FAMILY PLANNING 3

Dr. Soledad Chu-Crisostomo

TABLE OF CONTENTS reproductive system and to its functions and
processes.
1. PRINCIPLES OF FAMILY PLANNING p. 1 ● Capability to reproduce and the freedom to
2. BENEFITS OF FAMILY PLANNING p. 2 decide if, when and how often to do so.
3. FAMILY PLANNING METHODS p. 2
A. PERMANENT STERILIZATION METHODS p.2 REPRODUCTIVE HEALTH AND REPRODUCTIVE RIGHTS
a. BILATERAL TUBAL LIGATION p. 2 ● Right to be informed and to have access to
b. VASECTOMY p. 3 safe, effective, affordable and acceptable
B. TEMPORARY STERILIZATION METHODS methods of family planning of their choice as
p.3 well as other methods of their choice for
a. TRADITIONAL METHODS p. 3 regulation of fertility, which are not against
i. COITUS INTERRUPTUS p. 3 the law, and the right to access to health-care
b. NATURAL METHODS p. 3 services that will enable women to go safely
i. CALENDAR/ RHYTHM METHOD p 4
through pregnancy and childbirth.
ii STANDARD DAYS METHOD p.4

iii .CERVICAL MUCUS METHOD p.4
RESPONSIBLE PARENTHOOD AND REPRODUCTIVE
iv. .BASAL BODY TEMPERATURE p4
HEALTH ACT OF 2012 (RA NO. 10354) - REPRODUCTIVE
v. SYMPTO-THERMAL METHOD p.5
vi. LACTATION AMENNORRHEA p.5 HEALTH LAW OF RH LAW
METHOD ● Promote, without bias, all effective natural
c. ARTIFICIAL METHODS p. 5 and modern methods of family planning that
i. HORMONALp. 5 are medically safe and legal
ii. INTRAUTERINE DEVICE p. 10 ● Ensure that all women needing care for post
iii. BARRIER. P. 11 abortion complications shall be treated and
4. CONTRACEPTIVE EFFICACY p 13 counseled in a humane, non-judgemental and
5. CHARACTERISTICS OF AN IDEAL compassionate manner
CONTRACEPTIVE METHOD p. 13 ● Integrate FP and responsible parenthood into
all government anti-poverty programs
● Requires age-appropriate reproductive health
and sexuality education from grade 4 to 4th
year high school
● Guarantee the reproductive rights of female
PRINCIPLES OF FAMILY PLANNING
employees (paid half-day prenatal medical

leaves for each month of pregnancy period)
FAMILY PLANNING BY WHO
by Dept of Labor and Employment
● Allow individuals and couples to anticipate and
● Ensure availability of reproductive health
attain their desired number of children and the
services like FP and prenatal care
spacing and timing of their births.
● Penalize by imprisonment or fine for those
● Achieved through use of contraceptive
who prohibit or restrict the delivery of such
methods and the treatment of involuntary
services
infertility.

● A woman’s ability to space and limit her
INFORMED CHOICE
pregnancies has a direct impact on her health
● Service provider should not choose the
and well-being as well as on the outcome of
contraceptive method for the client but
each pregnancy.
instead present all the methods available,
● Reproductive Health and Reproductive Rights
effectiveness, safety (possible side effects),
● State of complete physical, mental and social
contraindications, advantages/ disadvantages,
well-being in all matters relating to the
and other aspects (ie simplicity of use, cost,
Family Planning (Dr. Sol Chu-Crisostomo)
May 21, 2018
 reliability, effect on sexuality, loss of fertility, ● Gives the parents and the rest of the family
pain, infection) more time to love and care for the children
● Patient should decide, you should not tell your ● Increases the likelihood of healthier children
patient what to do. because the mother’s health is safeguarded
● Provides more security, because fewer
BENEFITS OF FAMILY PLANNING children in the family have better
opportunities for adequate food, clothing and
BENEFITS TO THE MOTHER good education
● Provide love and attention to her husband and
children
● Enable her to regain her health after the last BENEFITS TO THE SOCIETY
delivery ● Prevent or reduce the existing problems of
● Recover and treated for certain illnesses overpopulation
● Work and practice her profession and help the ○ Poverty
husband earn a living ○ Overcrowding
● Pursue higher education, further her planned ○ Malnutrition
career ○ Contaminated water
● Participate in religious, social and civic activities ○ Energy crises
of the community ○ Air pollution
● Prevent pregnancy in the very young and in the ○ Deforestation and floods
older age group
● Prevent pregnancy in high risk women with GOALS OF FAMILY PLANNING
concurrent medical problems ● Birth spacing
● Prevent unwanted pregnancy ● Birth limitation
● Helping infertile couples
BENEFITS TO THE FATHER
● Provide more resources since there are fewer FAMILY PLANNING METHODS
members of the family ● Permanent Methods
● Nurture his children and give them a good ○ Female sterilization (BTL)
home, education, better future and a happy ○ Male sterilization (vasectomy)
contented life ● Temporary Methods
● Devote more time and attention to his wife ○ Traditional – Coitus interruptus
● Find more time for self-improvement (withdrawal method)
● Acquire extra resources and enough time to ○ Natural
actively participate in community services ○ Artificial
● Enjoy a sense of fulfillment and pride knowing
that he is a good family provider PERMANENT STERILIZATION METHODS

