Population dynamics

Definition:
Population dynamics is the branch of life
sciences that studies the size and age
composition of populations as dynamical
systems, and
the biological and environmental processes
driving them such as birth and death rates,
and by immigration and emigration.
 Population dynamics
The population is not static but is always in a
dynamic state.

The factors which are involved in population

dynamics are:

death, birth & migration

 Magnitude of the problem
The total world population was estimated to be about 6 billion
in the last century. Earlier in the last century, the rate of increase
of population was about 10 million per year. It is now increasing
at much faster rate of 100 million per year. If the rate of increase
continues at the same pace, the projected population would be
800 million in 2025.

Indias population has reached 1027 million in 2001 & the

projected population in 2015 is 1363 million. In 2050, the
projected population is 1628 million when India would be the
worlds most populous country exceeding China.
Impact of increased population
Adverse effects on the national
economy

Deleterious effect on the health of

mother & the child

Social & economical up liftman of the

family

Various obstetric & gynaecological

complications & nutritional problems

Increased maternal, perinatal & infant

deaths
Contraception
 Introduction

Family planning
Contraception or fertility
control
Ideal contraceptive methods

Highly
Acceptable Safe
effective

Simple to
Reversible Cheap
use

Requiring minimal
motivation, maintenance
& supervision
 Benefits of family planning:
To bring down the population growth for better standards of living.

To maintain social & economic status.

Mothers and babies are healthier when risky pregnancies are avoided.

Smaller families mean more money and food for each child.

Parents have more time to work and to be with family.

Delaying first or second pregnancy lets young people stay in school.

 Types

Temporary Permanent
contraception contraception
Methods of temporary Contraception

Natural family
Barrier Hormonal
planning
methods methods
methods
Natural family planning methods

Without identifying
physiological changes:

Abstinence

Coitus intterruptus
 Abstinence:
Also Known As:
Self-denial, continence, abstinent, temperance
Most commonly, the term being abstinent refers
to sexual abstinence, which means not having
any type of sexual intercourse or sex play with
a partner.
Abstinence is the only birth control
method that is 100% effective in preventing
pregnancy as well as sexually transmitted
diseases.
 Contd..
Abstinence: not having sexual
intercourse, but other sex play is
considered.

Abstinence: behavior that includes sexual

activity that do not lead to pregnancy.

Abstinence: not having sexual intercourse

during the time of the most fertile days.
 Advantages
Can be a positive way of dealing with sexuality
and/or resolving feelings about sexual intimacy
that stem from religious or moral beliefs.

No medical or hormonal side effects.

Doesn't cost anything.

 Disadvantages:

Hard to practice for long periods of time.

If you have not had sexual education or been given information

about contraception, and you choose to stop being abstinent,
you may not be prepared to protect yourself from pregnancy or
sexually transmitted infections.
 Indications
Want 100% prevention
Of religious beliefs May wait until you feel
against pregnancy and
and/or personal morals you are ready to be in a
sexually transmitted
and values. sexual relationship.
infections.

Want to focus on your

career, school, Waiting to find the right
extracurricular Of medical reasons. partner or until
activities, and/or marriage.
hobbies.

In the process of getting Want to have romance

over a break-up or the and fun without
death of a the responsibilities that
spouse/romantic come along with having
partner. sex.
 Coitus interruptus
The coitus interruptus also known as withdrawal method
of contraception, is the practice of withdrawing the penis
from the vagina and away from a woman's external
genitals before ejaculation to prevent pregnancy.
The goal of the withdrawal method is to prevent sperm
from entering the vagina.
Using the withdrawal method for birth control requires
self-control.
Even then, the withdrawal method isn't an especially
effective form of birth control.
Sperm may enter the vagina if withdrawal isn't properly
timed or if pre-ejaculation fluid contains sperm. The
withdrawal method doesn't offer protection from sexually
transmitted infections.
 Benefits

Is free and
Has no side
readily
effects
available.

Don't want
Doesn't
to use other
require a
contracepti
fitting or
ve
prescription
methods.
 Use
Properly time withdrawal.
When a man feels he's about to ejaculate, he must withdraw his penis from the woman's vagina. Make sure
that ejaculation occurs away from the woman's genitals.

