2. Contraceptive Methods

3. 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

4. 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

5. 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.

6. 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.

7. 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).

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

10. 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.

11. 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

12. 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

13. 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.

14. 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

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

16. 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

17. 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

18. 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

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

20. 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

21. Combined pills Major spacing method
30-35 microgram of synthetic estrogen
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

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

23. 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

24. Once a month pill
Long acting estrogen
Short acting progesterone

25. 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

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

27. 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

28. 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

29. 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

30. 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

31. Depot formulations Injectables: Never massage ± 2 weeks
DMPA 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

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

33. 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

34. 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.

35. COMPLICATIONS Operative Sperm granules Spontaneous reorganization
Autoimmune response
Psychological

36. 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.

37. 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

38. MCQ
Multi load contains
Copper
Zinc
Silver
Gold
Progesterone

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

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

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