BENEFITS TO THE COUPLE BILATERAL TUBAL LIGATION
● Insures more relaxed sexual relations knowing
that sexual intercourse will not lead to
unwanted pregnancy
● Favors more intimate relations and further
discovery of each other
● Increase sense of self-respect by being able to
prove their love for each other
● Provide a good example to the children by their
taking good care of the family and safeguarding The 2 surgical approaches most often used:
their health ● Minilaparotomy - Involves making a small
incision in the abdomen. The fallopian tubes
BENEFITS TO THE CHILDREN are brought to the incision to be cut or
blocked.
Family Planning (Dr. Sol Chu-Crisostomo)
May 21, 2018
 ● Laparoscopy - Involves inserting a long thin tube
with a lens in it into the abdomen through a A. Calendar/Rhythm Method
small incision. This laparoscope enables the B. Standard Days Method
doctor to see and block or cut the fallopian C. Cervical Mucus (Billing’s Method)
tubes in the abdomen. D. Basal Body Temperature
Can be done immediately after delivery (postpartum E. Sympto-thermal Method
BTL) or after (interval (BTL) F. Lactation amenorrhea Method


VASECTOMY

● Ligation of the vas deferens
● Requirements before becoming azoospermia:
○ 15-20 ejaculations (damn)
○ 2 sperm free ejaculates (1 and 2 months
after procedure) ● More physiological changes in a woman
● FSH and LH (resp for luteinization) – act on
TEMPORARY METHODS OF FAMILY PLANNING the uterus
● It will try to regulate the amount and
TRADITIONAL METHOD proliferation of the endometrium
● Follicular phase:
Case 1 ○ Key player: estradiol (increase =
The couple was wondering why the wife got pregnant trigger LH surge)
○ Once there is an LH surge -> ovulation
a month after arriving back home. They have been
->formation of corpus luteum ->
using withdrawal method for 10 years before the
produce progesterone
husband left for work abroad for 3 years. What could
● After ovulation, secretory phase
be the reason for such contraceptive failure?
○ Start to secrete glycogen (if there

would be implantation)
Withdrawal method
○ Increase in temperature because of
- Lack of self control
progesterone
- No practice for three years = so-so sex skills
§ Progesterone: will make basal
body temp to increase
COITUS INTERRUPTUS Based on 3 assumptions:
● Withdrawal right before the male ejaculates ● Human ovum – capable of being fertilized for
○ Advantages: 24 hrs after ovulation
§ No chemicals, devices ● Sperm – retain fertilizing ability for only 48 hrs
§ Available anytime after coitus
§ No expense ○ 48-72 hours: can still fertilize the egg
○ Disadvantages: ● Ovulation usually occurs 12 to 16 days (14 ± 2)
§ High failure rate due to lack of days before next menstruation
self control ○ Ovulation after 14 days, you will have
§ Premature ejaculation your menstruation
NATURAL METHODS
Family Planning (Dr. Sol Chu-Crisostomo)
May 21, 2018
 ○ E.g Student A, B, C LMP April 1, ○ Safe days: March 1- 7 and March 20
different menstrual length (21,25,28 until next menstruation
day cycle) – different day of ovulation
CERVICAL MUCUS/ BILLING’S METHOD
CALENDAR/RHYTHM METHOD

