contraception

In a dying economy of poor countries

contraception has become a necessary
way to achieve and preserve acceptable
standard living by smaller families
On the other hand in developed countries
with opened relationships ,lake of desire
of commitment & free untermed sex
contraception also is important
 contraception
 A wide variety of
effective methods of
regulating fertility is
currently available.
None is completely
without side effects or
categorically without
danger—for example,
latex condoms can
cause anaphylactic
reactions
Steps of conception
How to prevent conception

hormonal

contraception

others mechanical
 Methods of contraception

1. cocs
2. Pops
3. Long acting injectables
4. Subdermal implant
5. IUD
6. Male condom
7. Cervical cap
8. Vaginal diaphragm
9. Voluntary surgical cntraception
10. Spermicides
11. Physiological methods
 Hormonal contraception
These types of contraceptives are
currently available in a wide variety
of forms: pill, injection, transdermal
patch, implant, and a transvaginal
ring
Unfortunately there is no reliable
reversible male hormonal
contraception
 COCS-1
:TYPES
Monophasic:ethinylestradiol-1
+gestagen
high dose pill*
moderate dose pill*
low dose pill used now*

biphasic pill not used-2

EE2 30mg 30mg
NET 0.5mg 1mg
triphasic-3
 Mechanism of action
:central-1
The most important effect is to
prevent ovulation by
.suppression of FSH& LH

:peripheral- 2
they thicken cervical mucus to
,retard sperm passage
they make the endometrium
unfavorable for implantation
Decrease motility of the tubes.
 safety
 Ingeneral, oral contraceptives have
proven to be safe for most women.
 The possibility of adverse effects
from COCs has received so much
attention for so long that clinicians as
well as the public are frequently
confused by the often conflicting
reports.
 How to use
 Started at the frist 7 days
of the cycle or at any time
if pregnancy excluded
 After 6 weeks In non
lactating female
 After 6 month in lactating
female
 Take one pill every day in
the same time
 Advantage of cocs
1. most Effective
2. Suitable way of protection in young aged ptn not
completed here family
3. Reliable & revesible
4. Regain fertility soon after stoppage
5. Easy to use
6. Has None contraceptive use (DUB-endometriosis- PMS –
functioning ovarian cyst)
7. Doesn’t affect sexual satisfaction
 Possible adverse effects
1.Lipids and Lipoproteins metabolism:
 In general, COCs increase serum triglyceride and
total cholesterol levels. Estrogen decreases
concentration of low-density lipoprotein (LDL)
cholesterol and increases high-density lipoprotein
(HDL) cholesterol.

Estrogens increase hepatic production of a variety of.2

. globulins
 Increased angiotensinogen production appears to
be dose related, and its conversion by renin to
angiotensin I has been suspected to be associated
with so-called pill-induced hypertension.
3-Liver Disease :
 Cholestasis and cholestatic jaundice are uncommon
complications of oral contraceptives.
 It may accelerate the development of gallbladder
disease in women who are susceptible, but there is
no overall increased long-term risk .
4-Doesn’t protect against sexually transmitted –disease
5-Increased incidence of stroke, HTN.
6-Weight gain
 COCs and neoplasm
 Infact, a protective effect against
ovarian and endometrial cancer was
shown.
 There are, however, conflicting
reports concerning the risks of
premalignant and malignant changes
of the liver, cervix, and breast.
 Liver Cancer :Older contraceptives with larger
estrogen doses were linked with hepatic focal
nodular hyperplasia and benign hepatic
adenoma .
 Cancer cervix : increase risk after 5 years use.
 Breast: suppresion of lactation ,tenderness
&increase risk of cancer breast.
 Cocs and nutrition
 Changes in serum levels of several nutrients, similar to
those induced by normal pregnancy.
 Lower plasma levels are reported for ascorbic and
folic acid, vitamin B6 and vitamin B12, niacin,
riboflavin, and zinc. An adequate diet is sufficient
prophylaxis against any detrimental deficiency.
 Increase incidence of thrombosis and embolism.
 Increased incidence of stroke, HTN.
 Weight gain
 Effect on menestruation
 Inter menstrual bleeding :may be due to
irregular intake of pill
 Hypo menorrhea
 Postpil amenorrhea:
No menstruation for 6 month after stopping
pills
Caused by persistent inhibition of hypo-pit
axis &pituitary prolactinoma .
Teratogenic effect on pregnancy
 contraindications
 Combination contraceptives should not be used in women
with:

–   Thrombophlebitis or thromboembolic disorders

–   History of deep vein thrombophlebitis or thrombosis disorders
–   Cerebrovascular or coronary artery disease
–   Thrombogenic cardiac valvulopathies
–   Thrombogenic heart arrhythmias
–   Diabetes with vascular involvement
–   Severe hypertension
–   Known or suspected breast carcinoma
– Endometrial carcinoma
–   Undiagnosed abnormal genital bleeding
–   Cholestatic jaundice of pregnancy or jaundice
with pill use
–   Hepatic adenomas or carcinomas or active liver
disease with abnormal liver function
–   Known or suspected pregnancy
–   Major surgery with prolonged immobilization
Transdermal Administration
-3
 The patch is an effective alternative
hormonal contraceptive method for
women who prefer weekly application
rather than daily dosing and who find
a transdermal method acceptable.
 Its metabolic and physiologic effects
the same as with low-dose oral
contraceptives,
 It is more effective than low dose oral
contraceptive
 Transvaginal-4
Administration
 An intravaginal hormonal contraceptive
ring—NuvaRing
 is a flexible polymer ring with an outer
diameter of 54 mm and an inner
diameter of 50 mm Its core contains
ethinyl estradiol and the progestin,
etonogestrel, which are released at
rates of 15 g and 120 g per day,
respectively.
 Although this results in serum hormone
levels lower than comparable low-dose
oral contraceptives, ovulation inhibition
is complete
 It is highly effective, and in one study,
the failure rate was 0.65 per 100
woman-years
 Progestational Contraceptives
Oral Progestins
 Unlike COCs, they do not reliably inhibit
ovulation.
 Mechanism :
 depends more on cervical mucus alterations
and effects on the endometrium to un favorable
for implantation .
 Decrease the peristalsis of the tubes
 Because the mucus changes do not persist
beyond 24 hours, to be maximally effective it
should be taken at the same time every day.
 Has an increased risk of pregnancy
 Benefits
 Progestin-only pills have minimal if any effect on
carbohydrate metabolism or coagulation
 , they do not cause or exacerbate hypertension.
 They may be ideal for some women who are at
increased risk of cardiovascular complications.
 In addition, the mini-pill is often an excellent choice for
lactating women. In combination with breast feeding,
it is virtually 100-percent effective for up to 6 months

 Doesn’t affect sexual satisfaction

 Disadvantages
 contraceptive failure.
 relative increase in the proportion of ectopic pregnancies
 Irregular uterine bleeding may manifest as amenorrhea,
metrorrhagia, or prolonged periods of menorrhagia.
 Functional ovarian cysts develop with a greater frequency in
women using these agents,.
 these contraceptives must be taken at the same or nearly the
same time each day. If a progestin-only pill is taken even 4 hours
late, an additional form of contraception must be used for the
next 48 hours
 Their effectiveness is decreased by medications that include
anticonvulsants—phenytoin, carbamazepine,,,; and
antituberculous agents—rifampicin.
 unlike combined oral contraceptives, the mini-pill does not
improve acne, and may even worsen it in some women.
 cotraindications
 Pregnancy
 History of ectopic pregnancy
 women with unexplained
uterine bleeding breast cancer.
 Breast feeding less than 6
weeks after a childbirth.
 Current ttt with antibiotics.
 Gallbladder disease & active
liver disease.
 *Injectable Progestin
Contraceptives
 Depo-Provera and Norgest
 Their mechanisms of action are similar to those for
oral agents:
 ovulation inhibition
 , increased cervical mucus viscosity, and
stimulation of an endometrium unfavorable for
ovum implantation.
 How to use :
 Depot medroxyprogesterone is injected deeply into
the upper outer quadrant of the buttock or into the
deltoid muscles without massage to ensure that the
drug is released slowly.
 . An additional contraceptive method should be
used for at least 2 weeks after the initial injection.
 Benefits
 effectiveness comparable with or better than
COCs,
 a long duration of action, and minimal to no
impairment of lactation
 . Iron-deficiency anemia is less likely in long-term
users, probably as a result of amenorrhea, which
develops in 80 percent of women after 5 years.
 Non contraceptive use (DUB-endometriosis-fibroid-
precocious puberty)
 Excellent way of control in non reliable ptn
 Doesn't affect sexual satisfaction
 Disadvantages
 Menstrual disturbance
 Weight gain
 delayed fertility after
discontinuation
 Decreased density of bone.
 Breast enlargement &
tenderness.
 Once in the body its in
 Doesn’t protect against
sexually transmitted disease
 Progestin Implants

 There is two types of them:

