Budi Santoso

Departement of Obstetry Ginecology

RSUD Dr. Soetomo Surabaya Airlangga University

 To

understand Rational Cotraceptions

To

do counceling

To

do client assessment

Do

the best service

Give

education

GREET :
Warm greetings
Fiendly meet
Keep secrets
ASK :
Age, parity, marriage
Number of childrens
History of contraception
TELL :
Appropriate contraception
Contraception methods
Show the contraception device

HELP :
Choosing methods
Screening methods
EXPLAIN :
Mechanism of contraception
RETURN :
When to comeback evaluation
Side effects

Describe side effects of various methods, their frequency &

duration
Reassure re safety of methods
Emphasize client satisfaction with methods in general
Elicit & answer questions; correct misinformation courteously

Elicit and respond to client concerns

Be concise & clear

Be honest re frequency or severity of side effects

Provide support material

To AVOID sperm meets ovum

Conventional/ Natural Method :

o Calendar
o Coitus interruptus
o Lactational Amenorrhea
Method
Barrier Methods:
o Condoms ( and )
o Diaphragms
o Spermicides
o Foams , jelly ,tissue
Progestin-Only Contraceptives:
o Norplant Implants
o Injectable
o Pills

Combined Contraceptives:
o CICs
o COCs

IUD :
o CuT380A , Nova T ,
Lippes Loop . Multiload

Operative :
o Vasectomy
o Tubectomy

Diaphragm: High Failure Rates

Must Remain in ~6 Hrs post-coitus
Best if Combined with Spermicide
UTI Potential
Condom: STD Protection, Inconsistent Use by Men
Female Condom
Today Sponge

Cyclofem
25 mg depo-medroxyprogesterone acetate and 5 mg
estradiol cypionate injectable (IM) once a month
Mesigyna
50 mg norethindrone enanthate and 5 mg estradiol
valerate injected (IM) once a month

Mechanism of Action CICs

Anytime you can reasonably sure the client is not pregnant

Days 1 7 of the menstrual cycle
Postpartum:
after 6 months if using LAM
After 3 weeks if not breastfeeding
Postabortion (immediately or within 7 days)

Noncontraceptives
Benefits

Contain Synthetic Estrogen/Progestin

Modern E2 Dosage 50 Mcg
Despite Diversity, Side Effects and Efficacies Similar
Requires Patient Compliance
May Be Monophasic or Triphasic

Suppress ovulation

Reduce sperm
transport in upper
genital tract (fallopian
tubes)

Change endometrium
making implantation
less likely

Thicken cervical mucus

(preventing sperm
penetration)

Menstrual Regulation
Decreased Risk of Anemia
Ovarian, Endometrial CA: Risk
Lower PID Risk
Prevention of Benign Breast Disease

 Breakthrough

Bleeding (

25%)
Amenorrhea
Breast Tenderness,
Nausea
?Weight Gain

Thromboembolism ( 35 yo, Smoker)

MI (Smokers Only):

o
o

< 15 cig/day: 3X Risk

> 15 cig/day : 21X Risk

Liver Adenomas (Very Rare)

Injectable
Inhibits Ovulation
150 mg 3 months (14 day grace period)
Delayed Ovulation After Discontinuation
Main Side-Effects:
o Amenorrhea
o AUB
o Weight Gain
o Hair Loss

Pills
Unlike the combined pill, the progestin-only pill
(sometimes called the mini-pill) only has one
hormone, progestin, instead of both estrogen
and progestin.
It is prescribed by a doctor. It is taken at the
same time each day. It may be a good option for
women who cant take estrogen.
Typical use failure rate: 9%.

Implantable for 5 Years

Similar Side Effects as Depo-Provera
Avg. Yearly Failure Rate: 0.8/100 (Increases : > 2/100 after
5 years)
Occasionally Difficult to Remove

ParaGard (CuT380A), Progestasert

Very Effective (~ TL), Reversable
Risks OVERBLOWN
Monogamy Essential, However
Does Not Protect Against STDs
Can Remain for 10 Years

Types:

IUD, OCPs
Specific OCP Regimens Given 72 Hours After Unprotected
Intercourse
~ 75% Effective
Yuzpe Method: Ovral 2 tabs po now and 2 tabs 120 later
May Cause Nausea
Consider Dispensing at Yearly Visit

Female

Prevents pregnancy by
preventing sperm from
reaching the egg

Male
Prevents pregnancy by preventing
sperm from entering the semen; semen
is ejaculated without sperm

Sterilization is appropriate for people who:

Do not want any more children

Want highly effective contraception

Want permanent protection

Have difficulty with temporary methods requiring

compliance or resupply

There are no medical restrictions for age or parity.

Source: WHO, 2004; updated 2008.

It is IMPORTANT to distinguish side effects from rumors or

misinformation
o Challenge: Clients believe that certain methods will render a

woman sterile
o Solution: Always discuss returning to fertility as a significant
issue

Reasons
Too Busy

Worried that clients may

reject method(s)

Possible Solutions
Reassure that counseling
can be brief. Provide
literature.

Reassure that side effect

counseling increases use
& continuation.

Reasons
Unaware of frequency of
sides effects

Lack of support material

Possible Solutions
Give providers training on
common side effects.

Provide simple written & AV

materials for providers

 All

Methods have Risks and May Not be

Appropriate for all Patients

Give

enough counceling