Case 3
A couple wished to use the rhythm method. Her LMP
is May 1. Given her menstrual cycles, define her
fertile or “unsafe” days
· November – 32 days Case 5
· December – 28 days A diabetic patient was asking why she got pregnant
· January – 31 days considering she had her sexual contact when she was
· February – 28 supposed to be on her “safe period” using the
· March – 28 Billling’s method. That was the time when her
· April – 26 secretions are white, paste, to curd like in character.
Longest period 32-11= 21 How would you explain this to the patient?
Shortest period 26 – 18 = 8 - Patient is diabetic; secretion is changed
No contact between 8 - 21 brought about by infection. This method is
not advisable to use.
● Monitor menstrual cycle for 6-12 months
● Subtract 18 from the shortest cycle & 11 from ● Estrogen increases the quantity of mucus,
the longest cycle → fertile period makes it more slipper and elastic
● Progesterone makes mucus scant and dry
STANDARD DAYS METHOD ● Avoid unprotected sex when secretions begin
and until 4 days after “peak day”
Case 4 ○ Kasi di mo alam yung peak day mo
A patient came worried she might get pregnant ● If a woman has a vaginal infection or another
because she had sexual contact May 18. Her LMP was condition that changes cervical mucus, this
May 1 and she has a 28 – 10-day cycle. She is asking if method may be difficult to use.
it is true that it is safe to have sex “7 days before and 7 ○ Change will not be noticed
days after” her menstruation. Is there a high ● Once you notice that secretions become
probability she will get pregnant? watery, do not engage in sexual contact
- Standard days method
- Fertile days: days 8 – 19 BASAL BODY TEMPERATURE
- Safe days: Days 1-7 (including the menstrual
flow) and up to days 20 to the next cycle
Yes, but probably pregnant because she had
sex during fertile days

● Safe 7 days before and 7 days after
● Effective if menstrual cycles are 26 to 32 days
long Case 6
● Less effective for woman who has more than 2 Mrs. Cruz is using the basal body temperature as her
shorter or longer cycles within the year. form of family planning. She has been taking her oral
● Fertile days = Days 8 -19 temperature everyday since her LMP last May 1. She
● Safe days = days 1-7 and days 20 and up to next noted an increase of 0.5 C today, May 14. When will
cycle she have her sexual contact so as not to get pregnant
● LMP = March 1, 2018 using the BBT method?
○ Fertile days: March 8 -19, 2018
Family Planning (Dr. Sol Chu-Crisostomo)
May 21, 2018
 ● Only effective up to 6 months = additional
- No contact from the start of menstruation until the
method of contraception
third consecutive day of elevated BBT

- May 1 to 16 no contact, safe afterwards
ARTIFICIAL METHODS

Requirements: A. Hormonal
● At least 3 hours continuous sleep B. Intrauterine device
● Oral temperature for 5 minutes taken before C. Barrier
rising a. Mechanical (condom and diaphragm)
● 0.5°C increase for at least 3 consecutive days b. Chemical (vaginal tables, jellies,
● No intercourse from the onset of menstruation creams, sponge)
until the third
HORMONAL METHODS
SYMPTO- THERMAL METHOD A. Oral Contraceptive Pills
● More effective, more troublesome a. Combined Oral contraceptive Pills
“matrabaho” (COC)
● Calendar method and changes in cervical mucus b. Progestin Only Pills (POP)
to estimate onset of fertile period and changes B. Transdermal Patch
in cervical mucus and BBT to estimate its end C. Combined Ring
● Difficult because it uses multiple indexes but D. Injectables
more effective than using a single index alone a. Medroxyprogesterone
b. Norethesterone enanthate
LATATIONAL-AMENORRHEAL METHOD E. Implants
a. Norplant
b. Implanon
Case 7

A breastfeeding mother who delivered a year ago
ORAL CONTRACEPTIVE PILLS
consulted because her husband, an OFW is coming
When to start and How to take OCP - During
home. She is asking if she will be protected from
adolescence: HPO is mature and at least 3 regular
getting pregnant considering she is still breastfeeding
ovulatory cycles
her baby (no cow’s milk formula) until now and she

hasn’t has her menstruation yet. What will you tell
her? Case 8
- No, the patient delivered a year ago. Effective OP, who’s taking the 28 days combined oral
only for the first 6 months. contraceptive pills, forgot to take the last 3 pills in the
pack. She is afraid because she had sexual contact

during those days. Will she get pregnant?
Requirements:
- No. Last 7 days of 28-day pack are placebo.
○ Mother has fully breastfeed the infant
○ Mother has remain amenorrheic
○ Effective up to 6 months only therefore COMBINED ORAL CONTRACEPTIVE PILLS (COC)
need for additional form of - Can be given orally, patch, ring
contraception - Hormonal preparation that contains:
○ After 6 months, we give supplements to 1. Estrogen Ethynyl estradiol and Mestranol)
the baby 2. Progestin
○ lessen the time of breastfeeding = less a. Estranes – norethindrone,
production of prolactin norethindrone acetate, ethynediol
● Ovulation is suppressed by lactation acetate)
● After giving birth, increase in prolactin, b. Gonanes (less androgenic) –
inhibition of ovulation during lactation levonorgestrel, norgestrel,
● Menstruation – probability of ovulation desogestrel, norgestimate
c. Despirenone (Spironolactone analog)

