Contraception

European University
Definition
• Contraception is the act of preventing pregnancy. This can be a
device, a medication, a procedure or a behavior.
• Contraception allows a woman control of her reproductive health and
affords the woman the ability to be an active participant in her family
planning.
• Contraception=against conception
Need for contraception
• To avoid unwanted pregnancies
• To regulate the timing of pregnancy
• To regulate the interval between pregnancy
Ideal contraceptive???
• Safe
• Effective
• Acceptable
• Reversible
• Inexpensive
• Long lasting
• Requires little or no medical supervision
Contraceptive methods
Spacing methods Terminal methods
• Barrier • Male fertilization
• Female fertilization
• IUDs
• Hormonal
• Emergency
contraception
Barrier methods
• Male condoms
• Female condoms
• Diaphragm
• Spermicides
Male condom
• The most common type of male condom is a fine latex rubber sheath
• Most commonly known and used contraceptive
• Are 98% effective.
• Male condom also protect against STIs if used correctly during
vaginal, anal and oral sex.
Female condom
• The female condom, like the
male condom, is a barrier
contraceptive made of latex.
• The condom has a ring on each
end. The ring that is placed inside
the vagina fits over the cervix,
while the other ring, which is
open, rests outside of the vagina
and covers the vulva.
Diaphragm
• A contraceptive diaphragm is a circular dome made of thin, soft
silicone that's inserted into the vagina before sex.
• It covers the cervix so sperm cannot get into the uterus to fertilize an
egg.
• The diaphragm needs to be left in place for at least 6 hours after sex.

Diaphragms are about 94% effective

against pregnancy with perfect use and
88% effective with real life use.
Spermicides
• Spermicide is a kind of birth control that has chemicals that slow
sperm down to make it harder for them to swim to an egg.
• Ideally, spermicides must be deposited high in the vagina in contact
with the cervix shortly before intercourse.
• Their duration of maximal effectiveness is usually no more than 1
hour, and thereafter, they must be reinserted before repeat
intercourse.
• Douching is avoided for at least 6 hours after coitus.
Spermicides
Available in various forms like
1. Foams
2. Creams
3. Suppositories
4. Soluble films

Spermicide is 79% effective at preventing pregnancy.

Intrauterine devices
• Intrauterine devices (IUDs) are one of the most effective forms of
contraception available today ,, Fit and forget”
• The two types of IUDs that are presently used in the United States,
including the copper-containing IUD and levonorgestrel-containing
IUD, have similar rates of preventing pregnancy. This makes these
devices more than 99% effective in preventing pregnancy.
Indications for IUD
• All IUDs are indicated for the use of contraception.

• The copper IUD is approved for contraceptive use for up to 10 years.

• The 13.5 mg levonorgestrel-containing IUD is approved for use for up to
3 years, while the 19.5 mg and 52 mg IUDs are approved for up to 5
years.

• IUDs may be placed immediately post-partum within 10 minutes of

delivery of the placenta, delayed post-partum within 4-6 weeks of
delivery, and post-abortion, so long as it was not a septic abortion
Side effects for IUD
•Bleeding or spotting between periods
• Pain when the IUD is put in, and cramping or back aches for a few
days after or menstrual cramps worse
•Pelvic inflammatory disease
•Perforation of uterus -rates approximate 1 per 1000 insertions
•Ectopic pregnancy
Hormonal contraceptives
Combined pill
•combination of estrogen and progestogen
• MALA-N,MALA-D(0.15mg levonorgestrel & 0.03mg ethinyl estradiol)
Progestogen only pill
•used in people above 40 years of age & CVS problem
Post coital contraception:
•Levonorgestrel
•Ulipristal
•Mifepristone
99% effective
Benefits of Hormonal
Contraception
• Effective Pregnancy Prevention: Hormonal contraception is highly
effective in preventing unplanned pregnancies when used consistently
and correctly.
• Menstrual Cycle Regulation: Many hormonal contraceptives
contribute to the regulation of menstrual cycles, reducing symptoms
of irregular periods, cramps, and premenstrual syndrome
• Treatment of Gynecological Conditions: Some hormonal
contraceptives are prescribed to manage conditions such as
endometriosis, polycystic ovary syndrome (PCOS), and menstrual
disorders.
Adverse effects
1. Cardiovascular effects and increased risk of blood clots
2. Carcinogenesis
3. Metabolic effects
4. Liver adenomas
5. Weight gain
6. Breast tenderness
7. Changes in Libido
8. Headaches and Migraines
Depot formulations
Injectables:
•DMPA-150 mg IM injection every 3 monthly

