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OVERVIEW OF FAMILY
PLANING METHODS

Medical students revision

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Defination of Terms (Perfect
vs Typical use)
• Birth control works best when used
exactly as directed, known as “perfect
use.” But if you're like most people,
you may not always use it perfectly
each time. Experts refer to this as
“typical use,” and it can make some
forms of contraception less effective.

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Pearl Index
• The Pearl Index is defined as the
number of contraceptive failures per
100 women-years of exposure, and
uses as the denominator eg if 100
women are using a method under
supervision for a year what
percentage of them will fail.(Pearl Index
= (Number of pregnancies x 12) x 100 / (Number
of women in the study x Duration of study in
months)
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 Contraceptive Prevalence
Rate CPR
• For a given year, contraceptive prevalence
measures the percentage of women of
childbearing age who use a form of modern
contraception. To obtain a true contraceptive
use rate, the denominator should reflect the
population at risk (of pregnancy), i.e.,
sexually active women who are fecund and
neither pregnant nor amenorrheic.

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Unmet need for contraception
• Women with unmet need are those who
are want to stop or delay childbearing
but are not using any method of
contraception. wish to postpone the
birth of a child for at least two years or
do not know when or if they want
another child (want to space births), but
are not using any contraceptive
method.

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 Risk and Responsibility
• If intercourse occurs the day before
ovulation, the chance of pregnancy is about
30%.
• If intercourse occurs the day of ovulation,
the chance of pregnancy is about 15%.
• Over the course of one year, couples who
having regular coitus & do not use
contraception have a 90% chance of
pregnancy.

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Birth Control and
Contraception
• What is the difference
• Birth Control: Preventing birth from
taking place (Contraception &
Abortion)
• IUD
• Emergency contraceptive pills
• RU-486
• Surgical Abortion

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Birth Control and
Contraception
• Contraception: Preventing conception
(preventing the sperm and the egg
from uniting)
• Barrier methods
− Condoms, diaphragms, Cap, Sponge
• Spermicides
• Hormonal methods
− Pill
− Shot (depo)
− Implants
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CONTRACEPTIVE
METHODS:
Methods of Contraception
and Birth Control
• Choosing a Method (Counseling)
• The best method is the one you will
use consistently and correctly
• Know the reliability of method
• Know the advantages and
disadvantages
• Side effects
• Risks
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Methods of Contraception
and Birth Control
• Abstinence
• Choosing not to have intercourse
• Outercourse
• Sexual activity without penetration

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Methods of Contraception
and Birth Control
• Hormonal Methods
• The pill
• Implants
• Injections

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The Pill
• Combination of estrogen and progestin
(some progestin only)
• Inhibits ovulation
• Thickens the cervical mucous
• Changes the lining of the uterus to
inhibit implantation of the fertilized
ovum
• Alter the rate of ovum transport
• 99.5 % effective (if used correctly) 92 %
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The Pill

Advantages
• Easy to use
• Dependable
• No additional appliances
• Can regulate menstrual flow and
decrease cramps and other
symptoms of menses

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The Pill

• Problems
• Side effects
• Changes in menstrual flow
• Breast tenderness
• Nausea
• Vomiting
• Wt. gain or loss

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The Pill
• Contraindications
• Heart disease
• Kidney disease
• Asthma
• High blood pressure
• Diabetes
• Epilepsy
• Gall bladder disease
• Sickle-cell anemia
• Migraine headaches
• depression,
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The Pill

• ACHES
• Abdominal pain
• Chest pain or shortness of breath
• Headaches (severe)
• Eye problems (blurred vision, flashing
lights and blindness)
• Severe leg pain

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The Pill

• Smoking and the Pill

• DO NOT TAKE THE PILL IF YOU
SMOKE

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Implants
• Progestin only
(Norplant)
• Prevents
ovulation
• More effective
than the Pill

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Implants

• Advantages
• Convenience
• Eliminate user error
• No menses or very light
• Decreased cramping

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Implant
• Problems • Side effects
• Difficulty in
• wt. gain
removing
• Side effects • Acne
• Similar to the • breast
pill tenderness
• Changes in • hair growth
menstrual • ovarian cysts
bleeding
• Headaches
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Implant

• Contraindications
• Liver disease
• Breast cancer
• Cardiovascular disease
• Unexplained vaginal bleeding
• Pregnant
• Smokers

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 Transdermal
contraceptive patch
The patch is 4.5 square centimeter in size and has three
layers:
• the inner release liner which should be removed
before application,
• a layer containing hormones, and
• an outer polyester protective layer.
The patch contains 6 milligram of progestin,
Norelgestromin also called 17-acetylnorgestimate and
0.75 milligram of Ethinyle Estradiol.
The patch releases 120 microgram of norelgestromin
and 20 microgram of Ethinyl Estradiol every day.
 Transdermal
contraceptive patch

Mechanism of action:

• same as that of oral contraceptive

• 1 patch weekly: cyclically (1 patch weekly for 3
weeks, than 1 patch-free week) or continuously
 Transdermal
contraceptive patch:
Effectiveness

•Perfect use: 99.7 percent

•Typical use: 92 percent

 Transdermal
contraceptive patch:
Advantages
• Effective and reversible

• Once-a-week dosing schedule

• 48-hour "window of forgiveness"