Family Planning (Dr. Sol Chu-Crisostomo)

May 21, 2018
 d. Combined Oral Contraceptive Pills
Contraindications of Combined OCP Use
Preparations of OCP ● Known or suspected pregnancy
1. Older prep - contains as much as 150 mcg of ● Thromboembolic disorders
estrogen and 10mcg of progesterone ● DVT
2. Newer prep - with less than 50 mcg of EE, ● CVD or CAD
mostly 30 or 35 mcg ● Known or suspected breast carcinoma
a. Diminished circulatory side effects: ● Endometrial carcinoma or other known
nausea and vomiting, headache estrogen-dependent neoplasia
● Undiagnosed abnormal genital bleeding
Monophasic OCP – same amount of E and P throughout ● Cholestatic jaundice of pregnancy or jaundice
the cycle with prior pill use
● 21-day pill: taken for 21 consecutive days ● Hepatic adenomas or carcinomas
followed by 7 days without the pill to allow for ● Cirrhosis of the liver
withdrawal bleeding within the 7 day pill free ● Complicated or prolonged diabetes
period ● Hypertension
○ Instruct patient: Take 1st pill on the first ● Migraine headache
day of period ● >35yo and smoker
○ 1st day: na meron na spotting
○ Make sure the patient is not pregnant PROGESTIN ONLY PILLS (POP)
○ After 21 days, stop for 7 days, pag nag - Have lower dose of progestin than the combined
bleeding, take the 1st pill of the second pills and do not consistently inhibit ovulation (Mini
pack, on the 8th day pill)
● 28-day pill: 21 pills containing the hormones - Important to take the pill at the same time of day to
with 7 placebo tablets. Withdrawal bleeding ensure blood levels do not fall below the effective
occurs on the period of placebo intake contraceptive level
(Continuous lang) - Exert their contraceptive action via other
mechanisms
Multiphasic OCP - Safe and suitable for women who:
● Biphasic: each tablet has fixed amount of 1. Are breastfeeding (starting as soon as 6 weeks
estrogen with the amount of progestin after childbirth)
increases in the second half of cycle 2. Have or have not had children
● Triphasic: varying amounts of estrogen and 3. Are of any age, including adolescents and
progestins in three consecutive phases within women over 40 years old
the cycle 4. Have just had an abortion, miscarriage, or
ectopic pregnancy
How to take Combined Oral Contraceptive Pills 5. Smoke cigarettes, regardless of woman’s age
● Take one pill every day. For greatest or number of cigarettes smoked
effectiveness a woman must take pills daily and 6. Have anemia now or had in the past
start each new pack of pills on time. 7. Have varicose veins
● Bleeding changes are common but not harmful. 8. Are infected with HIV, whether or not on
● Typically, irregular bleeding for the first few antiretroviral therapy, unless therapy includes
months and then lighter and more regular ritonavir
bleeding.
● Take any missed pill as soon as possible. Missing How to take POP (Progestin Only Pills)
pills risks pregnancy and may make some side ● Take one pill every day. No breaks between
effects worse. packs.
● Can be given to women at any time to start ● Safe for breastfeeding women and their
later. If pregnancy cannot be ruled out, a babies. Progestin only pills do not affect milk
provider can give her pills to take later, when production.
her monthly bleeding begins.