Take precautions before having sex again.

If you plan to have sex again within a short period of time, make sure the man urinates and cleans off the tip
of his penis first. This will help remove any remaining sperm from the previous ejaculation.

Access:
Free & available to anyone

Effectiveness:
78-96%
 Risks
It doesn't offer protection from sexually
transmitted infections.

Some couples also feel that the withdrawal

method disrupts sexual pleasure.

As many as 28 out of 100 women who practice the

withdrawal method for one year will get pregnant.
Identifying the physiological changes

Basal
Lactation
body Cervical Symptoth
Calendar amenorr
temperat mucus ermal
method hea
ure method method
method
method
Basal body temperature
 Indications

Way to predict fertility or as a part of a method of

contraception

For religious reasons

Used to detect pregnancy. Following ovulation, a rise in basal

body temperature that lasts for 18 or more days may be an
early indicator of pregnancy.
Factors affecting on BBT
Illness or fever

Stress

Shift work

Interrupted sleep cycles or oversleeping

Alcohol

Travel and time zone differences

Gynaecologic disorders

Certain medications
Some women also ovulate without a clear rise
in basal body temperature.
 Use
Take basal body
temperature every Plot temperature
morning before getting readings on graph paper.
out of bed.

Success rate: 99%

effective in 1st year, if
Plan sex carefully during used correctly &
fertile days. consistently.
 Risks
It doesn't offer protection from
sexually transmitted infections
and it's one of the least
effective natural family planning
methods.

As many as 24 out of 100 women

who use fertility awareness-
based methods to prevent
pregnancy such as the basal
body temperature method for
one year will get pregnant.
 Cervical mucus method
The cervical mucus method, also called the ovulation
method and the Billings ovulation method, is a type
of natural family planning also known as fertility
awareness-based methods.
The cervical mucus method is based on careful
observation of mucus patterns during the course of
menstrual cycle.
Before ovulation, cervical secretions change.
By recognizing the changing characteristics of cervical
mucus, you can predict when you'll ovulate. In turn,
this may help you determine when you're most likely
to conceive.
 Normal cervical changes
No noticeable cervical secretions for three to four
days after period end.

Scanty, cloudy and sticky secretions for the next

three to five days.

Abundant, clear and wet secretions for the next

three to four days the period before and
during ovulation

No noticeable cervical secretions for 11 to 14

days until next period begin.
Consult the physician before use
Recently had first
period, gave birth, or
stopped taking birth
control pills or other Breast-feeding
hormonal
contraceptives

You have a condition

Approaching that disrupts regular
ovulation, such as
menopause polycystic ovary
syndrome
 Use

Record cervical Check cervical Plan sex

secretions for secretions before carefully
several cycles. and after during fertile
urinating. days.
 Risks
It doesn't offer protection from sexually transmitted
infections.

The risk of unintended pregnancy with the cervical mucus method is

somewhat higher than with other methods of birth control.

As many as 23 out of 100 women will get pregnant in the first year of
typical use. But, with correct use, the pregnancy rate may be as low as 3
out of 100 women a year.
 Calendar method
The calendar method also called rhythm
method or the calendar rhythm method, is a
form of natural family planning.
To use the rhythm method, track menstrual
history to predict ovulation.
This helps to determine the time for
conception.
 Use
Record the Determine Determine
length of 6 to the length of the length of
12 of your shortest longest
menstrual menstrual menstrual
cycles. cycle. cycle.

Plan sex
Update
Success rate: carefully
calculations
80-87% during fertile
every month
days.
 Risks
It doesn't offer protection from sexually transmitted
infections.

In addition, the risk of unintended pregnancy with the

rhythm method is higher than with some other methods
of birth control.

