Contraception Methods and Benefits
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REPRODUCTIVE BLOCK
Lecture: 2
Duration : 1 hour
Presented by
Dr.RAYA MUSLIM AL HASSAN
Academic year 2021-2022
5
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year
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•
BENEFITS
•
personal reasons. Many couples use contraception FOR :-
1.
to space their children
2.
to limit their family size
3.
Others desire to avoid childbearing because of the effects of
preexisting illness on the pregnancy, such as severe diabetes
or heart disease.
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The characteristics of the ideal contraceptive method would be:
•
highly effective
•
no side effects or risks
•
cheap
•
independent of intercourse
•
non-contraceptive benefits
•
acceptable to all cultures and religions
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Classification of contraception
according to mechanism
1
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1. Abstinance ‘Safe period’
prevent sperms to reach the female genital tract around time
of ovulation (fertile period).
Calculation of fertile period?Shortest cycle-20
Longest cycle-10
2. Coitus interrupts ‘ withdrawal’
•
the
penis withdraws from the vagina immediately before
ejaculation takes place.
•
Disadvantage :- high failure rate.
3. The lactational amenorrhoea method (LAM)
•
used by fully breastfeeding mothers during
the first
six
months
of infant life.
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1.
Condoms
F
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2. Diaphragm
inserted into the vagina between the
post-fornix and the symphysis pubis.
Needs correct fitting .
Holds sperm in the acidic environment
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Does not completely occlude the
passage of sperm .
3. Cap
:-
Fits across the cervix .
4. Spermicides
:- gel or pessaries .
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•
Spermicides are non-hormonal chemical products containing
the active ingredient
nonoxynol-9 (N-9) or octoxynol-9 (0-9).
•
They can be used in combination with other barrier
contraceptives such as condoms, cervical caps, or diaphragms.
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Advantages:
-protect against
STIs .
-
Safe .
- Cost effective .
Disadvantage of barrier methods
- high failure rate .
-
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-Small dose (e.g. mini-pills)
It is taken daily without a break
The main action :-
1)
Thick, ‘hostile’ cervical mucus plug
2)
Atrophic endometrium (prevent implantation)
-Large dose
{ e.g.Depoprovera, cerrazette ,
Subdemal implants
(implanon) }
The main action :-
inhibition of ovulation .
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B – Oestrogen
inhibition of ovulation
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C - Combined hormonal contraception
(Progesterone and Oestrogen)
Used for 21 days and stopped for 7 days .
a-
COC pills b-
rings
c -
patches
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CNS
: depression, headache, loss of libido.
GIT
: nausea and vomiting, weight gain, gall stones .
Breast
: mastalgia, breast enlargement.
Reproductive:
disturbance of menstrual cycle &
increased vaginal discharge .
Others
: chloasma , fluid retention .
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1.
Venous thromboembolism (VTE):
2. Arterial disease:
less common but more serious than VTE, especially in
hypertensive & smoker.
a) increase risk of MI.
b) increase risk of ischemic and hemorrhagic stroke
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•
Contraindications to COC
Contraindications to COC
Absolute contraindications
Absolute contraindications
•
Circulatory diseases:
Circulatory diseases:
- ischemic heart disease
- cerebrovascular accident
- significant hypertension
- arterial or venous thrombosis
- any acquired or inherited pro-thrombotic tendency
- any Significant risk factors for cardiovascular disease
•
Acute or severe liver disease
Acute or severe liver disease
•
Estrogen-dependent neoplasms, particularly breast cancer
Estrogen-dependent neoplasms, particularly breast cancer
• Focal migraine
• Focal migraine
smoking >15cigarette/day and age>35
smoking >15cigarette/day and age>35
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Types:
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Copper-IUD
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Progesterone IUD
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Complications
:
1. Menstrual disturbance : the effect of copper-IUD on
the local prostaglandin in the endometrium tends to
cause heavy menstrual bleeding and dysmenorrhea ,
while mirena will reduce menstrual blood flow.
2
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P
ermanent
sterilization
Written Consent
(permanent, very
occasionally may fail)
1.Vasectomy(
male sterilization)
- Divide vas deferens bilaterally so the
sperm can not reach the ejaculate .
-Check semen few months later
Complications : -
Failure
Hematoma
Infection .
Pain
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Laprotomy .
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Hysteroscopy (
Essure
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Complications??
