dr. mona a. almushait. methods of contraception i. combined hormonal products oral contraceptive...
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Dr. Mona A. AlmushaitDr. Mona A. Almushait
Methods of ContraceptionMethods of Contraception
I. Combined Hormonal Products
Oral contraceptive pillsDepot medroxyprogesterone acetate injections
Transdermal patches and Vaginal rings
II. Barrierand
Behavioral Methods
Male condoms, DiaphragmsCaps, Female condoms, Spermicides
Withdrawal, Fertility awareness method, Natural family planning
III. Longer Term
Progestin implants and Intrauterine devices
IV. Sterilization
Female sterilization and Vasectomy
Combined Estrogen and Progesterone Contraceptives
Oral contraceptive pills Monthly injections
Transdermal patches Vaginal rings
1. Combined Hormonal Products
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
Thromboembolism Post pill amenorrhea Cerebrovascular accidents Increased in Cholelithiasis (cholestatic jaundice)
HTN Benign hepatic tumors (Hepatoma)
Headache in the week off
Complications of Estrogen–Containing Contraceptives:
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 age, smoking, obesity, migraine
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
Progestin–Only Hormonal Methods of Contraception
(POPs)
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
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.
Transdermal Patch
Advantages: Very effective Rapidly reversible
Disadvantages: Requires a prescription Skin reactions Slight increase in risk of VTE
compared with COCs
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 weeksDisadvantages: Does not protect against STD Spotting Increased vaginal discharge
Vaginal Ring
II. Barrier and Behavioral Methods
Advantages: ↓transmission of STD, HIV,
Chlamydia and Gonorrhea Easily obtained
Disadvantages: Allergy Loss of sensation Slippage/breakage
Male Condom
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
Diaphragm and Cap
A lubricated polyurethaneA lubricated polyurethane
Advantages: Prevents the transmission of
infection No hormonal side effects
Disadvantages: Loss of sensation Can break or leak
Female Condom
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.
Jelly
Small, donut-shaped foam Small, donut-shaped foam that contains a spermicidethat contains a spermicide
A non hormonal barrier A non hormonal barrier method of birth controlmethod of birth control
Vaginal Contraceptive Sponge
Advantages:Advantages:
It kills the spermIt kills the sperm
It blocks the semen fluids from It blocks the semen fluids from
entering the cervical canalentering the cervical canal
No hormones are involved No hormones are involved
Disadvantages:Disadvantages:
IrritationIrritation
No protection against infectionNo protection against infection
Vaginal Contraceptive Foam Vaginal Contraceptive Foam
A paper-thin translucent film that A paper-thin translucent film that contains a spermicidecontains a spermicide
Its is placed in the vagina or near Its is placed in the vagina or near the cervix where it dissolves in the cervix where it dissolves in secondsseconds
It is effective for about one hourIt is effective for about one hour
Film
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
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
Implant
Disadvantages:Vaginal spotting
Weight gainHair or skin changes
HeadachesDepression
Decreased libido
Contains 52 mg of Levenogestrel
20 µg of Levenogestrel every 24-hr.
T–shape
Effective for at least 5 years
Levenogestrel–Releasing Intrauterine System (LNG–IUS)
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
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
Copper T380A I.U.D.
IV. Female sterilization and Vasectomy
Advantages: Permanent birth
control Immediately effective Requires no daily
attention Not messy Cost-effective in the
long run
Disadvantages: Does not protect
against STD Requires surgery May not be reversible Possible regret Possibility of Post
Tubal Ligation Syndrome
Permanent sterilization is the most common method of birth control used.
Mini Laparotomy sterilization Laparoscopic sterilization
Sterilization
One common form of female sterilization is the use of Hulka clips to block the fallopian tubes.
One common form of laparoscopic (camera) sterilization is the use of Filshie clips to occlude both fallopian tubes.
FILSHIE CLIP TUBAL LIGATION
HULKA CLIP STERLIZATION
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