Contraceptive Methods

Spacing Methods Barrier Methods: a. Natural methods b. Physical methods c. Chemical methods d. Combined Methods 2. Intra-Uterine Devices 3. Hormonal Methods 4. Post-Conceptional Methods 5. Miscellaneous

Natural methods Coitus interruptus Rhythm method or safe period methods This method is to abstain from sex during fertile period. Temperature change method The basal body temp in a fertile women rises by 0.4 to 1.0 F during ovulation. Lactation Ammenorrhea method Exclusive breast feeding in Lactation Ammenorrhea offers saves from pregnancy

Physical methods: Condoms & Diaphragm Advantages: Easily available Safe and inexpensive Easy to use No side effects Light, compact and disposable Provides protection against STDs & cervical cancer Disadvantages: It may slip off or tear during coitus due to incorrect use, Interferes with sex sensation locally Can cause irritation or allergic reaction.

Chemical methods Vaginal spermicidal agents Failure rate of spermicides when used alone is 10 to 20 percent. Vaginal contraceptive sponge ‘Today’ is the name given to vaginal contraceptive sponge available in USA and UK.

Intra-Uterine Devices IUD is a device based on spacing method of contraception , requiring one time insertion procedure and is effective for long duration ( 3-10 yrs depending on the type of IUD used).

IUCDs Types of IUCD Non-medicated: Medicated: Lippies loop, spirals, coils, rings Medicated: Copper, silver core, Multi load Devices Release of hormones Progestasert Levonorgestril

Action of IUCDs Foreign body, cellular and biochemical changes in endometrium - impair viability of gametes Hormone releasing devices increase viscosity of the cervical mucus High level of progesterone – unfavorable for implantation.

Advantages of IUCDs Most effective method Simple, in a few minutes Long acting, may be for 5-10 years Inexpensive Reversible Lower incidence of side-effects, free of metabolic side effects

Advantages of IUCDs Highest continuation rate No need for continued motivation Easier to fit even in nulli parous women Better tolerated by nulli para Effective as post-coital contraceptive

Mechanism of action of IUCDs At present, the most widely accepted view is that the IUCD causes a foreign-body reaction in the uterus causing cellular and biochemical changes in the endometrium and uterine fluids, and it is believed that these changes impair the viability of the gamete and thus reduce its chances of fertilization, rather than its implantation.

ABSOLUTE C/I OF IUCDs Suspected pregnancy Pelvic inflammatory diseases Vaginal bleeding of undiagnosed aetiology Cancer of the cervix, uterus or adnexia Previous Ectopic pregnancy

RELATIVE C/I OF IUCDs Anaemia Menorrhagia H / O PID since last pregnancy Purulent cervical discharge Malformations, Fibroids Unmotivated client or person

The ideal IUD candidate Who has borne at least one child Has no history of pelvic disease Has normal menstrual periods Is willing to check the IUD tail Has access to follow-up and treatment of potential problems

TIME OF INSERTION OF IUCD Any time during reproductive age During menstruation or within 10 days of the beginning of menstrual cycle First week after delivery-immediate postpartum insertion Better time is at 6-8 weeks after delivery-post puerperal insertion

Side effects of IUCD 1. Bleeding, greater loss, prolonged period 2. Pain 3. Pelvic infection 4. Uterine perforation 5. Pregnancy 6. Ectopic pregnancy 7. Expulsion 8. Fertility after removal 9. Cancer and teratogenesis 10. Mortality

HORMONAL CONTRACEPTIVES Most effective spacing method 100% effective Synthetic estrogens Ethinyl oestradiol Mestranol Synthetic progesterone Pregnanes Oestranes Gonanes

Classifications A. Oral Pills 1. Combined pill 2. Progestogen only pills (POP) 3. Post-coital pills 4. Once-a-month (long-acting) pill 5. Male pills B. Depot (slow release) formulations 1. Injectables 2. Subcutaneous implants 3. Vaginal rings

Combined pills Major spacing method 30-35 microgram of synthetic estrogen 0.5-1.0 microgram of progestogen. Pill is given orally for 21 consec. Days, starting on 5th day of menstrual cycle Pill is taken every day at a fixed time