Although effectiveness varies, in the first year of typical

use an estimated 13 out of 100 women practicing the
rhythm method for birth control will get pregnant.
 Symptothermal methods
It is combination of BBT methods, cervical
mucus methods and calendar techniques.
 Lactation Amenorrhoea method

The lactation amenorrhea method (LAM) is a

natural birth control technique based on the fact
that lactation causes amenorrhea.
Studies have confirmed that women who
exclusively breastfeed their baby around-the-
clock and who have not started menstruating are
very unlikely to get pregnant during the first six
months after they give birth.
 Mechanism
Breast feeding

Increased prolactin level

Inhibits ovarian response to FSH Suppress release of

LH

Less follicular growth No LH surge

Amenorrhoea Anovulation
 Effectiveness
If use LAM perfectly, fulfilling all of its conditions,
chances of getting pregnant during the first six
months after giving birth are less than 2 percent.
For most women, however, 1 in 50 chance of an
unintended pregnancy is more of a risk than they
want to take, so many combine LAM with another
contraceptive method.
Of course, LAM offers no protection against sexually
transmitted infections.
Success Rate: 1.1%
 Criteria for Use
You still haven't gotten your period. Once you start
menstruating, it's a clear sign that you've started
ovulating again.
You gave birth less than six months ago. Although some
women don't start menstruating again for many more
months, there's no predicting when it will happen.
And, since women usually ovulate before they get their
period, you can actually get pregnant even before your
period starts up again.
In fact, this can happen even if you're exclusively
breastfeeding, which is why LAM isn't 100 percent
effective but you're much less likely to be fertile
during the first six months postpartum.
Advantages of natural methods

Does Better
Is
not than not
There morally
require using
are no and
devices any
known No cost. culturall
or birth
side y
medicin control
effects. accepta
e in the method.
ble.
body.
Disadvantages of natural methods
Not recommended
if it is dangerous for
A high the woman to
rate of become pregnant
failure

Sex may not be No protection

as pleasurable against STD
 Barrier methods
Barrier methods of birth control block sperm from
entering the uterus.
Using a spermicide with a barrier method gives the best
possible barrier method protection.
The spermicide kills most of the sperm that enter
the vagina.
The barrier method then blocks any remaining sperm
from passing through the cervix to fertilize an egg.
Barrier methods include the diaphragm, cervical cap,
male condom, and female condom, cervical
sponge and spermicidal foam, sponges, and film.
Unlike other methods of birth control, barrier
methods are used only when you have sexual
intercourse.
 Care to be taken

A contraceptive A diaphragm or
A male or female
sponge has to be cervical cap has to
condom is
left in for 6 or be left in for 6 or
removed
more hours, then more hours, then
promptly and
removed and washed and
thrown away.
thrown away. stored for reuse.
 Indication
You want an option that does not require hormones or insertion of
an intrauterine device.

You want an option that does not restrict when you have sexual
intercourse, such as natural family planning.

You are planning to become pregnant soon and prefer a method you can
stop using anytime you want.

You are breastfeeding.

You have heavy menstrual periods.

You and your partner find it easy to use the method every time you have
sex.
 Types
Physical Male condom
Female condom
barrier Diaphragm
Vaginal ring
methods Cervical sponge

Chemical
Spermicides
barrier
methods
 Male condom
Male condom is a thin sheath placed over the erect penis.
When left in place during sexual intercourse, oral sex or
anal sex, male condoms are an effective way to protect
from sexually transmitted infections (STIs).
Male condoms are also an effective way to prevent
pregnancy.
Condoms, also called rubbers, are usually made of latex,
but some are made from polyurethane or lambskin. Latex
and polyurethane condoms provide the most protection
against STIs.
Male condoms are simple to use, inexpensive and widely
available. They are available with or without a lubricant
and come in a variety of lengths, shapes, widths,
thicknesses and colors. Some condoms are textured to
increase sensation.
 Some condoms are lubricated with nonoxynol-9, a
substance that kills sperm (spermicide) and is meant to
help prevent pregnancy.
However, condoms without spermicide are a better
option for several reasons:
Spermicidal condoms don't appear to be any more
effective than other lubricated condoms at preventing
pregnancy.
Nonoxynol-9 might irritate or damage skin cells in the
vagina or rectum. This could potentially increase the
risk of getting an STI.
Spermicide doesn't help protect you or your partner
against HIV/AIDS or other STIs.
Spermicidal condoms cost more than other types of
condoms and have a shorter shelf life.
Indication/benefits
very effective at preventing pregnancy
and the transmission of the human
immunodeficiency virus (HIV).

Condoms also reduce the risk of infection

from other STIs, such as gonorrhea and
chlamydia.

