Contraceptive methods updated

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CONTRACEPTIV

E METHODS
DEFINITION

Preventive methods to help woman to


avoid unwanted pregnancies .
How these two are connected?

Family planning allows people to attain their desired


number of children, if any, and to determine the spacing of
their pregnancies.

It is achieved through use of contraceptive methods & the


treatment of infertility .
AIMS OF CONTRACAPTION & ITS EFFECT
ON FAMILY PLANNING
TYPES OF CONTRACEPTIVE METHODS
CONTRACEPTIVE METHODS

Spacing methods Terminal methods

Male sterilization Female


sterilization

Barrier methods IUDs Hormonal Post Miscellaneous


methods conceptional
methods

Physical Chemical
methods methods
I. SPACING METHODS
1. BARRIER METHOD
 A.k.a “ occlusive” methods .
 Prevent live sperm from meeting the ovum .
 Have increased in popularity recently because of certain
contraceptive & non contraceptive advantages .

Protection
Absence of side
of STD
effects a/w
“pill” or IUD
 PHYSICAL BARRIER METHOD
1. Condom
 Most widely known & used barrier method .
 In India better known as NIRODH .
 Prevent the semen from being deposited in vagina .
 Prevent pregnancy & STDs for both men & women .
 Fitted on erect before intercourse .
 New one should be used for each sexual act .
 Pregnancy rates varing from 2-3 per 100 women years to more
than 14 in typical users .
 Manufactured in India by the Hindusthan Latex in Trivandrum .
ADVANTAGES
Light
compact &
Easily disposable
available

Easy to use ,
Provide do not require
protection medical
supervision
against STD
DISADVANTAGES

 May slip off or tear during coitus due


to incorrect use .
 Interferes with local sex sensation .
FEMALE CONDOM

 A pouch of polyurethane , which lines vagina.


 An internal ring in the close end of the pouch
covers the cervix & an external ring remains
outside the vagina.
 High cost & acceptability are major problems.
 Failure rates during the first year use vary
from 5 per 100 women years pregnancy rate to
about 21 in typical users.
 PHYSICAL BARRIER METHOD
2.DIAPHRAGM :

 A vaginal barrier .
 Aka “ Dutch cap”.
 It is a vaginal shallow cup made of synthetic
rubber or plastic.
 Inserted before sexual intercourse & must
remain in place for not less than 6 hrs after
sexual intercourse .
 Failure rate with spermicide vary between 6 to
12 per 100 women years .
ADVANTAGES
 Almost total absence of risk & medical
contraindication .
DISADVANTAGES

Initially a physician or other


trained person will be needed to
demonstrate .

If it is left in vagina for an


external period , there may be a
chance of toxic shock syndrome ,
which is a state of peripheral
shock requiring resuscitation .
3. VAGINAL SPONGE

Employed for hundred of


years commercially
marketed in USA under
the trade name TODAY
for the sole purpose of
preventing conception
 CHEMICAL METHODS

 In the 1960 , were used widely .


 Are or four categories –
1.Foams: foam tablet ,foam aerosol
2.Creams, jellies & pastes – squeezed
from a tube.
3. Suppositories – inserted manually
4. Soluble films – c film inserted manually
 Mostly surface active agents , spermicides.
2. IUDs

 Intra uterine devices .


 Are of two types 1. Non medicated (1st
generation)

2. Medicated (2nd &


3rd Gen)

Usually made up of polyethelene or polymers : in


addition, the medicated or bioactive IUDs release
either metal ions (copper) or hormones
(progestogens) .
FIRST GENERATION IUDs :

 Non medicated or inert IUDs.


 Usually made up of polyethene or other polymers .
 Shapes – loops spiral ring rows .
 Eg - Lippes Loop
LIPPES LOOP :

 Double S shaped device.


 Made up of polyethylene , a plastic material
that is non toxic, non tissue reactive &
extremely durable .
 Has attached thread or “tail” made up of
nylon .(easily felt &is assurance to user that
the loop is in its place)
 Exists in four size (larger for multiparous
women) .
SECOND GENERATION IUDs :

 Copper bearing devices (metallic copper had a strong anti


fertility effect )
 Earlier devices:
1. Copper 7
2. Copper T 200
 Newer devices :
1.COPPER T 200C , COPPER T 380 A or Ag
[*Surface area in (sq mm) of the copper on the device ]
2.Nova T
3.ML devices: ML – Cu 250 , ML –Cu 375
ADVANTAGES
 Low expulsion rate .
 Lower incidence of side effect .
 Easier to fit .
 Better tolerated.
 Increased effectivity.

*CuT 380A can be used for 10 years


PROCESS OF INSERTING
COPPER T :
THIRD GENERATION IUDs :

 Based on release of a hormone.


 Available on a limited scale .
 Eg –
- Most widely used is Progestasert
- LNG - 20
FIRST GENERATION IUDs SECOND GENERATION IUDs
 PROGESTASERT
 T shaped .
 Filled with 38 mg of progesterone .
 Released in uterus at a rate of 65 mcg
daily.
 As hormone supply depleted regularly,
regular replacement of the device is
necessary .
 LNG 20
 Aka Mirena
 T Shaped IUD releasing 20 mcg of
levonorgestrel.
 Low pregnancy rate (0.2 per 100 women)
 Less number of ectopic pregnancies .
 Particularly valuable for women in
developing countries in whom excess blood
loss caused by inert devices have been
shown to result in significant anaemia.