Family Planning (Dr. Sol Chu-Crisostomo)

May 21, 2018
 ● Add to the contraceptive effect of § Increase secretion of oviducts
breastfeeding. Together they provide effective = estrogen
pregnancy protection.
● Bleeding changes are common but not harmful.
Metabolic effects of Metabolic effects of
Typically, pills lengthen how long breastfeeding
Estrogen Progestin
women have no monthly bleeding. For women
having monthly bleeding, frequent or irregular o Nausea o Weight gain
bleeding is common. o Breast tenderness o Acne
● Can be given to a woman at any time to start o Fluid retention o Nervousness
later. If pregnancy cannot be ruled out, a o dec. levels of B-complex o Amenorrhea
provider can give her pills to take later, when and Vit C
her monthly bleeding begins. o Increased levels of Vit A
o Melasma
Contraindications of POP Use o Gallbladder diseases
● Acute blood clot in deep veins of legs or lungs
● Had breast cancer more than 5 years ago, and it
has not returned Case 10
● Severe liver disease, infection, or tumor AC, 27 y/o, G3P3, came for family planning
● Systemic lupus erythematosus with positive (or consultation. She has irregular cycles and when she
unknown) antiphospholipid antibodies. has her period, she would have heavy menstrual
● Taking barbiturates, carbamazepine, bleeding causing her to experience dizziness and
oxcarbazepine, phenytoin, primidone, body weakness. You noticed her to be pale and have
topiramate, rifampicin, rifabutin or ritonavir or acne on her face. She remembers she was once told
ritonavirbooste protease inhibitors. A backup by her dermatologist to see an OB-gynecologist.
contraceptive method should also be used What will be your advice?
because these medications reduce the - advice the patient to take Combined OCPs (benefits
effectiveness of POPs. below)

Mechanisms of Action:
● Progestins: inhibit ovulation and cause OCP’s and Carbohydrates
thickening of the cervical mucus ● Decrease glucose tolerance
● Estrogen: maintain the endometrium and ○ Progestin causes insulin resistance
prevent unscheduled bleeding ○ The higher the dose and potency, the
● Combined form: consistently inhibit mid-cycle greater the magnitude of impaired
gonadotropin surge thus prevent ovulation glucose tolerance
● Inhibit of mid-cycle gonadotropin surge ● If patient is taking the pills; One condition
○ No GnRH release → no ovulation seen is pruritus vulvae; dependent on the
● Makes cervical mucus thick and scanty (P) dosing and use of the pills
○ Retards sperm penetration
● Alter endometrium OCP’s and Lipids
○ P produces a decidualized endometrial ● Estrogen
bed with atrophied glands while E ○ Decreases concentration of LDL and
produces areas of edema alternating increases HDL
with portions of dense cellularity ● Progestin
○ With ↓ glycogen → ↓ Energy for ○ Reverse
blastocyte ● Combined OCP
● Slows peristalsis & ↑ secretions in oviduct ○ Increases triglycerides and total
○ Impair transport of ova and sperm cholesterol
§ Decrease fallopian tube ○ Effects are time and dose dependent
peristalsis = progesterone ○ Not good for patients with CVS
problems

Family Planning (Dr. Sol Chu-Crisostomo)
May 21, 2018
OCP’s and the Cardiovascular System ● Patient is breastfeeding
● Mechanism is unclear ○ Do not give Combined pills It has an
○ Increase synthesis of fibrinogen and effect on the breastmilk production
other coagulation factors → increased
blood viscosity → arterial thrombosis OCP and Drug Interaction
● CVA is the most serious complication associated ● Dictum
with combined OCP use ○ “the lower the hormone dose is, the
● Smoking, sedentary living, obesity, higher the chance that a medication
hypertension, diabetes, elevated lipids and age may decrease its effectiveness”
over 35 are risk factors for CVA and MI
○ Take note of the personal and social
Case 14
history of the patient
A G5P4 (4004) 6 weeks pregnant came for
● Stop OCP for at least 1 month before a major
prenatal check up. There than missing the last 3
surgery
tablets of the 28 day combined oral contraceptive
○ Patient would be at risk DVT; because
pills, she claimed to have taken the rest of the
patient is lying down during the
pills on time and without fail. She is presently on
procedure
anti PTB regimen. What could be the reason for

the contraceptive failure?
OCP’s and Cancer
- Caused by Rifampacin
● Prevents ovarian and endometrial cancer
- Take note of medical, surgical condition
● Conflicting reports concerning the risks of
of the patient
premalignant and malignant changes of the
- Look at the drug interaction
liver, pituitary, cervix and breast
- There are some drugs that
increase/decrease the effectiveness by combined
Case 12
OCP
Pops, 41 y/o, a breastfeeding mom who delivered 8
- she can still use OCP but with back up
months ago had her first day of menstruation today.
contraceptive like condom or withdrawal.
She plans to breastfeed as long as she has breastmilk.
She is asking what form of hormonal contraception
can she use? ● Drugs whose effectiveness is increased by
- Use progestin only. Combined pills cause Combined OCP
decrease breast milk production. Low dose ○ Alcohol, Aminophylline,
only so take on the same time everyday Antidepressants, Benzodiazepines,
without fail Beta-blockers, Caffeine,
Corticosteroids,Theophylline