They're available without a prescription,

so it's easy to have one on hand when
you need it.
 Safety tips
Store condoms in
Check the Check condoms
a cool, dry
expiration date. for damage.
place.

Use only a latex

Be sure to use
Never reuse a or polyurethane
only water-based
condom. condom to
lubricants.
prevent STIs.

Use a condom
during any
sexual activity.
 Use
Put on a condom before any sexual contact.

Open the package carefully.

Apply lubricant outside of the condom.

Pull your foreskin back.

Place the tip of the rolled-up condom over your penis.

Gently press the tip of the condom to remove air.

Roll the condom down.

After sex, grasp the base of the condom before you remove
it.
Dispose of the condom in the trash.
 Results:
Male condoms are an effective form of birth control.
However, about 1 out of 50 couples who use condoms
correctly will get pregnant in a year.
Chances of pregnancy increase if you don't always
wear a condom during intercourse, or you use
condoms incorrectly.
Condoms are effective at preventing the transmission
of most STIs, although there's still some risk. When
used correctly, a condom creates a barrier that limits
your exposure and your partner's exposure to
semen or other body fluids that can carry STIs.

Success rate: 82%

 Risks
Condoms can trigger a latex
allergy. Reactions to latex can include
rash, hives, runny nose, and in severe
cases tightening of the airways and loss
of blood pressure. If you or your partner
is allergic to latex, a polyurethane or
lambskin condom may be an alternative.

Condoms aren't foolproof. There's still

a risk of getting an STI or becoming
pregnant when using a condom,
especially if it breaks or comes off
during sex.
 Female condom
The female condom is a birth control device that
acts as a barrier to keep sperm from entering the
uterus.
It protects against pregnancy and sexually
transmitted infections (STIs).
The female condom is a soft, loose fitting pouch
with a ring on each end.
One ring is inserted into the vagina to hold the
female condom in place. The ring at the open end
of the condom remains outside the vagina. The
outer ring helps keep the condom in place and is
also used for removal.
 Benefits
Is immediately Offers protection from Is available without a
sexually transmitted prescription or special
effective infections fitting

Doesn't require a
Rarely causes allergic
partner's cooperation
Can be inserted up to reactions and has
or an erect penis as
eight hours before sex minimal risk of side
the male condom
effects
does

female condoms made of polyurethane and

synthetic latex aren't affected by dampness or
changes in temperature. In addition, some
women find that the female condom's
external ring stimulates the clitoris.
 Contraindications

Are allergic Have vaginal

Aren't
to abnormalitie
Are at high comfortable
polyurethan s that
risk of with the
e or interfere
pregnancy insertion
synthetic with the
technique
latex placement
 Use
Open the package carefully.

Consider using additional

lubrication.

Insert the female condom. Guide

the penis into the female condom.

After sex, remove the female

condom carefully.
 Use
Check the expiry date & any damage.

Practice inserting the female condom

before the first time you use for sex.

Never reuse the condom.

Dont use female & male condom

together.
 Risks
An estimated 21 out of 100 women will become pregnant
in a year of typical use of female condoms.
The female condom has a higher failure rate than the male
condom.
The female condom may not protect if:
The condom breaks
The condom slips out of the vagina
The penis slips between the vagina and the outer surface of
the condom
The outer ring of the condom gets pushed into the vagina
during sex
The female condom may also cause discomfort during
insertion, a burning sensation, itching or a rash.

Success rate: 95%

 Diaphragm
The diaphragm is a birth control (contraceptive)
device that helps prevent sperm from entering
the uterus.
The diaphragm is a small, reusable rubber or
silicone cup with a flexible rim that covers the
cervix.
Before sex, the diaphragm is inserted deep into
the vagina so that part of the rim fits snugly
behind the pubic bone. The diaphragm is most
effective at preventing pregnancy when used
with spermicide.
 Benefits
Allows prompt return to fertility

Can be used as a backup method of

birth control
Can be used during breast-feeding
beginning six weeks after childbirth
Can be inserted up to six hours before
sex and left in place for up to 24 hours

