Contraception: Nur Hafizah Ainaa Abu Hassan
Contraception: Nur Hafizah Ainaa Abu Hassan
Highly 100%
Acceptive Safe Reversible
effective
Requiring minimal
Having non-
motivation,
Cheap contraceptive Simple to use
maintainence
benefits
and supervision
TYPES OF CONTRACEPTION
TEMPORARY PERMANENT
NATURAL
HORMONAL BARRIER STERILIZATION
METHOD
Rhythm
ORAL PARENTERAL DEVICE MECHANICAL CHEMICAL FEMALE MALE
Method
Coitus
COCP Depo-Povera Patch Condom Spermicides Tubal Ligation Vasectomy
Interruptus
Emergency
IUCD Cervical Cap
Contraception
Sponge
NATURAL METHOD
Certain methods used to achieve and avoid pregnancies.
Based on observation of the naturally occurring signs and symptoms of
the fertile and infertile phases of a woman's menstrual cycle.
No drugs, devices, or surgical procedures are used.
WITHDRAWAL RHYTHM METHOD
• Coitus Interruptus • Based on identification of the
• Removal of penis from the vagina fertile period of a cycle and to
before ejaculation occurs abstain from sexual intercourse
• Effectiveness rate is 60-80% during that period.
• Failure due to • Requires partner’s co-operation.
• Delay withdrawal • Methods to determine:
• Presence of sperm in the pre- a) Calendar Rhythm
ejaculatory fluid
b) Temperature Rhythm
c) Mucus Rhythm
a) CALENDAR
• What? Predicting fertility based on
menstrual cycles
• Desogestrel
• Norethisterone
Progestogen • Ethynodiol
• Norgestimate
• Gestodene
• Levonorgestrel
HORMONAL CONTRACEPTION
ORAL PARENTERAL DEVICE
TRANSDERMAL
COMBINE SINGLE INJECTABLES IMPLANTS IUCD VAGINAL RING PATCH
Suppression of hypothalamic
gonadotropin-releasing
Prevents pituitary factors
secretion of FSH
and LH
Inhibit implantation
↓ cervical mucus
penetrability
Inhibit ovum
transport in
tube
Failure rate: 1%
Progestin prevents ovulation
• The first pill has to be taken on the first day of the cycle then continuously and regularly
and at the same time of the day to be maximally effective
CONTRAINDICATION
• Absence of • Acne • Older women • Pregnancy
INDICATION
major metabolic • Mastalgia • Lactation • Unexplained
disturbance • Headache • Smokers over 35 uterine bleeding
• Excellent choice • Disturbance of • Intolerance or • Recent breast
for lactating menstrual cycle contraindication cancer
women s to oestrogen • Arterial disease
• Functional
• Easy to take ovarian cysts • Hypertension • Thromboembolic
• Reduced the risk develop disease
of PID and • Must be taken at
endometrial the same or
cancer nearly the same
time daily
INJECTABLE PREGESTIN INTRAMUSCULARLY
DEPO-POVERA Dose:
• Depo medroxyprogesterone
acetate (every 3 months) •150mg IM, every 12 weeks
• Absorbed more slowly •reach active levels within 24
hrs
NORGEST •levels decrease by 4 – 5
• Norethisterone oenanthate
months
(2 monthly) •undetectable by 7 – 9
months
INDICATION CONTRAINDICATION ADVANTAGES DISADVANTAGES
•Good option for women •High risk for osteoporosis •Safe during lactation •Irreguler bleeding
who find it difficult to •Same as POP •No estrogen related side •Delay in return of fertility
remember to take pill effect of 6 months
•Useful if oestrogen is •Menstrual symptoms •Injections
contraindicated reduced •Depression
•Lactation •Protective against Weight Gain
endometrial cancer •Low failure rate (<1%)
Diminised anemia •Reduce risk of ovarian
and endometrial cancer
•Long term use (>2 years)
can lead to decreased
bone density
IMPLANON
• Progestin only delivery system containing:
Etonorgestrel 68mg
• Single closed capsule Sub dermal implant-
40mm x 2mm road, inserted on day 1-5 of the
menstrual cycle
• into the non-dominant arm in between the head of
the biceps and triceps
• It release hormone about 60 mcg, gradually
reduced to 30 mcg/ day over 3 years.
• Efficacy 99%
• Long-lasting (3 years)
Reversible Surgical Menstrual History of
Longevity of Difficult to irregularity cardiovscular
effectiveness remove Headache disease
No effect on Not Mood change Hypertension
ADVERSE EFFECT
ADVANTAGES
DISADVANTAGES
CONTRAINDICATION
lactation biodegradable Depression Obesity
Not user Migraine
dependent Chronic
hepatitis
Breast cancer
NORPLANT I VS. NORPLANT II
• NORPLANT I : Six capsules (Five years)
• NORPLANT II : Two capsules (Three years)
• Rods : 4 cm long with diameter of 2.5 mm.
• Each rod contains 75mg of levonorgestrel.
• It release 50 mcg of levonogestrel / day.
Administration;
Under LA
6 slicone rubber rods
Effective within 6 hours of insertion
5 years action
PATCH (EVRA)
• Delivers 150 g progestin norelgestromin + 20 g of ethinyl estradiol daily.
• Patch (Evra) is applied to :
• Buttocks
• Upper outer arm
• Lower abdomen
• Upper torso (avoiding the breasts)
• A new patch is applied weekly for 3 weeks
• followed by a patch-free week to allow for withdrawal bleeding
• The patch was slightly more effective than a low-dose oral contraceptive in
preventing pregnancy.
ADVANTAGES DISADVANTAGES
Dysmenorrhea
Well tolerated
Breast tenderness
Breakthrough bleeding in
the first two
Safe overall
3% of women
• application site reaction
severe enough to limit usage
INTRAVAGINAL RING
• Flexible polymer ring
Side effects
• Nausea and
Preventing vomiting are major
problems due to
implantation the estrogen in
Disrupt • alteration of the these regimens
fertilization endometrium
SIDE EFFECTS
CONTRAINDICATION
a person to take • Current STI or PID • Menstrual loss
medication • Distortion of the • Expulsion <3%
• Good for those shape of uterine • Uterine
with a contra- cavity perforation 1 in
indication to • Severe 1000
taking oestrogen dysmenorrea • Salpingitis 1.5-7.5
• Useful for patients • Valvular heart per 1000
who are not disease • Endometritis
compliant to
• Cooper allergy
taking medicines
• Heavy periods
TIME OF INSERTION
• Barrier methods have higher failure rates than hormonal methods due
to design and human error.
MALE CONDOM
• Most common and effective
when used properly
• Latex and Polyurethane
• Benefit
• risk of venereal infection
• Controlling the spread of HIV
• Perfect effectiveness rate = 97%
• Combining condoms with
spermicides raises effectiveness
levels to 99%
FEMALE CONDOM
• Male sterilisation
• failure 1:10 000, not 100% reversible
TUBAL LIGATION VASECTOMY