Transcript Slide 1

Dr. Mona A. Almushait
Dean, Girl’s Centre
Associate Professor & Consultant
Obstetrics and Gynaecology
College of Medicine
King Khalid University
Abha, Saudi Arabia
Methods of Contraception
Methods of Contraception
I.
Oral contraceptive pills
Combined
Depot medroxyprogesterone acetate injections
Hormonal
Transdermal patches and Vaginal rings
Products
Male condoms, Diaphragms
Barrier
II.
Caps, Female condoms, Spermicides
and
Withdrawal, Fertility awareness method,
Behavioral
Natural family planning
Methods
III. Longer Term Progestin implants and Intrauterine devices
IV. Sterilization
Female sterilization and Vasectomy
1. Combined Hormonal Products
Combined Estrogen and
Progesterone Contraceptives
 Oral contraceptive pills
 Monthly injections
 Transdermal patches
 Vaginal rings
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
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
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
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
RELATIVE
 Risk factor for arterial disease
 Complicated prolonged Diabetes
 Estrogen–dependent neoplasm
 Depression, Hyperprolactinemia
 Severe varicose veins
 Hypertriglyceridemia
 Increasing
migraine
age,
smoking,
obesity,
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
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
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
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
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.
Advantages:
 Very effective
 Rapidly reversible
Disadvantages:
 Requires a prescription
 Skin reactions
 Slight increase in risk
compared with COCs
of
VTE
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
II. Barrier and
Behavioral Methods
Male Condom
Advantages:
 ↓transmission of STD, HIV, Chlamydia
and Gonorrhea
 Easily obtained
Disadvantages:
 Allergy
 Loss of sensation
 Slippage/breakage
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
Female Condom
 A lubricated polyurethane
Advantages:
 Prevents the transmission of infection
 No hormonal side effects
Disadvantages:
 Loss of sensation
 Can break or leak
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.
Vaginal Contraceptive Sponge
 Small, donut-shaped foam
that contains a spermicide
 A non hormonal barrier
method of birth control
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
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
Behavioral Methods
 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
III. Longer Term
Progestin Implants and
Intrauterine Devices
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
Disadvantages:
 Vaginal spotting
 Weight gain
 Hair or skin changes
 Headaches
 Depression
 Decreased libido
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
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
Contraindications:
 Pregnancy
 Active liver disease
 Severe arterial disease
 Undiagnosed irregular bleeding
 Mechanical heart valves
 Untreated STD
 Hx of ovarian or endometrial
carcinoma
Copper T380A I.U.D.
Mode of action:
 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
IV. Female sterilization
and Vasectomy
Sterilization
 Permanent sterilization is the most common method of birth control used.
 Mini Laparotomy sterilization
 Laparoscopic sterilization
Advantages:
Disadvantages:
 Permanent birth control  Does not protect
against STD
 Immediately effective
 Requires surgery
 Requires no daily


attention
Not messy
Cost-effective in the
long run
 May not be reversible
 Possible regret
 Possibility of Post Tubal
Ligation Syndrome
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.
Risks include:
 Infection
 Bleeding
 Scrotal
pain or swelling at the time
of the procedure