1. CONTRACEPTION Dr. Mona A. Almushait Dean, Girl’s Centre
Associate Professor & Consultant
Obstetrics and Gynaecology
College of Medicine
King Khalid University
Abha, Saudi Arabia 1

2. Methods of Contraception
Combined Hormonal Products
Oral contraceptive pills
Depot medroxyprogesterone acetate injections Transdermal patches and Vaginal rings
II.
Barrier
and Behavioral Methods
Male condoms, Diaphragms Caps, Female condoms, Spermicides
Withdrawal, Fertility awareness method,
Natural family planning
III.
Longer Term
Progestin implants and Intrauterine devices
IV.
Sterilization
Female sterilization and Vasectomy 2

3. Combined Estrogen and Progesterone Contraceptives
1. Combined Hormonal Products
Combined Estrogen and Progesterone Contraceptives
Oral contraceptive pills
Monthly injections
Transdermal patches
Vaginal rings

4. Mode of action:
Suppression of the LH surge (to prevent ovulation) → to inhibit ovulation
Thickening of the cervical mucus (to prevent sperm entering the upper genital tract)
Other mechanisms:
→ slowing of tubal transport
→ atrophy of the endometrium 4

5. Complications of Estrogen–Containing Contraceptives:
Thromboembolism
Post pill amenorrhea
Cerebrovascular accidents
Increased in Cholelithiasis (cholestatic jaundice)
HTN
Benign hepatic tumors (Hepatoma)
Headache in the week off 5

6. Contraindications to the Use of Estrogen–Containing Contraceptives
ABSOLUTE
Arterial thrombosis
Venous thrombus (Thromboembolism)
Pulmonary embolism
Coronary vascular disease, IHD → cardiomyopathy, vascular heart disease
Past cerebrovascular accident
Pulmonary HTN
Current pregnancy
Breast cancer within the last 5 years 6

7. ABSOLUTE Cont’d Endometrial cancer
Hepatic tumor or abnormal liver function, Dubin–Johnson or Rotor syndrome, known gallstones
Unexplained abnormal uterine bleeding
Age >35 and cigarette smoking
Uncontrolled hypertension
History of melanoma
Hyperlipidaemia, focal and crescendo migraine
Trophoblastic disease 7

8. RELATIVE Risk factor for arterial disease
Complicated prolonged Diabetes
Estrogen–dependent neoplasm
Depression, Hyperprolactinemia
Severe varicose veins
Hypertriglyceridemia
Increasing age, smoking, obesity, migraine 8

9. Progestin–Only Hormonal Methods of Contraception
(POPs)
PoPs are taken as a continuous preparation, in 28 day packs.
Taken at the same time each day
Mode of action:
Thicken the cervical mucus
Inhibit ovulation
Twining the endometrium 9

10. Pills most frequently used by breastfeeding women Side effects:
Safe → when oestrogen–containing pills cause side effects, or contraindicated
Smokers, immediately post–partum, breastfeeding, risk of DVT, hypertension, migraine, or diabetes, PMS
Pills most frequently used by breastfeeding women
Side effects:
Menstrual changes
Amenorrhea
↑ functional ovarian cyst
↑ risk of ectopic pregnancy
Acne, headache, breast tenderness, nausea, irregular bleeding
Weight change
↑Breast cancer diagnosis 10

11. Advantages: DMPA (Depo–Provera) 150 mg every 3 months, I.M.
Suppresses gonadotropins to inhibit ovulation
Change cervix mucus (thickening)
Twining endometrium
Advantages:
High efficacy
No need to remember to take a pill
Use when oestrogen contraindicates
No increased in ovarian cyst or risk of ectopic pregnancy 11

12. Delayed of fertility, weight gain, irregular bleeding and amenorrhea
Disadvantages:
Delayed of fertility, weight gain, irregular bleeding and amenorrhea
↑ risk of Osteoporosis due to long term Medroxy progesterone acetate
Contraindications:
Pregnancy
Severe arterial disease
Undiagnosed vaginal bleeding
Liver disease 12

13. Transdermal Patch
Applied once a week to the abdomen, buttock, upper outer arm.
The patch releases 150 µg of norelgestromin and 20 µg of ethinyl estradiol to inhibit ovulation.
3-consecutive 7-day pathches (21 days) are applied followed by 1 patch free week per cycle. 13

14. Advantages: Disadvantages: Very effective Rapidly reversible
Requires a prescription
Skin reactions
Slight increase in risk of VTE compared with COCs 14