● Drugs whose effectiveness are decreased by
OCP’s and Reproduction
Combined OCP
● Return of ovulation
○ Acetaminophen and aspirin,
○ Variable
Benzodiazepine tranquilizers,
○ Rebound ovulation
Methyldopa, Oral anticoagulants, Oral
● Intake during pregnancy
hypoglycemics
○ No effect on fetus
● Drugs known and suspected to decrease
● Intake during lactation
contraceptive effectiveness of Combined OCP
○ Secreted in small amount in breastmilk
(Use back-up contraceptive: natural family
○ Cause decrease in breastmilk
planning, condom use)
production in combined pills but not
○ Barbiturates, Rifampicin,
with progestin-only pill
Carbamazepine, Phenytoin,
● Some patients with polycystic ovarian syndrome
Felbamate, Topiramite, Griseofulvin,
○ Once they take the pills – regular cycle
Primidone, Ketoconazole /
○ Stopped the pills – irregular cycle
Itraconazole
● Pregnant patient uses pills

○ No effect on fetus; no need for abortion
OCP’s and Side Effects
Family Planning (Dr. Sol Chu-Crisostomo)
May 21, 2018
 ● Nausea, Acne, Melasma, Weight gain,
Amenorrhea, Yeast infection, Depression,
Headache, Breast tenderness, Decreased libido
(sad)

Case 9
● Made of flexible plastic with ethinyl estradiol
Since OP’s compliance to taking the oral pills is poor,
and etonogestrel
she is asking if there is a method similar to the
● Placed into the upper vagina early in the
combined oral contraceptive pills that will not require
menstrual cycle to release hormones for at
daily dosing. What method can you offer to her? How
least 21 days
would you instruct her to use it?
● Remove the ring after 3 weeks of use and
- You can advise her to use combined patch or ring.
wait a week to insert a new ring during the
- Put the patch arm or torso except on the breast, good
time she would menstruate
for 7 days
● Effectiveness depends on the user: Risk of
- Ring is placed into the upper vagina and it releases
pregnancy is greatest when a woman is late
hormone for 21 days
to start the new ring.
● Combined ring is new, and research on
COMBINED PATCH effectiveness is limited
● Bleeding changes are common: irregular
bleeding for the first few months and then
lighter and more regular bleeding
● No delay in return of fertility after ring use is
stopped
● No protection against sexually transmitted
● Transdermal, placed on a woman’s arm or torso infections
(except the breast) ● Health Benefits and Health Risks
● Slowly releases ethynyl estradiol and ○ Long-term studies of the vaginal ring
norelgestromin wh/c establishes steady serum are limited, but researchers expect
level for 7 days that its health benefits and risks are
● Should apply one patch in a different area each like those of combined oral
week for 3 weeks followed by a patch-free contraceptives
week, during she will have a withdrawal ● Medical eligibility criteria are the same for the
bleeding combined ring as for combined oral
● Effectiveness depends on the user: Risk of contraceptives
pregnancy is greatest when a woman is late to Case 13
change the patch. Maria, just like Pops, is a breastfeeding mom who
● Combined patch is new, and research on also plans to breastfeed as long as she has breast
effectiveness is limited. milk. However, unlike pops, she is a very busy
● Bleeding changes are common: irregular working mom and therefore compliance to daily pill
bleeding for the first few months and then intake is very poor. Her husband is known to be
lighter and more regular bleeding. promiscuous. What would be the hormonal
● Pregnancy rates may be slightly higher among contraceptive method for Maria?
women weighing 90 kg or more. - Advice the patient to use Injectable or Implants.
● No delay in return of fertility after patch use is

stopped
INJECTABLES
● No protection against sexually transmitted
Types
infections
● Depot Medroxyprogesterone Acetate (DMPA)

- Injected deep IM at the upper outer
COMBINED RINGS
quadrant of the buttocks (gluteal muscle), the

Family Planning (Dr. Sol Chu-Crisostomo)

May 21, 2018
 upper arm (deltoid muscle), do not massage; ● Prevention of cyclic maturation of the
150 mg every 90 days endometrium
● Norenthindrone Ethanthate (Noristerat) -
Injected deep IM at the upper outer quadrant Procedure:
of the buttocks (gluteal muscle), the upper arm ● 6 silastic rods each 2-4 mm in width and 34
(deltoid muscle), do not massage; 200 mg every mm long containing 36 mg of levonorgestrel
60 days; Injectables are implanted on inner surface of the arm
● Insertion done on OPD basis
Mechanism of Action: ● Period of effectivity: 3-5 years
● Ovulation is inhibited
● Endometrium becomes thin Major Side Effect
● Cervical mucus becomes thick and viscous ● Irregular pattern of bleeding