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Emergency contraception ‘
Post-Coital
Contraception’
M
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c
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a
n
i
s
m
:
1-May disrupt ovulation
2-Blocks implantation
3-May also impair luteal function
I
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d
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a
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s
:
•
unprotected intercourse has occurred
•
failure of a barrier method(e.g a burst or slipped condom)
•
or if hormonal contraception has been forgotten.
T
y
p
e
s
o
f
E
C
:
Hormonal
:
Ulipristal acetate (UPA) UP TO 5 days or levonorgestrel
(LNG) (Up to
72 hours
after intercourse) .
IUD
(
Up to
5 days
after intercourse) .
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Contraception, or family planning, involves various birth control methods to delay or prevent pregnancy. This includes natural, barrier, ovulation prevention, sperm transport inhibition, and implantation inhibition techniques. Couples use contraception for spacing children, limiting family size, and health reasons. Some countries promote contraception to manage population growth. The ideal contraceptive method is highly effective, safe, affordable, with no side effects. Understanding different methods can help individuals make informed choices.
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Ministry of higher Education and Scientific Research University of Basrah University of Basrah Al-Zahraa Medical College Al-Zahraa Medical College Academic year 2021-2022 5thyear REPRODUCTIVE BLOCK Lecture: 2 Duration : 1 hour CONTRACEPTION Presented by Dr.RAYA MUSLIM AL HASSAN Block staff: Dr.Raya Muslim Al Hassan (Block leader) Dr.Marwa Sadik (co leader) Dr. Abdul kareem Hussain Subber Dr.Alaa Hufdhi GYNAECOLOGY 20th EDITION by Ten Teachers
Ministry of higher Education and Scientific Research University of Basrah Al-Zahraa Medical College OBJECTIVES describe the main methods of contraception and their advantages and disadvantages .
Ministry of higher Education and Scientific Research University of Basrah Al-Zahraa Medical College Contraception or Family planning generally refers to those birth control measures that allow people to postpond or prevent conception.
Ministry of higher Education and Scientific Research University of Basrah Al-Zahraa Medical College BENEFITS personal reasons. Many couples use contraception FOR :- 1. to space their children 2. to limit their family size 3. Others desire to avoid childbearing because of the effects of preexisting illness on the pregnancy, such as severe diabetes or heart disease.
Ministry of higher Education and Scientific Research University of Basrah Al-Zahraa Medical College As a matter of public policy some countries promote contraception in an effort to curb undesired population growth
Ministry of higher Education and Scientific Research University of Basrah Al-Zahraa Medical College The characteristics of the ideal contraceptive method would be: highly effective no side effects or risks cheap independent of intercourse non-contraceptive benefits acceptable to all cultures and religions
Ministry of higher Education and Scientific Research University of Basrah Al-Zahraa Medical College Classification of contraception according to mechanism 1-natural. 2-barrier 3-prevention of ovulation 4-inhibition of sperm transport 5-inhibition of implantation.
Ministry of higher Education and Scientific Research University of Basrah Al-Zahraa Medical College Natural Contraception 1. Abstinance Safe period prevent sperms to reach the female genital tract around time of ovulation (fertile period). Calculation of fertile period?Shortest cycle-20 Longest cycle-10 2. Coitus interrupts withdrawal the penis withdraws from the vagina immediately before ejaculation takes place. Disadvantage :- high failure rate. 3. The lactational amenorrhoea method (LAM) used by fully breastfeeding mothers during the first six months of infant life.
Barrier Methods 1. Condoms For male 2. Diaphragm 1 inserted into the vagina between the post-fornix and the symphysis pubis. Needs correct fitting . Holds sperm in the acidic environment of vagina and reduces survival time Does not completely occlude the passage of sperm . 2 3. Cap :- Fits across the cervix . 4. Spermicides:- gel or pessaries . 3
Ministry of higher Education and Scientific Research University of Basrah Al-Zahraa Medical College Spermicides are non-hormonal chemical products containing the active ingredient nonoxynol-9 (N-9) or octoxynol-9 (0-9). They can be used in combination with other barrier contraceptives such as condoms, cervical caps, or diaphragms.
Ministry of higher Education and Scientific Research University of Basrah Al-Zahraa Medical College Advantages: -protect against STIs . - Safe . - Cost effective . Disadvantage of barrier methods - high failure rate . - need cooperative couple .
