1. Prepared by : Dr. Latifa Mari’e
Birth Control
(Contraception)
Prepared by : Dr. Latifa Mari’e

2. Objective: Review of reproductive systems
To learn about the various methods of contraception or birth control to prevent pregnancy and STIs

3. Reproductive system: female

4. Fallopian tube: connects ovaries to the uterus, creating passageway for the egg to be transported from the ovaries to the uterus
Ovary: main reproductive organ. They produce hormones and eggs
Uterus: connects all the organs. This is where a baby develops.
Cervix: neck of the vagina
Vagina: muscular tube leading from external genitals to the cervix. Menstrual blood leaves the body through this passageway. A penis is inserted in to the vagina during vaginal sex. A baby is delivered from the uterus through the cervix and vaginal opening.

5. Reproductive system: female

6. Menstrual cycle

7. Review menstrual cycle.
Girls are born with hundreds of thousands of tiny eggs, called ova – one is called an ovum.
These egg cells are only half formed.
At puberty, hormones tell the ovaries it is time to start releasing ova.
Usually one egg at a time matures (develops) and is released from an ovary.
At the same time, the uterus starts to grow a thick lining on the inside wall.
The lining has lots of tiny blood vessels.
The lining is there to protect and feed an egg that has combined with a sperm to form a fertilized egg.

8. If an egg does not meet a sperm, the lining is not needed.
It breaks up.
Mixed with some blood it comes out the uterus into the vagina and then out the vaginal opening.
This is called menstruation.
If a woman is not pregnant then her ovary will release another egg, the lining build up and, if the egg is not fertilized, she has another period.
This is called the menstrual cycle.

9. Reproductive system: male

10. Reproductive system: male

11. STIs and Pregnancy Prevention
Hormonal Methods
Non-hormonal Methods

12. What is the most effective method of preventing pregnancy and STIs?
Abstinence

14. Hormonal methods of
birth control

15. The pill A hormonal method that contains:
Combined : estrogen and progesterone or
Mini pill :progesterone only pills

16. cocp
.It includes a combination of an estrogen (usually ethinylestradiol) and a progestogen (specifically a progestin). When taken correctly, it alters the menstrual cycle to eliminate ovulation and prevent pregnancy.

17. Combined oral contraceptive pills are a type of oral medication that is designed to be taken every day, at the same time of day, in order to prevent pregnancy.
When taken correctly, the pill is over 99% effective at preventing pregnancy.

18. Benefits
The hormones in the pill have also been used to treat other medical conditions, such as polycystic ovary syndrome (PCOS), endometriosis, adenomyosis, acne, hirsutism, amenorrhea, menstrual cramps, menstrual migraines, menorrhagia (excessive menstrual bleeding), menstruation-related or fibroid-related anemia and dysmenorrhea (painful menstruation).Besides acne, no oral contraceptives have been approved by the U.S. FDA for the previously mentioned uses despite extensive use for these conditions.

19. contraindications Thrombophlebitis or thromboembolic disorders
Cerebro-vascular or coronary artery disease
Carcinoma of the breast or other estrogen- dependent neoplasia
Undiagnosed abnormal genital bleeding
Known or suspected pregnancy
Benign or malignant liver tumor

22. Cocp and cancer
Combined oral contraceptive use reduces the risk of ovarian cancer by 40% and the risk of endometrialcancer by 50% compared with never users
But they increase a woman's risk of breast and cervical cancer

23. pop
The "traditional" progestogen-only pill (POP) prevents pregnancy by thickening the mucus in the cervix to stop sperm reaching an egg.
The desogestrel progestogen-only pill can also stop ovulation.
You need to take the progestogen-only pill reliably every day.

24. If you take the minipills on time, they are 99% effective. 

25. Benefits
It may be suitable for women who cannot take the combined pill because of the oestrogen it contains. For example, those with heart disease, high blood pressure, a history of stroke, those at risk of blood clots, and women who experience certain types of migraine headaches.
It can be used when you are breast feeding.
It doesn’t interfere with sexual spontaneity.
It allows fertility to return without delay after you stop taking it
Menstrual bleeding may be reduced or stopped

26. Side effects breast tenderness; possible mood changes; headaches;
bloating;
acne;
decreased or increased libido (sex drive); and
nausea.