Major Side Effects Complications
● Complete disruption of the menstrual cycle ● Infection, Local irritation
(DMPA) ● Painful reaction at the site
○ First 3 months: Irregular bleeding, or ● Headache, Weight change, Acne, Mastalgia
Prolonged bleeding ● Mood changes – anxiety, depression and
○ At one year: No monthly bleeding, nervousness
Infrequent bleeding, or Irregular ● Irregular pattern of bleeding
bleeding
INTRAUTERINE DEVICE (IUD)
Other Side Effects
● Weight gain, Headaches, Dizziness, Abdominal
bloating and discomfort, Mood changes, Less
sex drive and Other possible physical changes:
Loss of bone density

Non-contraceptive health benefits of DMPA
● Decrease in:
Chemically inert
○ Dysmenorrhea
Medicated or Chemically active
○ Ovulatory pain

○ Functional ovarian cysts
Mechanism of Action
○ Symptoms of endometriosis
● Copper bearing IUD
○ Risk of developing iron deficiency
Spermicide due to local, sterile, intense
anemia
inflammatory reaction produced by
○ Risk of PID
the presence of the foreign body in the
○ Risk of endometrial CA
uterine cavity.

● Levonorgestrel containing IUD
IMPLANTS
Prevention of sperm penetration thru
thickened mucus
Atrophic endometrial changes

Contraindications for IUD
● Known or suspected malignancy
● Abnormalities of the uterus resulting to
distortion of the uterine cavity
Mechanism of Action of Implants ● Acute PID or history of PID
● Prevention of ovulation due to progestin ● History of ectopic pregnancy
content ● Known or suspected cervical or endometrial
● Cervical mucus is thick and scanty cancer
Family Planning (Dr. Sol Chu-Crisostomo)
May 21, 2018
 ● Genital bleeding of unknown cause ○ Diaphragm
● Puerperal sepsis or immediate post septic ○ Cervical cap
abortion ● Chemical
● Untreated acute cervicitis or vaginitis until ○ Vaginal tablets
infection is controlled ○ Jellies and creams
● Patient or her partner has multiple sexual ○ Sponge
partners
● Conditions associated with susceptibility to MALE CONDOM
infections (leukemia, AIDS, IV drug abuse)

Adverse effects of IUD
● Uterine bleeding, Pain and cramps, Pelvic
infection, Perforation, Lost thread or lost
devices

● Sheaths, or coverings, that fit over a man’s
Complications related to pregnancy
erect penis.
● Ectopic pregnancy, Pregnancy with IUD in utero,
○ Also called rubbers, “raincoats,”
Spontaneous abortion, Prematurity, Sepsis,
“umbrellas,” skins, and prophylactics;
Congenital anomalies?
○ Most are made of thin latex rubber.

○ While erected insert/remove the
Procedure for insertion and removal
(penis daw) condom
● Best time to insert and remove IUD:
● Work by forming a barrier that keeps sperm
○ If the patient is menstruating; cervical
out of the vagina, preventing pregnancy.
os is open
○ Also keep infections in semen, on the
○ You can remove the IUD anytime but
penis, or in the vagina from infecting
may be painful to the patient (cervical
the other partner.
os may be closed)
● Have no hormonal side effects

● Can be used as a temporary or backup
Expulsion of IUD
method
● How will you know if IUD is in place/ removed?
● Are sold in many places and generally easy to
○ Do ultrasound
obtain
○ Ask the husband to do an internal exam
● Help protect against both pregnancy and STIs,
and feel for the string
including HIV


Locating a lost IUD
What condom users should not do:
● Use ultrasound
● Do not unroll the condom first and then try to
● Use x-ray
put it on the penis (well duh)

● Do not use lubricants with an oil base because

they damage latex
Concomitant pregnancy
● Do not use a condom if the color is uneven or
● Leave it longer
changed
○ Higher incidence of infection
● Do not use a condom that feels brittle, dried
○ Rupture of the bag of water
out, or very sticky
○ Higher risk of abortion
● Do not reuse condoms (yeah coz eww) (kung
○ Remove IUD earlier when patient is
walang pambili ng condom wag mag sex -__-)
pregnant


Medical Eligibility Criteria
BARRIER METHODS
● All men and women can safely use male
Types condoms except those with severe allergic
● Mechanical reaction to latex rubber
○ Condom
Family Planning (Dr. Sol Chu-Crisostomo)
May 21, 2018
 FEMALE CONDOM ● Comes in different sizes and requires fitting
by a specifically trained provider.