*Effective life: 10 years


ADVANTAGES OF
IUDs :

Simplicity Insertion Inexpensive


takes only
few mins
Free of Highest
Reversible on
systemic continuation
removal
metabolic side rate
effect
CONTRAINDICATIONS

Absolute Relative

Suspected pregnancy Anemia


Pelvic inflammatory disease History of PID since last
Vaginal bleeding pregnancy
Uterine fibroid,
Cancer of cervix
Congenital malformation
Previous h/o ectopic preg.
S/E and Complications
1. Bleeding
2. Pain
3. Pelvic infection (PID)
4. Uterine perforation
5. Pregnancy
6. Ectopic pregnancy
7. Expulsion
8. Fertility after removal
3. HORMONAL METHODS

 Most effective spacing methods when used


properly .
 Combined oral contraceptives are almost
100% effective
 65 million in world are estimated to be taking
this .
 Among them 9.52 million in India .
CLASSIFICATION

Oral pill Depot (slow


relase)

Combined Post Once-a- Male Injectable Subcutaneous Vaginal


Progestogen coital month pill implant rings
only pill pill pill
(POP)
A. ORAL PILL

1. COMBINED PILL
 30 -35 mcg of synthetic oestrogen
(EE) & 0.5-1.0 mg of progestogen
(NG/ LNG/ DG)

 Given 21 days daily beginning on the


5th day of menstrual cycle, followed
by a break of 7 days.
 MALA-N, MALA –D (LNG 0.15 mg, EE 0.03mg)
 21 OCPs + 7 Iron tabs (60mg Fe Fumerate)  Should be taken each day at a fixed
time
2. PROGESTOGEN ONLY PILL ( POP)

 Aka “ minipill”, “ micropill”


 Contains only progestogen , which is given in small
doses through out the cycle .
 Never gained widespread use because of poor cycle
control.
 No cardiovascular risk unlike combined pill
(preferred in older women)
3. POST COITAL CONTRACEPTION
 IUD (simplest; cu device within 5 days may be effective)

 Hormonal
LEVONORGESTREL One (0.75 mg) tablet within 72
hrs second one after 12 hrs
or
2 OCPs containing 50 mcg of ETHINYL
ESTRADIOL within 72 hrs same dose after 12hrs
or
MIFEPRISTONE 10 mg once within 72 hrs .

*Yuzpe methods: Involves the use of birth control pill as a form of


emergency contraception .
Adverse effects:
1. Cardiovascular effects (d/t oestrogen component)
2. Carcinogenesis (Ca Cervix)
3. Metabolic effects (d/t Progestogen component)
4. Others: Liver d/o, Lactation
5. Common unwanted effects: Breast tenderness, Weight gain, Headache & migraine, Bleeding
disturbances

Contraindications:
A. Absolute: Ca Breast & Genitals, Liver d/o, Previous & present h/o Thromboembolism,
undiagnosed abnormal uterine bleeding

B. Special problems requiring medical surveillance: Age >40y, Age >35y and smoker, Mild
HTN, CKD, Epilepsy & Migraine, Lactating mothers, T2DM, H/O bleeding abnormalities
B. DEPOT METHOD
INJECTABLE CONTRACEPTIVES

 Are of two types –


I. Progestogen only injectable–
-DMPA
-NET-EN
-DMPA –SC

II. Combined injectable contraceptives


- Given at monthly intervals
- Cervical mucus is highly affected
• DMPA (Depot- medroxyprogesterone acetate)
Dose: 150mg, IM, Every 3 months

• NET-EN (Norethisterone enantate)


Dose: 200mg, IM, Every 2 months
SUBDERMAL IMPLANTS

 Eg. – Norplant ( for long term)


VAGINAL RINGS

 Contain LEVONORGESTREL
 Hormone slowly absorbed by vaginal
mucosa .
 Worn in the vagina for 3 weeks of the
cycle & removed for fourth .
4. POST CONCEPTIONAL METHOD
Menstrual induction
(P/V PGF2α)

Post Oral abortifacient


conceptional (Mifepristone +
method Misoprostol)

Abortion (termination of
pregnancy before the fetus
becomes viable)
II. TERMINAL METHOD :
 In India :
85% sterilization of female
15% sterilization of male

ADVANTAGES DISADVANTAGES

 One time method  Irreversible


 Does not require  Surgical methods , have
sustained motivation normal risk factor
MALE STERILIZATION :

 Aka vasectomy
 A simple out patient procedure
 The vas deferens is isolated &
cut
 The two ends are ligated .
 Can be performed under local
anaesthesia .

VASECTOMY
FEMALE STERILIZATION :
 Part of fallopian tube is removed .
 The two ends are tightly ligated .
 Can be done as :
1. Minilap operation
2. Laparoscopic sterilization

TUBAL LIGATION METHOD


EVALUATION OF CONTRACEPTIVE
METHODS
 Assessed by measuring the number of unplanned pregnancies that occur during
a specific period of exposure & use of a contraceptive method.

 Two methods are used –


1. Pearl index: Failures per 100 women–years of exposure (HWY)
2. Life table analysis ( failure rate of each moth of use )

Failure rate per HWY x 1200

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