Doesn't require a partner's cooperation

Has few, if any, side effects

 Contraindication
Are allergic to silicone, latex or spermicide

Are at high risk of or have HIV/AIDS

Are at high risk of pregnancy

Have vaginal abnormalities that interfere with the fit,

placement or retention of the diaphragm

Have frequent urinary tract infections

Have a history of toxic shock syndrome

Have significant pelvic organ prolapsed, such as uterine

prolapsed

Recently gave birth or had a miscarriage or an abortion

 Contact to physician
The diaphragm slips out of place when you
walk, sneeze, cough or strain.
You or your partner experience pain during or
following use of the diaphragm.
Have signs or symptoms of toxic shock
syndrome, such as sudden high fever,
diarrhoea, dizziness, vomiting, muscle aches
or a rash that looks like sunburn.
Unable to remove the diaphragm.
 Use
Before you use the diaphragm for the first time, practice inserting
the diaphragm until you are comfortable with it.
Always use the diaphragm with spermicidal cream, foam or gel.
Avoid use of body lotions near your vagina and vaginal
medications when using the diaphragm. If you're using a
diaphragm and douche, wait until at least six hours after sex to
avoid washing away spermicide.
Make sure you regularly check your diaphragm for puncture
marks or cracks. To search for holes, hold your diaphragm up to
the light and gently stretch the rubber between your fingers or fill
the diaphragm with water. Replace your diaphragm at least every
two years.
 Contd..
Apply spermicide.
Insert the diaphragm.
Check the diaphragm's position before sex.
Gently remove the diaphragm.
After sex, leave the diaphragm in place for at least six hours
and up to 24 hours. To remove the diaphragm, hook your
finger under the front rim of the diaphragm and gently pull it
down and out of your vagina. If the diaphragm is difficult to
remove, insert your finger between the rim of the diaphragm
and your vaginal wall to break any suction.
After removal, wash the diaphragm with mild soap and warm
water and allow it to air-dry. Store the diaphragm in its
provided container.
 Risks
The diaphragm doesn't offer reliable protection from
sexually transmitted infections (STIs).
In a year of typical use of the diaphragm and spermicide, an
estimated 21 out of 100 women will get pregnant.
Without the use of spermicide, however, an estimated 29
out of 100 women will get pregnant in a year of typical use
of the diaphragm.

Spermicide applied to the diaphragm may rarely damage the

cells lining the vagina, causing:
An increased risk of contracting STIs
Vaginal irritation
Urinary tract or vaginal infection

Success rate: 94%

 Vaginal ring
Vaginal ring is a hormonal birth control device for
women. It's a flexible, transparent plastic ring that's
inserted into the vagina. You wear Vaginal ring for
three weeks, and then remove it allowing
menstruation to occur and then insert a new ring
after a week.
Similar to combination birth control pills, Vaginal ring
prevents pregnancy by releasing hormones into
body. Vaginal ring suppresses ovulation. Vaginal ring
also thickens cervical mucus to keep sperm from
reaching the egg.
 Benefits
Is comfortable and easy to use

Doesn't require a personalized fitting

Eliminates the need to interrupt sex for contraception

Doesn't require the need to remember a daily pill

Is safe for women with latex allergies

Doesn't appear to cause weight gain

 Contraindications
breast-feeding
older than age 35 and smoke
sensitive to any components of Vaginal ring
diabetes with complications related to your blood vessels
history of blood clots
history of breast, uterine or liver cancer
history of heart attack or stroke
liver disease
migraines with aura
uncontrolled high blood pressure
unexplained vaginal bleeding
 Use
Insert Vaginal ring.
No need to remove Vaginal ring during sex. However, if you
prefer, the ring can be removed for up to 3 hours and
then reinserted.
Gently remove Vaginal ring.
After three weeks of continuous use, gently remove Vaginal
ring.
Discard the used Vaginal ring. Don't flush it down the toilet.
Wait one week to insert a new ring. Withdrawal bleeding
usually begins two to three days after removing the ring.
You may still be bleeding when you insert the new ring. If
you locate Vaginal ring in your vagina but can't remove it,
consult physician.
 Use
If vaginal ring falls out, reinsert it.
Vaginal ring can be expelled during tampon removal, sex or a
bowel movement. If Vaginal ring accidentally falls out, rinse
the ring with cool or warm not hot water and reinsert it
within three hours.
If Vaginal ring remains outside of vagina for longer than
three hours, use backup contraception.
If this happens during the first or second week of Vaginal ring
use, reinsert Vaginal ring as soon as possible and use a backup
method of contraception for a week.
If this happens during the third week of Vaginal ring use, discard
the ring.
 Alternatively, if the Vaginal ring is outside the vagina
for more than three hours during the third week, start
using a new ring right away. This may cause
breakthrough spotting or bleeding. Use a backup
method of contraception until you have used the new
ring continuously for seven days.
Vaginal ring, however, can interfere with the
placement of a diaphragm. Don't use a diaphragm as a
backup method of birth control while using Vaginal
ring.
If a ring breaks, discard it and use a new ring.

