Transcript Certain facts & myths about contraception

Certain facts & myths about
contraception
Who needs contraception
All the women who have not achieved menopause and
are sexually active need contraception ( even the
grandmothers can conceive)
Types of contraception
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1.Abstinence,breast
feeding,Withdrawl method
2.Barrier method-condoms, Today
vaginal pessary
3.Hormonal- Oral pills, Inj Depo
provera, Mirena
4.Multiload/ Cu-T 380-A
5.ligation- Tubal ligation, Vasectomy
6.Emergency contraception
Contraceptive methods and failure rate in
first year with typical use
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Tubal ligation
Vasectomy
Multiload/Cu-T380A
Inj Depoprovera
OCP
Condom
Fertility awareness
withdrawl Method
No contraception
0.3-0.5%
0.1%
<1%
<1%
<1%
15-25%
>25%
25-35%
85%
Breast Feeding as Contraceptive
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EXCLUSIVE BREAST FEEDING- has
a failure rate of 5%
It is not effective after 6 months or
earlier if the period start.
Additional contraceptive need to be
used after 6 months, even if there
is no period.
For newly married girls
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1.ORAL PILLS –Very safe and very
popular contraceptive in the west
FOURTH GENERATION OCPS are now
available in India, There is no wt. Gain
and takes care of acne. BP is also not
aggravated.
Contraception for young women
who have not completed family
2.a) Barrier methodCondom +Today
 Condom has a high failure rate in common
practice . Mainly because of not knowing the
correct technique of its use. It is mandatory to
use it every time while having sex. This method
is the only method to prevent sexually
transmitted diseases. Ideally the failure should
be less than 5% with correct usage. Young
couples is advised to use double contraception
i.e. OCP to prevent pregnancy & condom to
prevent STDs
2.b)Today vaginal pessary :- failure rate 5%
Few patients C/O Discharge and itching
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Contraception for young women
with completed family
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1.Multiparous patient with youngest child
4-5 yrs old-Tubal ligation/ Husband undergoes vasectomy
2.Youngest child< 5yrs (spacing method)
-Cu-T 380 A -To be changed every 10 yrs
-Multiload, has to be changed every 3 or 5 yrs.
-Mirena- to be changed every 5 yrs
-Inj Depoprovera- to be taken every 3 months
-OCPs- taken 21 days in a month,followed by
7 days pill free period
Contraception for middle aged women till menopause
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Menopause- cessation of periods for at least 1yr.
Options for perimenopausal women
1.Tubal ligation
2.Cu-T/Multiload/Mirena
3.Low dose Oral contraceptive pills- other health
benefits include
-lower risk of endometrial &ovarian cancer
-relieves hot flushes,night sweats,vaginal dryness
-protects agaist loss of bone density
4..Condom + Today
Greatest risk of conception for perimenopausal women
because of irregular cycles
40-45yrs-75% cycles are ovulatory
>46yrs-60% cycles are ovulatory
women should not stop contraceptive measures until 2 yrs
after the last menstrual period
KNOW MORE ABOUT
FOLLOWINGS
Oral Contraceptive pills
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When to start?- on the 1st day of period
How long can be taken?-as long as required
Who shouldn’t take-H/O epilepsy,on ATT,DVT, Coronary artery
disease,Thrombogenic cardiac valvular disease, cardiac
arrythmias,diabetes, hypertension,active liver disease
Is there any problem in getting pregnant after using the birth
control pill? - No, regular period & ovulation usually start up right
away. However Girls who were very irregular before starting the pill,
may be irregular after they stop the pill.
Advantages-Very safe & has only a few minor side effects.
Protects against cancer of ovaries & cancer of the lining of uterus.
Most experts believe that it does not cause any increased risk of
getting cancer Breast.
Other health benefits include regulation of menstrual
period,decrease in cramps,treatment for acne &PCOS, lower risk of
anaemia
Multiload /Cu-T 380 A
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Most misunderstood contraception
It has a small T shaped body which bears a coil of copper wire on it.
Prevents pregnancy by interference with sperm transport ,Ovum transport
,fertilization & implantation
Incidence of complications
- Heavy periods in 10% cases, can be controlled with medicine, more common
with wrong case selection
-Perforation 0.5 in 1000 cases (WHO 1987),very little chances in experienced
hands
Timing of insertionImmediately after periods
6 weeks after normal delivery
6 weeks after caesarean section
Immediately after early abortion
Lactational Amenorrhoea after reasonably excluding pregnancy
As emergency contraception
Fertility returns immediately after discontinuation
CU-T 380 A IS BEST IUCD according to W.H.O in the world. It has a
failure rate like permanent method of tubal ligation. It can be kept
as long as 10 years.
Even those with previous caesarean can go for it.
MIRENA
Mirena is a small flexible plastic device, inserted inside the
uterus,. It slowly releases progesterone hormone, which stops
ovulation,alters the cervical mucus &changes the lining of uterus.
 Things to know about Mirena
-99.9% effective in preventing pregnancy
-provides lower & steadier hormones than pills
-lasts for up to 5 yrs or less if you choose
-easily removed when you want it to be
-won’t cause significant weight gain
-May also help shorten,lighten or even eliminate periods
----.Imp safety information about Mirena-Designed for women who have had at least one child & have no risk
of ectopic pregnancy or PID
-Ovarian cyst may occur & typically disappear
-Complications may occur from placement
-Missing periods or irregular bleeding is common in first few months,
followed by shorter,lighter periods
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Emergency Contraception
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Levonorgestrel pill is available
Single tablet has to be used within
72 hours of unprotected coitus. It is
effective to the tune of 90%.
Every women & adolescent girl
should know. However emergency
contraceptive can not replaced
regular contraceptive for people
who are sexually active.