May help protect against:
● Certain STIs (chlamydia, gonorrhea, pelvic
inflammatory disease, trichomoniasis)
● Cervical precancer and cancer

Side Effects:
● Sheaths, or linings, that fit loosely inside a ● Irritation in or around the vagina or penis
woman’s vagina, made of thin, transparent soft ● Higher risk for urinary tract infection
plastic film. ● Frequent use of nonoxynol-9 may increase
● Have flexible rings at both ends risk of HIV infection
○ One ring at the closed end helps to ● Extremely rare: Toxic shock syndrome if left
insert the condom more than 24 hrs
○ The ring at the open end holds part of How to use:
the condom outside the vagina ● Insert the diaphragm less than 6 hours before
having sex
Why some women say they like female condom: ● Keep the diaphragm in place at least 6 hours
● Women can initiate their use after having sex but no longer than 24 hours.
● Have a soft, moist texture that feels more ● Leaving the diaphragm in place for more than
natural than male latex condoms during sex one day may increase the risk of toxic shock
● Help protect against both pregnancy and STIs, syndrome.
including HIV ○ For multiple acts of sex, make sure
● Outer ring provides added sexual stimulation that the diaphragm is in the correct
for some women position and also insert additional
● Can be used without seeing a health care spermicide in front of the diaphragm
provider before each act of sex.

Why some men say they like female condoms:
● Can be inserted ahead of time so do not
interrupt sex
● Are not tight or constricting like male condoms
● Do not dull the sensation of sex like male
condoms CERVICAL CAP (uncommon)
● Do not have to be removed immediately after
ejaculation

DIAPHRAGM

● A soft, latex or plastic rubber cup that snugly
covers the cervix.
● Comes in different sizes; requires fitting by a
● A soft latex cup that is placed to cover the specifically trained provider.
cervix before sex. Plastic and silicone ● Fill one-third of the cap with spermicidal
diaphragms may also be available. cream, jelly, or foam.
● Used with spermicidal cream, jelly, or foam to ● Inserted any time up to 42 hours before
improve effectiveness. having sex and left for at least 6 hours after
Family Planning (Dr. Sol Chu-Crisostomo)
May 21, 2018
 her partner’s last ejaculation, but not more ● Easy and simple to use
than 48 hours from the time it was put in. ● Use unrelated to the time of intercourse
● Leaving the cap in place for more than 48 hours ● Freely reversible effect
increases risk of toxic shock syndrome and can ● Free of side effects
cause bad odor and vaginal discharge. ● Readily available
● Free of cultural barriers
SPONGE
REFERENCES
1. 2019 trans
2. Recording
3. Online References

TRANSCRIBED BY:
1. Group 22B: Castillo, De La Cruz, Moldez,
● Made of plastic and contains spermicides. It is Nolasco, Paraiso
moistened with water and inserted into the 2. Subtranshead: Marielle Dizon
vagina so that it rests against the cervix.
● Can be used only once. It is not widely available.
● Effectiveness depends on the user: Risk of
pregnancy is greatest when a woman does not
use the sponge with every act of sex.

CONTRACEPTION EFFICACY
Methods grouped into:
● Always very effective
● Effective as commonly used and very effective
when used correctly and consistently
● Only somewhat effective as commonly used,
effective when used correctly and consistently

● No method used
Most effective: 99+ (<1 pregnancy per 100 women in
one year)
● Implants: 99.95% effective
● IUD: 99.8% effective
● Vasectomy: 99.85% effective
● Tubal ligation: 99.5% effective
91%+ (6-9 pregnancies per 100 women in one year)
● Injectables: 94% effective
● Vaginal ring: 91% effective
● POP and COC pill: 91% effective

Least effective: 76+ (18+ pregnancies per 100 women in
one year)
● Diaphragm: 88% effective
● Male condom: 82% effective
● Female condom: 79% effective
● Natural methods: 76-78% effective

CHARACTERISTICS OF AN IDEAL CONTRACEPTIVE
METHOD
● Inexpensive
Family Planning (Dr. Sol Chu-Crisostomo)
May 21, 2018