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