• Non-contraceptive benefits similar to

those of oral contraceptive
Transdermal
contraceptive patch
Side effects:
• similar to those of oral contraceptives;

• local skin irritation in 20 percent

• Patch detachment (uncommon)

Risks:
• similar to those of oral contraceptive;

• possibly increased risk of venous

thromboembolism
Transdermal
contraceptive patch

• Less effective in women

weighing >90 kg

• Higher overall estrogen dose,

but lower peak levels, than with
oral contraceptive
Injectable Contraceptives

• Depo-Provera (DMPA) Progesterone

• Can stop menses
• Side effects include
• Spotting, wt. gain, headaches, breast
tenderness, dizziness, loss of libido and
depression
• Lunelle Progestin and estrogen
• Similar to the pill in all aspects

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Injectable Contraceptives:
Lunelle Progestin
• Contains 25 milligram of medroxyprogesterone acetate
and 5 milligram of Estradiol Cypionate in half a milliliter of
aqueous solution.
• Highly effective with the first year failure rate of 0.1 to 0.22
percent.
• The first injection is given within the first 5 days of the
menstrual cycle or immediately after a first trimester
abortion.
• The injection should be repeated at the interval of 28-33
days. The maximum injection free interval should not be
greater than 10 days. If reinjection is delayed by more than
10 days, pregnancy should be ruled out before reinjection.

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Barrier Methods

• The condom
• Female condom
• Diaphragm
• Cervical cap
• Sponge

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Spermicides

• Nonoxynol-9
• Used in combination with barrier
methods of contraception
• Foam
• gel
• Film
• Creams, jellies and suppositories

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 Vaginal
contraceptive ring:
Description
• The ring is 54 mm by 4 mm.
• It contains 11.7 milligrams of
etonogestrel and 2.7 milligrams of
Ethinyle Estradiol.
• It releases 120 micrograms of
etonogestrel and 15 micrograms of
Ethinyle Estradiol every day.
 Vaginal
contraceptive ring:
Description
• Mechanism of action: same as that
of oral contraceptive

• 1 ring monthly: cyclically (1 ring

for 21 days, then 7-day ring-free
interval) or continuously
Vaginal contraceptive
ring: Effectiveness

Perfect use: 99.7 percent

Typical use: 92 percent

 Vaginal
contraceptive ring:
Advantages
Effective and reversible

Once-a-month dosing schedule

1-week "window of forgiveness"

Noncontraceptive benefits similar to

those of oral contraceptive
 Vaginal
contraceptive ring:
Side-effects
• Similar to those of oral
contraceptive.
• Ring-specific side effects:
• vaginitis (5.6 percent),
• leukorrhea (4.6 percent),
• vaginal discomfort (2.4 percent).
 Vaginal
contraceptive ring
• Vaginal Spermicides and
antifungal have no effect on
ring efficacy
• Use does not worsen low-grade
squamous intraepithelial lesions
• Effect of avoiding first-pass
metabolism in liver uncertain
 Vaginal
contraceptive ring:
Side-effects
Side effects: similar to those of oral
contraceptive.
Ring-specific side effects: vaginitis (5.6
percent), leukorrhea (4.6 percent), vaginal
discomfort (2.4 percent).
Expulsion (uncommon)

Uterovaginal prolapse or vaginal stenosis are

relative contraindications
Risks: similar safety profile as that of oral
contraceptive
 Vaginal
contraceptive ring
• Vaginal spermicides and
antifungals have no effect on
ring efficacy
• Use does not worsen low-
grade squamous intraepithelial
lesions
• Effect of avoiding first-pass
metabolism in liver uncertain
IUD
• Intrauterine device
• Copper and plastic
(Copper T-380A) 10
years
• Progesterone
(levonorgestrel IUD) 5
years
• 90-96 % effective in
use
• Increased risk of
PID
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Fertility Awareness
Methods
• Calendar or rhythm method
• Midway in cycle
• Basal body temperature (BBT) method
• Increase in body temperature
• Cervical Mucous Method
• Clear slippery mucous
• Symptothermal method
• Combination of BBT and Cervical Mucous
methods
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Sterilization
• For Women
• Tubal ligations
• Cut and seal the fallopian tubes
• Hysterectomy
• Removal of the uterus
• For Men
• Vasectomy
• Vas deferens are cut and sealed

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Emergency Contraception

• Emergency Contraception Pill

(ECP)
• Copper IUD
• RU486 (Mifepristone)

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 Woman requests a new birth control
method: pill, patch, ring, injection

If pregnancy test is positive, provide options

* Because counseling.
hormonal EC is not 100 percent effective, check urine pregnancy test two weeks after EC use.
Reproduced with permission from: RHEDI/The Center for Reproductive Health Education In Family Medicine, Montefiore Medical Center, New York City. Copyright ©2007 RHE
 Cost of
contraception

Five-year costs associated with contraceptive methods in the managed payment model. Data from: Trussel, J, Leveque, JA, Koenig,
JD, et al. The economic value of contraception: a comparison of 15 methods. Am J Public Health 1995; 85:494. Original Figure #2.
Abortion

• Spontaneous abortion
(miscarriages)
• Induced abortion

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Induced Abortion

• Drug induced
• Mifepristone (RU-486)
• Misoprostol
• Surgical Methods
• Vacuum aspiration
• Dilation and evacuation
• Hysterectomy
• Saline, prostaglandins and urea (after the
first trimester)
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