• Depo-Provera is indicated for long-term female contraception. Each

injection prevents ovulation and provides contraception for at least 12
weeks (+/- 5 days). However, it should be taken into consideration
that the return to fertility (ovulation) may be delayed for up to one
year
Depot formulations
Subdermal implant:

Contraception can be provided by thin, pliable progestin­containing

cylinders that are implanted sub dermally and release hormone over
many years
Norplant consists of six matchstick-size silicone capsules that are
inserted in a woman's upper arm, each containing 35 mg of
levonorgestrol. Protection for 5 years
Subdermal implant:
Nexplanon is a single rod implant with 68 mg etonogestrel covered by
an ethylene vinyl acetate copolymer cover. The implant is placed sub
dermally on the medial surface of the upper arm 8 to 10 cm from the
elbow in the biceps groove and is aligned with the long axis of the arm.
It may be used as contraception for 3 years, removed, and then
replaced at the same site or in the opposite arm
Female sterilization
• Laparoscopy
• Mini laparotomy
Benefits:
• Permanent Contraception: Female sterilization is a permanent and
irreversible form of contraception.
• High Effectiveness: Female sterilization is highly effective, with a low
failure rate. Once the procedure is successfully performed, the
likelihood of unintended pregnancies is minimal.
Evaluation of contraceptive
methods
• Pearl index:

• The Pearl Index is a measure of contraceptive efficacy, specifically

representing the number of pregnancies per 100 woman-years of
exposure to a particular contraceptive method.
• The Pearl Index allows for the direct comparison of contraceptive
methods
• The Pearl Index serves as a crucial tool in the field of reproductive health
How to insert intrauterine
device
• Introduce yourself to the patient including your name and role.
• Confirm the patient’s name and date of birth.
• Explain the reason for the consultation: “I understand you are
interested in using the intrauterine system for contraception. Is
that correct?”.
• It is important to establish an open line of communication with
the patient early in the consultation: “If you have any questions at
any point, or if something is not clear, please feel free to interrupt
and ask me.”
• Make sure to check the patient’s understanding at regular
intervals throughout the consultation and provide opportunities
to ask questions
How to insert intrauterine
device
• Candidates are counseled, and written consent obtained.
• The cervical surface is cleansed with an antiseptic solution
• A tenaculum is placed on the cervical lip, and the canal and uterine
cavity are straightened by applying gentle outward traction.
• The cav­ity is then probed by a uterine sound to identify its direction
and depth.
Tenaculum
Uterine sound
How to insert intrauterine
device
The inserter tube, with the IUD
loaded, is passed into the
endometrial cavity. When the
blue flange contacts the cervix,
insertion stops
How to insert intrauterine
device
To release the IUD arms, the solid
white rod within the inserter tube is
held steady, while the inserter tube
is withdrawn no more than 1 cm
How to insert intrauterine
device

The inserter tube, not the

inserter rod, is then carefully
moved upwards towards the top
of the uterus until sight
resistance is felt
How to insert intrauterine
device
First, the solid white rod and then the
inserter tube are withdrawn
individually.
Only the treads should be visible
protruding from the cervix.
Risks of IUS insertion include:
• Pain
• Bleeding
• Infection
• Perforation of the uterus