Success rate: 99.7%

 Risks
Breakthrough
Vaginal infection Increased vaginal
bleeding or
or irritation secretion
spotting

Headache Nausea Depression

blood-clotting
Decreased sex problems, heart
Breast tenderness attack, stroke, liver
drive cancer, gallbladder
disease
 Contact physician
Foul vaginal odour or vaginal itching
Irregular vaginal bleeding during more than
one menstrual cycle
New or worsening headaches
Signs or symptoms of a blood clot in your leg,
such as persistent pain in your calf
Two missed periods or other possible signs of
pregnancy
 Cervical sponge
The contraceptive sponge is a type of birth control that
prevents sperm from entering the uterus. It is soft and disk-
shaped, and made of polyurethane foam.
The contraceptive sponge contains spermicide, which blocks or
kills sperm.
Before having sex, insert the sponge deep inside the vagina so
that it covers the cervix. Vaginal muscles hold it in place. The
contraceptive sponge has a strap on one side for easier
removal.
The contraceptive sponge can prevent pregnancy but doesn't
protect against sexually transmitted infections (STIs).
 Benefits
Doesn't require a prescription or fitting

Can be inserted immediately or up to 24 hours before sex

Provides protection from pregnancy for 24 hours

Can be used as a backup method of birth control

Doesn't require a partner's cooperation

 Contraindications
Are sensitive or allergic to spermicide or polyurethane
Have a vaginal abnormality that affects the way the
contraceptive sponge fits
Have frequent urinary tract infections
Have a history of toxic shock syndrome
Recently gave birth, had a miscarriage or had an
abortion
Are at high risk of contracting HIV or you have HIV or
AIDS
Are at high risk of pregnancy younger than age 30,
have sex three or more times a week, had previous
contraceptive failure with vaginal barrier methods, or
not likely to use the contraceptive sponge consistently.
 Use
Remove the sponge from its package.
Insert the contraceptive sponge.
Check the placement of the contraceptive
sponge.
Leave the contraceptive sponge in place for at
least six hours after sex. However, do not
leave it in longer than 24 hours to reduce the
risk of an infection.
Remove the contraceptive sponge.
Discard the used sponge
 Contact physician
Have signs and symptoms of toxic shock
syndrome, such as sudden high fever,
diarrhea, dizziness, vomiting, fainting or a rash
that looks like sunburn.
Have trouble removing the contraceptive
sponge or you're able to remove only part of
the sponge.

Success rate: 88%

 Risks
An estimated 12 out of 100 women who've never given
birth will get pregnant during the first year of typical
use of the contraceptive sponge.
An estimated 24 out of 100 women who've given birth
will get pregnant during the first year of typical use of
the contraceptive sponge.
The contraceptive sponge doesn't protect against
sexually transmitted infections (STIs).
The contraceptive sponge and the spermicide it releases
may cause:
Vaginal irritation or dryness
Urinary tract or vaginal infection
An increased risk of contracting STIs
Advantages of physical barrier
methods
Do not affect a woman's or man's future fertility.

Are only used at the time of sexual intercourse.

Are safe for a woman to use while she is breastfeeding.

Do not affect other health conditions, such as high blood

pressure or diabetes.

Are less expensive than hormonal methods of birth

control, and some are available without a prescription.

Condoms and diaphragms may reduce the risk of cervical

cancer, STD & HIV.
 Disadvantages of physical barrier
methods
Failure rates for barrier methods are higher than for most other methods of
birth control.

Be prepared to use it every time you have sex.

