CONTRACEPTIO

N
PRESENTER: DR AMMAR
SUPERVISOR: DR FAUZIHA

1
 INTRODUCTION
• Use of methods or other techniques to prevent
pregnancy.
• Use of contraception prevents pregnancy-related health
risks for women, especially for adolescent girls, and when
expressed in terms of interbirth intervals, children born
within 2 years of an elder sibling have a 60% increased
risk of infant death, and those born within 2–3 years a
10% increased risk, compared with those born after an
interval of 3 years or longer
• The number of women desiring to use family planning
has increased markedly over the past two decades, from
900 million in 2000 to nearly 1.1 billion in 2021 .
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•
CLASSIFICATION OF
CONTRACEPTION
Oral contraceptive

Implants

Intrauterine contraception

Barrier method

Naatural method

Sterilization
 EFFECTIVENESS OF
CONTRACEPTION
• Very effective (0–0.9 pregnancies per 100
women)
• Effective (1–9 pregnancies per 100 women)
• Moderately effective (10–19 pregnancies per
100 women)
• Less effective (20 or more pregnancies per
100 women).

SOURCE: WHO 2023

Sources: Calculations based on United Nations, Department of Economic and
Social Affairs, Population Division (2022). World Contraceptive Use 2022;
United Nations, Department of Economic and Social Affairs, Population
Division (2022). Estimates and Projections of Family Planning Indicators 2022
ORAL CONTRACEPTIVE
 CLASSIFICATION

ORAL
CONTRACEPTIVE
PILLS

Combined Oral Emergency

Progestin-only Pills
Contraceptive Pills Contraceptive Pills
Combined Oral Contraceptive
Pills
(COCP)
 FORMULATIONS
• Estrogen
 Ethinyl estradiol.
 Daily dose of 15-35 microgram.
• Progestin
 Traditional: ethynodiol.
 2nd Generation: levonorgestrel, norethisterone.
 3rd Generation: desogestrel, gestodene,
norgestimate, drospirenone.
 Newer progestin: less androgenic activity, but
higher risk of venous thrombosis
MECHANISM OF
ACTION
Source: Pharmacy bulletin, pharmacy department, Hospital Canselor Tuanku
Mukhriz,Edition 20
 PREPARATION

 Yasmin
EE 30µg + drospirenone 3mg

 YAZ
EE 20µg + drospirenone 3mg
24/4 (24 hormone pills, 4 inert pills)

 Drospirenone
Synthetic progestin, analogue of
spironolactone
CONTRAINDICATION
CARDIOVASCULAR
• Previous arterial or venous thromboses
• Ischaemic or severe heart disease
• Pulmonary embolism
• Hypercoagulable tendency
• Stroke
• Severe hypertension

HEPATIC DISEASE
• Cholestatic jaundice in pregnancy
• Hepatoma

OTHERS
• Estrogen-dependent tumors like active breast cancer
• Smoking
• Age >35
 MINOR SIDE EFFECT
 Mood swing
 Nausea
 Breast tenderness
 Headache
 Breakthrough bleeding and spotting
PROGESTIN ONLY
PILLS
 PROGESTIN ONLY
PILLS
• Contain only progestins.
• Sold in 28-day packs &
all pills are active (No
day without tablet).
• Must be taken at precisely
the same time each day to
maintain effectiveness.
Source: Pharmacy bulletin, pharmacy department, Hospital Canselor Tuanku
Mukhriz,Edition 20
• POP do not contain estrogen, is a SAFE
choice for
1. women >35 years
2. obese
3. smokers
4. contraindication to estrogen use
 MISSED PILLS