27. contraindicated in suspected pregnancy, breast cancer and undiagnosed vaginal bleeding. Relative contraindications are active viral hepatitis and severe chronic liver disease.

28. Oral Contraceptive (The Pill)

29. Implanon
implanon NXT is a contraceptive implant preloaded in a disposable applicator. The implant contains 68 mg of the active substance etonogestrel. Etonogestrel is a synthetic female hormone resembling progesterone. A small amount of the hormone etonogestrel is continuously released into the bloodstream for three years. The rod itself is made of ethylene vinylacetate copolymer, a plastic that will not dissolve in the body. It also contains small amounts of barium sulfate (which renders it visible under X-ray) and magnesium stearate.

30. Although the implant may be removed at any time, it must be removed no later than three years after insertion.

31. It prevents the release of an egg cell from the ovaries (ovulation)
It causes changes to cervical mucus that makes it difficult for sperm to enter the womb

34. advantages
High effectiveness of up to 99 percent within seven days of implant insertion
Safe in the majority of women
Efficacy for three years without further intervention
Easily removed in most cases to allow pregnancy to occur naturally
Independent of user memory or schedule, and of sexual intercourse, as it provides continuous contraception
Safe for use during lactation
Relieves menorrhagia and dysmenorrhea in many cases
Amenorrhea in one of every five women on the implant, which is often perceived to be a benefit
Reduces the risk of pelvic inflammatory disease 
Suitable in conditions which preclude the use of combined hormonal contraception
Quick return of fertility within 21 days of implant removal

35. Side effects changes in your menstrual periods;
vaginal itching or discharge;
acne, mood changes, weight gain;
breakthrough bleeding, menstrual cramps;
nausea, stomach pain;
breast tenderness;
dizziness
flu-like symptoms, sore throat.

36. contraindications Pregnancy.
Liver disease, including severe cirrhosis or liver tumors.
Personal history of breast cancer.
Undiagnosed abnormal vaginal bleeding.
Allergy or hypersensitivity to any of the implant materials.

37. Transdermal patch A patch that releases hormones through the skin
Thin, smooth and beige patch
Prevents the release of a mature egg
Thickens cervical mucous
Changes the lining of the uterus
Typical effectiveness rate is 91%

38. Transdermal Patch or EVRA
Can be placed on the buttocks, upper outer arms, lower abdomen, or upper torso excluding the breast

39. What are the advantages?
1. A reversible and highly effective birth control method
2. Once-a-week regimen; no daily contraceptive routine required,used for 3 weeks/ m
3. Simple and easy to use
4. Regulates menstrual cycle and reduces cramps
5. Does not interfere with intercourse
6. Expected to provide other benefits similar to oral contraceptives; research is needed

40. What are the disadvantages?
1. May cause irregular bleeding or spotting
2. May cause breast sensitivity or headache
3. Does not protect against STIs
4. Patch may detach from skin (less than 2%)
5. Possible skin irritation at the application site

41. Nuva Ring (vaginal ring)
Soft and flexible ring, inserted into the vagina
The ring slowly releases hormones while in the vagina for 3 weeks
Prevents the release of a mature egg
Thickens cervical mucous
Changes the lining of the uterus
Typical effectiveness rate is 91%

42. Vaginal Ring or Nuvaring

43. What are the advantages?
1. A reversible and highly effective birth control method
2. Once-a-month regimen; no daily contraceptive routine required
3. Regulates menstrual cycles
4. Does not interfere with intercourse
5. Does not require daily attention

44. What are the disadvantages?
1. Does not protect against STIs
2. May cause irregular bleeding or spotting
3. May cause side effects such as headache, nausea, or breast tenderness
4. May cause vaginal discomfort
5. The ring may be expelled from the vagina but this is uncommon

45. Depo Provera – Injectable contraceptive
An injection of progestin administered every 12 to 13 weeks
Prevents the release of a mature egg
Thickens cervical mucous
Changes the lining of the uterus
Typical effectiveness rate is 94%