POP Contains only progesterone Small doses throughout the cycle For those women- c/I combined pills

Post coital contraception Morning after Within 48 hours of unprotected intercourse IUCD Hormonal: high doses of estrogen and progesterone 2 pills immediately & 2 pills after 12 hours

Once a month pill Long acting estrogen Short acting progesterone

Mode of action of OCP Prevents the release of ovum from ovary by locking pituitary secretion of gonadotropin. Progesterone only pills renders the mucus thick, scanty that inhibits sperm penetration. Progesterone also inhibits tubal motility OCP are 100 % effective if taken regularly Certain drugs affects the effect of OCP

Beneficial effects 100 % effective contraception Protection against Benign breast disorders Ovarian cysts Iron deficiency anaemia PID Ectopic pregnancy Ovarian cancer

Adverse effects of OCP Cardiovascular effects Carcinogens Metabolic effects Elevation of BP, decrease in high density lipoprot. Blood clotting, increase sugar level Increase in atherogenesis Increase in myocardial infarction & stroke Others: Liver disorder, lactation, fertility, ectopic preg. Breast tenderness, weight gain, headache, Bleeding disturbances , Foetal development

Contraindications of OCP Cancer of breast & genitals Liver disease Cardiac diseases, DVT Congenital hyperlipideamia Undiagnosed abnormal uterine bleeding Age above 40 & smoker at age 35 Hypertension, migraine, headache, epilepsy, diabetes, gall bladder disease Nursing mother in first 6 months

Checklist for Oral Contraceptives Above 40 years of age Above 35 years of age & heavy smoker H / O Seizures Severe pain in the calves or thighs Symptomatic varicose veins in the legs Severe chest pains, shortness of breath Severe headache Visual problems

Lactating less than 6 months Inter menstrual bleeding Bleeding after sexual intercourse Amenorrhoea Abnormally yellow skin & eyes High Blood pressure Mass in the breast Oedema - legs

Depot formulations Injectables: Never massage ± 2 weeks DMPA 150 mg every 3 months 99%, safe, effective, acceptable during lactation Wt. gain, irregular menstrual bleeding prolonged infertility NET-EN 300 mg 2 months Inj. During first 5 days of menstruation Deep intramuscular into gluteus maximus. Never massage ± 2 weeks

Depot formulations Sub dermal implants Norplant 6 silicone rubber capsules containing 35 mg of Levonorgestril Implanted under the skin of left upper arm

Terminal Methods Permanent methods Male sterilization Female sterilization Females 90 – 95% Males 5 – 10% One time method, no sustained motivation Risk of complications is rare

Male sterilization: Vasectomy Post-operative advice Patient is not sterile immediately after the operation At least 30 ejaculations may be necessary before the seminal examination is negative To use contraceptives until aspermia has been established To avoid taking bath for at least 24 hours after the operation. To wear a T-bandage or scrotal support for 15 days and to keep the site clean and dry To avoid cycling or lifting heavy weights for 15 days Remove stitches on the 5th day after the operation.

COMPLICATIONS Operative Sperm granules Spontaneous reorganization Autoimmune response Psychological

Female sterilization: Bilateral Tubal Ligation (BTL) It is the most widely used contraceptive method. The procedure can be carried out in the immediate post menstrual and post partum period. Laparoscopic sterilization is most commonly employed method. Failure and complications only due to surgical skills.

MCQ Thread attached with IUCD is meant for Anti inflammatory effect Device can be pulled out when needed Shape of loop Assurance of loop’s presence Blocking of sperm penetration

MCQ Multi load contains Copper Zinc Silver Gold Progesterone

MCQ OCP is not c/I in Pregnancy Lactation Fibroid Overweight A woman having 2-3 children

MCQ Most effective contraceptive method for spacing between pregnancies is IUCD Oral pills Condom Vasectomy Abstinence from sexual intercourse

MCQ Estrogen content of OCP causes all except: Myocardial infarction Venous thrombo - embolism Decreased quantity of breast milk Increased blood sugar Breast tenderness