Ministry of higher Education and Scientific Research University of Basrah Al-Zahraa Medical College Hormonal Contraception A - Progesterone -Small dose (e.g. mini-pills) It is taken daily without a break The main action :- 1) Thick, hostile cervical mucus plug 2) Atrophic endometrium (prevent implantation) -Large dose { e.g.Depoprovera, cerrazette , Subdemal implants (implanon) } The main action :- inhibition of ovulation .
Ministry of higher Education and Scientific Research University of Basrah Al-Zahraa Medical College B Oestrogen inhibition of ovulation
Ministry of higher Education and Scientific Research University of Basrah Al-Zahraa Medical College C - Combined hormonal contraception (Progesterone and Oestrogen) Used for 21 days and stopped for 7 days . a-COC pills b-rings c -patches
Ministry of higher Education and Scientific Research University of Basrah Al-Zahraa Medical College A- Minor side effects CNS : depression, headache, loss of libido. GIT : nausea and vomiting, weight gain, gall stones . Breast : mastalgia, breast enlargement. Reproductive: disturbance of menstrual cycle & increased vaginal discharge . Others : chloasma , fluid retention .
Ministry of higher Education and Scientific Research University of Basrah Al-Zahraa Medical College B-Major side effects 1. Venous thromboembolism (VTE): 2. Arterial disease: less common but more serious than VTE, especially in hypertensive & smoker. a) increase risk of MI. b) increase risk of ischemic and hemorrhagic stroke
Ministry of higher Education and Scientific Research University of Basrah Al-Zahraa Medical College Contraindications to COC Absolute contraindications Circulatory diseases: - ischemic heart disease - cerebrovascular accident - significant hypertension - arterial or venous thrombosis - any acquired or inherited pro-thrombotic tendency - any Significant risk factors for cardiovascular disease Acute or severe liver disease Estrogen-dependent neoplasms, particularly breast cancer Focal migraine smoking >15cigarette/day and age>35
Ministry of higher Education and Scientific Research University of Basrah Al-Zahraa Medical College Interaction with other drugs This can occur with liver enzyme inducing agents such as some antiepileptic drugs, sulphonamide, rifampicin (reduce efficiency). Some antibiotics alter intestinal absorption of COC and reduce efficiency.
Ministry of higher Education and Scientific Research University of Basrah Al-Zahraa Medical College Intrauterine Contraceptive Device (IUD) Types: Copper-IUD Progesterone IUD (mirena) Mechanism of action 1) Stimulate inflammatory reaction in the uterus which prevent implantation. 2) Copper IUDs have toxic effect on sperm that prevent sperm transport and fertilization . 3) Hormonal IUDs have local hormone effect on the cervical mucus and endometrium
Ministry of higher Education and Scientific Research University of Basrah Al-Zahraa Medical College Complications: 1. Menstrual disturbance : the effect of copper-IUD on the local prostaglandin in the endometrium tends to cause heavy menstrual bleeding and dysmenorrhea , while mirena will reduce menstrual blood flow. 2. Perforation (usually occur at time of insertion). 3. Expulsion 4. Ectopic pregnancy 5. Infection (usually at time of insertion) 6. Pregnancy .
Ministry of higher Education and Scientific Research University of Basrah Al-Zahraa Medical College Permanent sterilization Written Consent (permanent, very occasionally may fail) 1.Vasectomy(male sterilization) - Divide vas deferens bilaterally so the sperm can not reach the ejaculate . -Check semen few months later Complications : - Failure Hematoma Infection . Pain
Ministry of higher Education and Scientific Research University of Basrah Al-Zahraa Medical College 2. Tubal ligation - Permanent bilateral tubal blockage using ( clips, rings, ligation or diathermy ) . - Performed by Laprotomy . Laparoscopy . Hysteroscopy ( Essure) Complications??
Ministry of higher Education and Scientific Research University of Basrah Al-Zahraa Medical College Emergency contraception Post-Coital Contraception Mechanism: 1-May disrupt ovulation 2-Blocks implantation 3-May also impair luteal function Indications: unprotected intercourse has occurred failure of a barrier method(e.g a burst or slipped condom) or if hormonal contraception has been forgotten. Types of EC : (LNG) (Up to 72 hoursafter intercourse) . IUD (Up to 5 days after intercourse) . Hormonal: Ulipristal acetate (UPA) UP TO 5 days or levonorgestrel