ONE PILL TWO PILLS

 If one pill is missed,  If 2 pills are missed, take

take 2 pills next day. BOTH forgotten pills.
 Continue with the rest  Continue with the scheduled
of the pills.
pill at the regular time.
 Additional
contraception NOT  REQUIRE contraceptive
necessary. backup for the next 7 days in
another form (eg. Barrier)
 EMERGENCY
CONTRACEPTIVE
 EMERGENCY
CONTRACEPTIVE
 Emergency measure.
 Not as regular method
 Indications:
I. Unprotected
intercourse
Condom rupture
II. Missed pill
III. Sexual assault or
rape
IV. On teratogenic
 TYPES
1. Copper intrauterine device (IUD.
2. Emergency contraceptive pill, or morning-after
pill.
 INTRAUTERINE DEVICE
(COIL)
 Most effective form of emergency contraception.
 The copper alters the cervical mucus, which makes
it more difficult for sperm to reach an egg and
survive.
 The IUD must be fitted by a healthcare
professional within 5 days (120 hours) of having
unprotected sex.
 EMERGENCY
CONTRACEPTIVE PILLS
1. Levonelle
 Contain levonorgestrel.
 2 tab (0.75mg each).
 1st tab within 72 hours of
coitus.
 2nd tab after 12
hours.
2. Yuzpe Method
 2 tabs containing Ethinyl estradiol
(50µg) + Levonorgestrel (250µg).
 taken first tabs within 72hrs of coitus.
 repeat after 12 hours.
 3. EllaOne (30mg)
 single dose within 120 hrs(5 days) of coitus.
 INJECTABLE
CONTRACEPTION
 INJECTABLE
CONTRACEPTION
 Only 1 Type Available.
 Depo-Provera
 (Depot Medroxyprogesterone
Acetate) 150mg I.M every 3 months.
ADVANTAGES DISADVANTAGES
Injected once in 90 Weight gain (due to
days. increased appetite)

Not secreted in breast milk Menstrual irregularities

(safe for breastfeeding)
Does not increase risk of Abdominal pain
DVT, pulmonary embolism,
stroke or MI. (due to not
containing estrogen).
Minimal drug interaction. Fertility may be delayed for
10-12months after
stoppage
Does not protect against
STI
 IMPLANT
CONTRACEPTION
 Single flexible rod containing the progestogen
etongesterel.
 Inserted subdermally 8cm above medial
epicondyle, non dominant hand.
 Mechanism: prevent ovulation and thickening of
cervical mucuous
 Provide 3 years of contraception.
 Nexplanon: 68mg of 3-keto-desogesrel.

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ADVANTAGES DISADVANTAGES

Protection for 3/5 Cause local

years irritation (bruise,
swelling,
tenderness)

Ideal for women who Irregular periods may be

can’t use estrogen experienced for 1st few
containing contraception cycles
Not affected by other Risk of expulsion and
medications migration
Can be taken out Does not protect against
anytime STI
 Intrauterine
Contraceptive Devices
 A device inserted into the uterus to prevent
conception (pregnancy).
 Levonorgesterel intrauterine (LNG-IUS)
 Last 3-10 years depending on type, woman’s
age at insertion.
 Contains 52 mg levonorgestrel, released at rate
20µg per day.
ADVANTAGES DISADVANTAGES

Work for 3-5 years Insertion and removal require

trained medical personnel in
clinic setting

Does not interrupt sex Does not protect against

sexually transmitted diseases

Safe for breastfeeding Cause menstrual cramps and

heavy flow

Can lead to pelvic infection

 COMPLICATION

I. Abnormal menstrual bleeding

II. Pelvic infection Uterine rupture
III. Spontaneous expulsion
IV. Perforation of uterus
V. Missing Threads

Migration into bladder

BARRIER METHOD

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BARRIER METHODS
Condoms

Diaphragm and cap

Spermicides
 CONDOM
 Condoms are made from very thin latex (rubber),
polyisoprene or polyurethane.
 Condoms are the only type of contraception that can
both prevent pregnancy and protect against sexual
transmitted infection.
 There are 2 types of condoms:
 external condoms, worn on the penis – male
condoms
 internal condoms, worn inside the vagina – female
condoms

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ADVANTAGES DISADVANTAGES

Cheaper with no contraindication May accidentally break

or slip off during coitus

No hormonal side effects Psychologically

inadequate sexual
pleasure
Easy to carry, simple to use and Quite high failure rate
disposable due to improper use
Protection against STD
Useful when coital is infrequent
& irregular
 FEMALE CONDOM

 Pouch made of polyurethane

which lines the vagina and also
external genitalia.
 15cm length with one flexible
polyurethane ring at each end
 Inner ring(closed end) is smaller
compared to outer ring(open end)
 Gives protection against STD and
PID.

