Contraception Dr. Hany Ahmed Assistant Professor of Physiology (MD) Al Maarefa College (KSA) Zagazig Faculty of Medicine (Egypt) Dr. Hany Ahmed Assistant Professor of Physiology (MD) Al Maarefa College (KSA) Zagazig Faculty of Medicine (Egypt)

Contraception Is prevention of pregnancy before the implantation has taken place.

Methods of Contraception 1. Prevention of ovulation  Hormonal contraceptive (OCP) 2.Blockage of implantation 1.IUCD 2.Emergency contraception/morning after pill 3. Blockage of sperm transport to ovum I.Natural Methods 1.Rhythmic abstinence 2.Coitus interruptus II.Barrier methods III.Use of spermicidal IV.Sterilization 1.tubal ligation 2.vasectomy

Types of contraception 1- Hormonal Combined oral contraceptive pills Progestogen only contraceptive pills Depot injections Implants

Combined Pills The most popular method. Relatively few contraindications Tablets are taken once daily for 21 days commencing at 5th day of menstrual cycle,it is than stopped for 7 days during which time bleeding occurs

Combined Pills Increased risk of venous thrombosis May raise blood pressure Cannot be used while breast feeding Caution with liver enzyme inducers Caution with broad spectrum antibiotics

Mode of action of Combined Pills: 1. Suppress synthesis and secretion of FSH and the mid-cycle surge of LH, thus inhibiting the development of ovarian follicles and ovulation. 2. Thickening cervical mucus to prevent penetration of sperm. 3. Reducing endometrial receptivity to inhibit blastocyst implantation.

Contraceptive Mechanism of Action

Combined Pills Benefits Highly effective and convenient to use. Can bring relief from menstrual problems. May protect against pelvic inflammatory disease (PID). Reduces incidence of benign breast disease, ovarian cysts, ovarian cancer and endometrial cancer.

Combined Pills Non-contraceptive uses Acne Polycystic ovaries Cycle control Menorrhagia Dysmenorrhoea

Combined Pills Contraindications Previous DVT Breast or gynaecological cancer Any liver disease Ischaemic heart or Cerebrovascular disease Gross obesity

Combined Pills problems (side effects) breast tenderness, mood swings. Increased risk of venous thromboembolism Failure Weight gain BP Migraine Breakthrough bleeding PMT symptoms Malaise

Progestogen only pills Reversible Needs to be taken daily May cause menstrual irregularity May be used in hypertension May be used while breastfeeding

Progestogen only pills Mode of action Ovulation is inhibited in 97% of cycles. Transport of the ovum is delayed. The cervical mucus becomes more viscous and impenetrable to sperm. The endometrium becomes unsuitable for implantation.

Progestogen only pills Benefits It is reliable if taken correctly, is easily reversible and convenient to use. Avoids the cardiovascular risks of oestrogen. It can often be used by women with contra- indications to the COCP. It can be used during breast-feeding. Problems Menstrual problems (amenorrhoea and breakthrough bleeding). It has to be taken meticulously at the same time each day.

Progestogen injectables A progestogen-only injectable contraceptive is a long-acting, reversible contraceptive. A synthetic progesterone or progestogen is slowly released into the systemic circulation following intramuscular injection. Every 2-3 months Very effective Delay fertility return May cause weight gain May cause menstrual irregularity

Progestogen-only subdermal implant The progestogen-only subdermal implant is a long-acting reversible contraceptive. Etonogestrel contained in a rod is released slowly into the systemic circulation following subdermal insertion in the upper arm.

IUD/IUS Intra Uterine Contraceptive Device(IUCD) Most effective Prevents pregnancy >99% of the time IUD/IUS 19

Mechanism of action Intra Uterine Contraceptive Device(IUCD): – Are devices which are introduced & left inside the uterus for longer period of time Mechanism of action : They produce local nonspecific inflammatory reaction in the endometrium & disturbing the endometrial cyclic changes & prevent implantation of blastocyst. 20

IUD Side effects : –Bleeding –Abdominal pain / backache –Displacement –Perforation 21

IUD / IUS Contraindications Unexplained vaginal bleeding PID or recent PID Uterine distortion Risk of endocarditis (Murmurs)

Barrier Methods Protection against STD Loss of spontaneity No drugs No side effects Reliability depends on usage

Barrier Methods Condoms Caps and diaphragms: specialist skills needed, to fit and educate about use. Non-hormonal Non-invasive Used only when necessary

Spermicide Contain ingredients that disable sperm Available in various forms: sponges, creams, jellies, tablets, foams, film and suppositories Very effective when used with a barrier method (condom) 82% effective when used alone (perfect use)

Female Condom It's the only contraceptive controlled by girls that protects against pregnancy and STI’s

Sterilisation Non-reversible At discretion of the surgeon to people who have no children

Female Sterilization “Getting your tubes tied” A surgical procedure to permanently block the fallopian tubes Prevents sperm and egg from meeting 99.5% effective

Male Sterilization Also called “vasectomy” A surgical procedure to permanently block the vas deferens Stops sperm from being released into the man’s ejaculate, so the egg cannot be fertilized 99.9% effective

Current Contraceptive Options Most effective Prevents pregnancy >99% of the time Male/Female Sterilization IUD/IUS Implants Very effective Prevents pregnancy ~91-99% of the time Pills Injectables Patch Ring Moderately effective Prevents pregnancy ~81-90% of the time Male/Female Condom Sponge Diaphragm Effective Prevents pregnancy up to 80% of the time Fertility awareness Cervical cap Spermicide 30