 Norplant which act for 5 years &
Implanon which act for 3 years
 Effective & reliable
 Reduce risk of endometrial &
ovarian cancer.
 Suitable for lactating women.
 Durable &and can be removed at
any time with rapid return of
fertility.
 Disadvantages
&Contraindications
 Menstrual disturbance in the
form of amenorrhea, heavy
bleeding& irregular uterine
bleeding.
 Breast enlargement
 Wt gain
 Can not be used in ptn with
breast cancer &un explained
uterine bleeding.
 Local trauma
Mechanical contraception
 Intrauterine device
1. types:
2. Non medicated
3. Medicated:
4. Copper medicated
5. Progesterone
medicated
6. Antifibrinolytic
medicated
 Mechanism of action
1. Local sterile inflammation caused by
polyethelene & barium componant which
endometrium unfavourable for
implantation
2. Local pgs release which cause uterine
contraction to abort any fertilized ovum
3. Act as a foreign body which lead to
dislodgment of zygot
 How to use
1. Time : Inserted at the last days of
menestruation or at any time after
exclusion of pregnancy.
2. Method of insertion :
*pushing technique “associated with
increased incidence of perforation “
*withdrawal techniqe
3.Duration : according to the type
 How to insert
 A sound is used to
determine the depth
 The theory is very simple.
Expose the vagina using
a speculum.
 then use an inserter to
poke through the cervical
canal.
 Inside the inserter, there
is a IUD.
 When the inserter is in
the uterus, push the IUD
into the uterus or
withdraw the inserter.
 Advantage
1. Reliable
2. Cheap
3. Safe
4. Doesn’t affect lactation
5. Has a non cotraceptive value
6. Durable & can retain fertility immediately
after removal
 Disadvantage
1. Increase incidence of PID which leads
eventually to tubal affection & infertility
2. Bleeding in the form of menorrhagia
3. Perforation
4. Ectopic pregnancy
5. Pregnancy with retained IUD which increase
incidence of abortion
6. Low backPain
7. Missed loop
Different barrier methods
 Male condom
1. Disposable formed of latex
rubber or less commonly
polyethylene
2. Ejaculation inside it then rapid
withdrawal before relaxation
3. High failure rate 8-5 HWY
4. Non contraceptive use in
immunological infertility
&premature ejaculation
5. Affect sexual satisfaction
 key steps to ensure maximal
condom effectiveness
1. It must be used with every coital act. 
2. It should be placed before contact of the
penis with the vagina. 
3. Withdrawal must occur with the penis still
erect.  
4. The base of the condom must be held
during withdrawal.
5. Either an intravaginal spermicide or a
condom lubricated with spermicide should
be employed
 Female Condom (Vaginal
(Pouch
1. These devices prevent pregnancy and
sexually transmitted diseases.
2. it is a polyurethane sheath with a
flexible polyurethane ring at each end
3. The open ring remains outside the
vagina, and the closed internal ring is
fitted under the symphysis like a
diaphragm
4. In vitro tests have shown the condom
to be impermeable to human
immunodeficiency virus,
cytomegalovirus, and hepatitis B
virus. It has a 0.6 percent breakage
rate.
5. The slippage and displacement rate
is about 3 percent,
6. The pregnancy rate is higher than
with the male condom
Diaphragm Plus Spermicide
 The diaphragm consists
of a circular rubber
dome of various
diameters supported by
a circumferential metal
spring
 It can be very effective
when used in
combination with
spermicidal jelly or
cream.
 How to use

 The spermicide is applied to the

cervical surface centrally in the cup
and along the rim.
 The device is then placed in the
vagina so that the cervix, vaginal
fornices, and anterior vaginal wall
are partitioned effectively from the
remainder of the vagina and the
penis.
 At the same time, the centrally
placed spermicidal agent is held
against the cervix by the
diaphragm.
 If too large, it will be uncomfortable
when forced into position. Because
the variables of size and spring
flexibility must be specified
 Cervical Cap
 cervical cap is a flexible, cup-like
device, made of natural rubber that is
fitted around the base of the cervix
 It can be self-inserted and allowed to
remain in place for up to 48 hours.
 It should be used with a spermicide
applied once at insertion.
 If properly fitted and used correctly,
the cap is comparable in effectiveness
to the diaphragm
 The cap is relatively costly, and in
practice, incorrect fitting or improper
placement make it less effective
overall than the diaphragm and
spermicide
Voluntary surgical
contraception
vasectomy-1
tubal sterilization-2
 vasectomy
 Surgical Procedure
of interruption of
vas difference
 Easy& rapid
 Failure rate <0.02
HWY mainly due to
delayed sterility
 Not preferred as it
is irreversible,
surgical procedure
 Tubal sterilization
 Surgical procedure
targeting the integrity of
the tubes
 Indicated in cases with
absolute contraindication
of pregnancy as it causes
permenant sterility
 Methods either:
1. laparoscopic
2. Laparotomy
3. Hysteroscopy
4. Culdoscopic
5. Posterior colpotomy
 Physiological methods

1. Lactation amenorrhea
2. Safe period “allowing intercourse in the
infertile periods of the cycle”
3. Coitus interruption “sexual intercourse
with ejaculation outside the vagina”
need wife approval as it cause sexual
unsatisfaction
4. Coitus reservant “sexual intercourse
without ejaculation
 How to detect proper method
for your patient
 There is certain points that should be taken in
consideration
1. Age
2. Parity
3. Obstetric & gynecological history
4. Either terminal or temporary contraception
5. General health of the patient
6. Reliability of the patient
7. Husband cooperation
  Welfare may makes life better
But children still the joy of life
 To have a career may make you
successful
But what the meaning of success if you
don’t have someone to share with
 Presented by

1. Sarah Mohammed Abo El Soud

2. Sarah Ahmed El Shehaby.
3. Sarah el Madany.
4. Radwa Rezk.
5. Rasha El Mougy.
6. Randa El Said.
 THANK YOU
Dedicated to gynecology
&obstetric department of
Mansoura university with our best
wishes & sincere love