15. Vaginal Ring
A thin, transparent, flexible ring that contains oestrogen/progestogen hormones.
It stops ovulation and thickens the cervical mucus.
Advantages:
Easy to use
Can be worn for 3 weeks
Disadvantages:
Does not protect against STD
Spotting
Increased vaginal discharge 15

16. II. Barrier and Behavioral Methods

17. Male Condom Advantages:
↓transmission of STD, HIV, Chlamydia and Gonorrhea
Easily obtained
Disadvantages:
Allergy
Loss of sensation
Slippage/breakage 17

18. Diaphragm and Cap To be filled and coated with spermicide
84% to 94% effective for pregnancy prevention
Must be left in place for at least six hours.
Advantages:
Easy use
Protection from sexually transmitted infections
Disadvantages:
Cystitis
Skin irritation 18

19. Female Condom A lubricated polyurethane Advantages:
Prevents the transmission of infection
No hormonal side effects
Disadvantages:
Loss of sensation
Can break or leak 19

20. Jelly
Jellies come in tubes and are usually used with a diaphragm or cervical cap.
It allows for immediate protection, which lasts for about 1 hour. 20

21. Vaginal Contraceptive Sponge
Small, donut-shaped foam that contains a spermicide
A non hormonal barrier method of birth control 21

22. Vaginal Contraceptive Foam
Advantages:
It kills the sperm
It blocks the semen fluids from entering the cervical canal
No hormones are involved
Disadvantages:
Irritation
No protection against infection 22

23. Film A paper-thin translucent film that contains a spermicide
Its is placed in the vagina or near the cervix where it dissolves in seconds
It is effective for about one hour 23

24. Behavioral Methods Natural family planning Lactational amenorrhea
Natural family planning
Tracking basal body temperature
Checking the consistency of cervical mucus
→ Moist, sticky, white pre–ovulation, clear, copious and stretchy spinnbarkheit → The most fertile time
Time in cycle
→ Ovulation occurs every 12–16 days before a period
→ Pain from ovulation, breast change → less
Lactational amenorrhea
Withdrawal or coitus interruptus 24

25. III. Longer Term Progestin Implants and Intrauterine Devices

26. Implant
It is placed in the s/c layer of the medial aspect of a woman’s upper arm to release steady amounts of Levenogestrel → 5 years
Have low circulatory levels of progestin
Suppress ovulation and change cx mucus
Twining endometrium 26

27. Disadvantages:
Vaginal spotting
Weight gain
Hair or skin changes
Headaches
Depression
Decreased libido

28. Levenogestrel–Releasing Intrauterine System (LNG–IUS)
Contains 52 mg of Levenogestrel
20 µg of Levenogestrel every 24-hr.
T–shape
Effective for at least 5 years 28

29. Twins the endometrium→atrophic endometrium Inhibition of ovulation
Mode of action:
Thickens the cx mucus
Twins the endometrium→atrophic endometrium
Inhibition of ovulation
Disadvantages:
Amenorrhea
Irregular bleeding for the first 3 months
↑ functional ovarian cyst
Expulsion and perforation 29

30. Contraindications: Pregnancy Active liver disease
Severe arterial disease
Undiagnosed irregular bleeding
Mechanical heart valves
Untreated STD
Hx of ovarian or endometrial carcinoma 30

31. Copper T380A I.U.D. Mode of action: Disadvantages:
Copper is spermicidal
It is inserted in the first 7 days of cycle with antibiotics cover
Inflammatory changes to prevent implantation
Disadvantages:
Pregnancy with I.U.C.D.
Increased rate of Ectopic pregnancy
↑ Menorrhagia
↑ PID
Perforation and expulsion
Actinomycosis → cx smear
Lost coil 31

32. IV. Female sterilization and Vasectomy

33. Sterilization Disadvantages: Advantages: Does not protect against STD
Permanent sterilization is the most common method of birth control used.
Mini Laparotomy sterilization
Laparoscopic sterilization
Disadvantages:
Does not protect against STD
Requires surgery
May not be reversible
Possible regret
Possibility of Post Tubal Ligation Syndrome
Advantages:
Permanent birth control
Immediately effective
Requires no daily attention
Not messy
Cost-effective in the long run 33

34. filshie clip tubal ligation
One common form of laparoscopic (camera) sterilization is the use of Filshie clips to occlude both fallopian tubes.
Hulka clip sterlization
One common form of female sterilization is the use of Hulka clips to block the fallopian tubes.
VASECTOMY (interruption of the vas deferens)
It is a minor surgical procedure wherein the vasa deferentia of a man are severed, and then tied/sealed in a manner which prevents sperm from entering the seminal stream. 34

35. Risks include: Infection Bleeding
Scrotal pain or swelling at the time of the procedure