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 DIAPHRAGM
 It’s a shallow cup made of
synthetic rubber and has a flexible
rim.
 Spermicides can be used along
with it.
 Inserted before sexual
intercourse and should remain
in place for at least 6hours
after.
NONOXYNOL-943
 CERVICAL CAP
• Smaller compared to the
Diaphragm.
• Fits over cervix, prevent sperm
from entering the uterus.

ADVANTAGES DISADVANTAGES
Inexpensive Failures quite common
Only need to use when Not reliable protection
having sex against STI
No medical consultation Irritation
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 FERTILITY AWARENESS
METHOD
 Cycle based a natural method which
relies on observing the changes in the
body that indicates fertility.
 Methods include:
 Basal body temperature
 Cervical mucus (ovulation)
 Calendar / Rhythm method
 Symptothermal

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NATURAL METHOD

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 CALENDAR OR RYHTM
METHOD

 Fertile days are calculated based on the cycle

length recorded over at least 6 cycles.
 First fertile day = shortest cycle minus by 20
 Last fertile day = longest cycle minus by 10
 For women with 28 days cycle this equate to
abstinence for 10 days in each cycle (eg. Day
8-18)
 BASAL BODY TEMPERATURE
METHOD
• Ovulation will cause slightly increase in basal body
temperature (0.2-0.5 degree celcius).
• Temperature should be taken when women just get up
in the morning before taking any hot drinks.
• Women will be fertile 2-3 days prior to rise of
temperature.

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• Fertile window is 6 days long. Start 5 days before
ovulation and ends on the day of ovulation.
• Chances of fertility is highest between days 10-17 in
the menstrual cycle but might be different for each
women
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CERVICAL MUCUS METHOD
• Woman takes a sample of cervical mucus
by hand everyday for at least 1 month to
record its:
I. Quantity
II. Appearance
III. Feel

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PERMANENT METHOD

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 VASECTOM
Y
It is a permanent sterilization operation done
in the male where a segment of vas deferens
of both sides are resected & the cuts end are
ligated.

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 FEMALE
STERILIZATION
 The fallopian tubes are blocked or sealed to
prevent the eggs reaching the sperm and
becoming fertilised.
 Examples are:
 Laparoscopic sterilization
 Mini laparotomy
 Hysteroscopic sterilization
 These are relatively permanent method and
irreversible.
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 LAPAROSCOPIC
STERILIZATION

• During laparoscopic procedure, either Fallope

ring or Filshie’s clip is applied to fallopian tubes.
• Done under local anesthesia.

Fallope ring Filshie’s clip 54

 MINI LAPAROTOMY
• Usually done as MiniLaparotomy (Mini-Lap)
after childbirth.
• Mini-lap is when tubectomy is done through a
small abdominal incision less than 5cm in length
along with some device.
• Incision is made below the umbilicus.
• Done within 24 to 36 hours after delivery.

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 HYSTEROSCOPIC
STERILIZATION
• Hysteroscopic sterilization is done by
inserting substances through cervix to
block the tubes.

VITTAL 56
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 REFERENCES
• United Nations,World Family Planning 2022, Meeting
the changing needs for family planning: contraceptive
use by age and method.
• WHO,2023, Family planning/contraception methods
• United Nations, Department of Economic and
Social Affairs, Population Division (2022). Estimates
and Projections of Family Planning Indicators
2022.
THANK YOU

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