46. Injectable contraceptive or “Depo-Provera” or “the needle”

48. What are the disadvantages?
1. Initially, irregular bleeding is the most common side effect
2. Decrease in bone mineral density which may be reversible when a woman stops taking the injection. Calcium supplementation is advised.
3. May be associated with weight gain in some women
4. Takes an average of nine months after the last injection for the ovaries to start releasing eggs again
5. Does not protect against STIs
6. The lack of a monthly period may be bothersome for some women

49. Not given for more than 2 years ,risk of osteoporosis.

50. Intrauterine Contraception -IUC
T-Shaped device that is inserted in the uterus by a Doctor or Nurse Practitioner
Two types of IUC:
the Copper intrauterine device (no hormone)
the levonorgestrel-releasing intrauterine system (contains a progestin)
Typical effectiveness rate is 99.8%
IUD prevent pregnancy by preventing fertilization

51. Intrauterine System (IUS)

53. IUD also decreases the risk of ectopic pregnancy.

55. LNG-IUS
Advantages
-Very low dose of hormone
-May make periods lighter with less cramping
-Many women won’t get a period ~6 months after insertion
-Improves symptoms of endometriosis
Disadvantages
-Risk of hormonal side effects: acne, headaches, breast tenderness, changes in mood
-Irregular bleeding, light or no periods

57. Hormonal methods of birth control
Side effects that may occur during the first few months on hormonal contraception include :
irregular bleeding, spotting
nausea
mood swings
bloating
breast tenderness
headaches

58. Emergency contraception
Can be taken up to 5 days after intercourse
The sooner it is taken, the better it works
Delays or prevents the release of an egg
May prevent implementation of a fertilized egg
95 % effective if taken within 24 hours after intercourse
85% effective if taken hours after intercourse
58% effective if taken hours after intercourse

59. Insertion of a copper IUD up to five days after unprotected sex
Two options:
Plan B : Plan B is a safe form of emergency contraception that only contains progestin. It is used to prevent pregnancy up to 72 hours (3 days) after a single act of unprotected intercourse,, but that it may not be as effective.
2. Ella: The active ingredient of Ella is ulipristal acetate. It works by blocking the effects of the hormone progesterone. Ella is used to prevent pregnancy up to 120 hours (5 days) after unprotected intercourse.
Insertion of a copper IUD up to five days after unprotected sex can also be used an emergency contraception
Plan B : Plan B is a safe form of emergency contraception that only contains progestin. It is used to prevent pregnancy up to 72 hours (3 days) after a single act of unprotected intercourse
Insertion of a copper IUD up to five days after unprotected sex
Ella: Ella is a type of emergency contraceptive pill (prevent pregnancy up to 120 hours (5 days) after unprotected intercourse

60. Barrier methods
(non-hormonal)

61. Condom Thin latex or polyurethane that fits over an erect penis
Catches sperm during ejaculation to prevent it from entering the vaginal/cervical canal
Typical effectiveness is 82%
Reduces but does not eliminate the spread of STIs and HIV

64. Condom (female) Polyurethane sheath inserted into the vagina
Provides a physical barrier to prevent sperm from entering cervical canal
Sperm is trapped in the condom, which is thrown away after use
Typical effectiveness rate is 79%

65. Female Condom

66. Sponge and Spermicides
The sponge is a soft, disposable, device with a spermicide
Typical effectiveness is 76%-88%
Fits over the cervix
Traps and absorbs sperm to increase effect of spermicide
Spermicide in the sponge disables the sperm
Effective for up to 12 hours
Spermicides disable sperm
Typical effectiveness is 88%onge

67. spermicides can cause vaginal irritation which can increase the risk of STI transmission

68. Surgical
Methods

69. Sterilization
Tubal ligation - a surgical procedure to close or block the fallopian tubes ensuring sperm and egg do not meet

70. Female sterilization = tubal ligation
Permanent; only for couples who are absolutely sure their family is complete
Abdominal surgery

71. Sterilization
Vasectomy - A surgical procedure to close or block the vas deferens

72. Comparing Birth Control Effectiveness
Abstinence 100% Implanon 99.9% IUC 99.8% Depo Provera 94% The Pill 91% The Patch 91% The Ring 91% Male Condom 82% Female Condom 79% Sponge and Spermicides 76-88%

73. Thank you