 Long duration of action cramps.
(1,3-5 years).
 Risk of pelvis infections.
 No systemic side
 Increase ectopic
effects. pregnancy.
 Does not interrupt
 Uterine perforation.
sexual activity.  No STD protection.
 Suitable for breast  Insertion requires
feeding women. involvement of trained
 Progesterone personal.
containing devices  Initial expense of
decrease menstrual insertion is high.
flow.
Hormonal
Contraception
CLASSIFICATION:
i) Oral contraceptives:
Combines estrogen/progesterone.
Progesterone only.
ii) Depot progesterone:

Injections.
Subcutaneous silicon implants.
Skin patches
iii) Vaginal:
Silicone rings releasing estrogen and
progesterone.
Mechanism of action:
 It suppresses ovulation, both estrogen

and progesterone act on the
hypothalamus affecting negative
feedback mechanism to prevent
production of FSH and LH.
 It prevents estrogen surge and

progesterone component keeps the
mucus scanty and viscous. This type of
cervical mucous prevents sperm
penetration and migration.
i) Oral contraceptives:
There formulations may be:
 Monophasic (each tablet contains a fixed
amount of estrogen and progestin);
 Biphasic (each tablet contains a fixed
amount of estrogen, while the amount of
progestin increases in the second half of the
cycle); or
 Triphasic (the amount of estrogen may be
fixed or variable, while the amount of
progestin increases in 3 equal phases).
A typical 28-day dispenser
Side effects:
Breakthrough Bleeding (≤ 25%)
Amenorrhea
BreastTenderness, Nausea
H/A (+/–)
HTN
Weight Gain
ii) Depot progesterone:
Depo-Provera:
Depo-Provera:
 Inhibits Ovulation
 150 mg q3months (14 day grace period)
 Delayed Ovulation After Discontinuation
 Main Side-Effects:
 Amenorrhea
 AUB
 Weight Gain
 Hair Loss
Norplant:
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
Skin patches
 The R W Johnson Pharmaceutical Research Institute

submitted a new drug application for a seven day
contraceptive patch last month. The Ortho Evra weekly patch
can be worn on a woman’s lower abdomen or buttocks
Surgical contraception
DEFINITION
 It is the termination of fertility or

conception by operative procedure.
 The patient can’t conceive after the
operation but the patient is not
castrated.
Classification
 Male- vasectomy.
 Female- tubal ligation.
Female tubal ligation
INDICATIONS
It is indicated for married women over 30
years who want a permanent method of
contraception and are free of any
gynecological pathology that would otherwise
dictate an alternate procedure.
Women in premenopause age.
It is also indicated for women with disease in
whom a pregnancy could represent a
significant clinical and medical risk or life
threatening to the mother.
CONTRAINDICATIONS
 Obesity.
 Cardiovascular arrhythmias,
thromphlebitis,embolic predisposition.
 Poor anesthesia risk.
 Asthma.
 Coagulative complications cause by
heparin or inherited diseases like
hemophilia.
 Metabolic immunosuppression.
 History of previous abdominal or pelvic
infection.
Male vasectomy
Thank you so much for your peaceful
and kind attention.

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KURSK STATE MEDICAL UNIVERSITY

DEPARMENT OF OBSTETRICS AND GYNECOLOGY

Профессор кафедры акушерства и гинекологии

ii) Coitus Interruptus:

1) BBT (Basal Body Temperature) Measuring:

3) Cervical Mucus Method:

A = Intermediate type mucous B = Infertile type mucous

 Highly effective, failure

ii) Depot progesterone:

 It suppresses ovulation, both estrogen

 It prevents estrogen surge and

 The R W Johnson Pharmaceutical Research Institute

 It is the termination of fertility or

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