For some couples, barrier methods are not a good choice because one or
both partners:
Find it embarrassing to use.
Interrupt foreplay or intercourse.
Some people develop allergies to spermicides. But using spermicide is
advised with diaphragms or cervical caps.

For people who have an allergy to latex, polyurethane condoms are

available.
 Chemical barrier methods
Contraceptiv Suppositorie
Creams
e Jelly (Gel) s

Contraceptiv Foaming
Sponge
e Foam tablets

Vaginal Already on
Contraceptiv some
e Film (VCF) condoms
 Spermicide is a type of contraceptive that kills sperm or
stops it from moving. You insert spermicide in the
vagina before sex.
The chemicals in the spermicide, such as nonoxynol-9,
prevent sperm from entering the uterus.
It's available in many forms, including cream, gel, foam,
film, suppository and tablet.
Spermicide isn't a very effective birth control method
when used alone.
However, you can use spermicide with a barrier method
such as a condom, diaphragm or cervical cap to
improve its effectiveness with preventing pregnancy.
Spermicide doesn't protect against sexually transmitted
infections.
 Benefits
Is most effective when used with a barrier
method, such as a condom, diaphragm,
contraceptive sponge or cervical cap

Doesn't require partner cooperation

Doesn't require a prescription

Doesn't have the

same side effects as
hormone-based birth
control methods
Contraindications

frequent
have HIV or
urinary tract
AIDS
infections

not likely to
consistently
high risk of use spermicide
pregnancy along with
other barrier
methods.
 Use

Choose a type
of
spermicide.

Be cautious Apply
after sex. spermicide.
 Contact physician
Persistent vaginal irritation
Recurring urinary tract infections

Success rate: 72% (alone)

Success rate: 97% (combined with condom)
 Advantages

No hormones,
No Spermicide
and nothing
prescription is can act as a
needs to be
needed. lubricant.
taken daily.
 Disadvantages
If used frequently (for example - three times a
day), spermicide may cause irritation of the
vagina or penis. This could increase the risk
of sexually transmitted infections.
Must be used with a condom , cervical
cap , diaphragm or birth control pills for best
effectiveness against pregnancy.
Can be messy, must be re-applied during each act
of intercourse (5-15 minutes beforehand).
May interrupt intercourse.
 Risks
About 28 out of 100 women who use spermicide alone will
get pregnant in the first year of typical use.
Spermicide may increase the risk of urinary tract infections.
Vaginal irritation such as burning or itching or a rash is
the most common side effect of spermicide.
Spermicide may also cause an allergic reaction.
Spermicide doesn't prevent sexually transmitted infections.
Shouldn't be used spermicide rectally because it may cause
irritation and increase the risk of contracting sexually
transmitted infections.
Spermicide may cause penile irritation or burning urination in
sexual partner.
 Hormonal methods

Oral steroidal Parentral

contraceptive contraceptive

Device
 Oral contraceptives

It is given in 2 ways:

Combined preparations

Single preparations
 Combined pills
Combination birth control pills, also known as the pill,
are oral contraceptives that contain estrogen and a
progestin.
Combination birth control pills suppress ovulation.
Combination birth control pills also cause changes in the
cervical mucus and the lining of the uterus
(endometrium) to keep sperm from joining the egg.
Different types of combination birth control pills contain
different doses of estrogen and progestin.
Some combination birth control pills, called continuous
or extended-cycle pills, allow to reduce the number of
periods each year.
 Mechanism
Combined oral contraceptive pills were developed to prevent
ovulation by suppressing the release of gonadotropins. Combined
hormonal contraceptives, including COCPs, inhibit follicular
development and prevent ovulation as their primary mechanism
of action.
Progestagen negative feedback decreases the pulse frequency of
gonadotropin-releasing hormone (GnRH) release by the
hypothalamus, which decreases the release of follicle-stimulating
hormone (FSH) and greatly decreases the release of luteinizing
hormone (LH) by the anterior pituitary. Decreased levels of FSH
inhibit follicular development, preventing an increase in estradiol
levels. Progestagen negative feedback and the lack of estrogen
positive feedback on LH release prevent a mid-cycle LH surge.
Inhibition of follicular development and the absence of a LH
surge prevent ovulation.
 Estrogen was originally included in oral contraceptives for
better cycle control (to stabilize the endometrium and
thereby reduce the incidence of breakthrough bleeding),
but was also found to inhibit follicular development and
help prevent ovulation. Estrogen negative feedback on the
anterior pituitary greatly decreases the release of FSH,
which inhibits follicular development and helps prevent
ovulation.
A secondary mechanism of action of all progestagen-
containing contraceptives is inhibition of sperm
penetration through the cervix into the upper genital tract
(uterus and fallopian tubes) by decreasing the amount of
and increasing the viscosity of the cervical mucus.
Other possible secondary mechanisms have been
hypothesized. One example is endometrial effects that
prevent implantation of an embryo in the uterus.
 Composition
Mala D & Mala N: (21+7 tablets)
Levonorgestrel-0.15 mg + Ethinyl oestradiol- 0.03mg
Each film coated white colored tablet contains
levonorgestrel-0.15 mg and ethinyloestradiol- 0.03mg.
Each brown coloured film coated tablet contains ferrous
fumerate 60mg equivalent to ferrous iron 19.5mg
Loette: (21 tablets)
Desogestrel 0.15 mg + Ethinyl estradiol 20 mg
Yasmin: (21 tablets)
Drospirenone 3 mg + ethinyl estradiol 30 mg
 Monophasic.
In this type of combination birth control pill, each active
pill contains the same amount of estrogen and
progestin.
Biphasic.
In this type of combination birth control pill, active pills
contain two different combinations of estrogen and
progestin.
Triphasic.
In this formulation, active pills contain three different
combinations of estrogen and progestin.
In some types, the progestin content steadily increases
while in others the progestin dose remains steady and
the estrogen content increases.
 Conventional pack.
The most common type of combination birth control pills
contains 21 active pills and 7 inactive pills. Formulations
containing 24 active pills and 4 inactive pills, known as a
shortened pill-free interval, also are available. A pill is taken
every day and a new pack is started when the previous pack is
completed (every 28 days). Bleeding occurs every month
during the week when you take the last four to seven inactive
pills.

Continuous dosing or extended cycle.

These combination birth control pills typically contain 84 active
pills and 7 inactive pills. Bleeding generally occurs only four
times a year during the week when you take the inactive pills.

A 365-day pill is also available. This pill is taken every day at

the same time. For some women, periods stop altogether. For
others, periods become significantly lighter.
 Indications
Decreased risk of ovarian and endometrial cancers, ectopic
pregnancy, ovarian cysts, benign breast disease.
Improvement in acne.
Less severe menstrual cramps (dysmenorrhea).
Reduction in androgen production caused by polycystic ovary
syndrome.
Reduction in heavy menstrual bleeding due to uterine fibroids
and other causes, as well as a reduction in related iron
deficiency anemia.
Relief from premenstrual syndrome (PMS).
Shorter, lighter and more predictable periods or, for some
types of combination pills, fewer periods each year
 Benefits
Prevention and treatment of excessive
bleeding related to uterine fibroids

Prevention of menstrual migraine

Reduction in the menstruation-associated

worsening of certain conditions, including
seizures and asthma

Relief from pain related to endometriosis

 Contraindications
Are in the first month of breast-feeding
Are older than age 35 and smoke
Have poorly controlled high blood pressure
Have a history of or current deep vein thrombosis or
pulmonary embolism, stroke or heart disease, breast cancer
Have migraines with aura
Have diabetes-related complications, such as nephropathy,
retinopathy or neuropathy
Have liver disease
Have unexplained uterine bleeding
Will be immobilized for a prolonged period due to major
surgery
 Risks
Breakthrough bleeding or spotting (more common with
continuous or extended-cycle pills)
Breast tenderness
Elevated blood pressure
Headaches
Nausea & vomiting
Mastalgia
Weight gain
Menstrual irregularity
Libido
Depression
Leucorrhoea
Hypertension
Chloasma & acne
 Contact physician
Abdominal pain
Breast lump
Chest pain
Depression
Difficulty speaking
Eye problems, such as blurred or double vision or loss of vision
Fainting
Jaundice (yellowish discoloration of the skin)
New or worsening headaches
Seizure
Severe allergic skin rash
Severe leg pain or swelling
Severe mood swings
Two missed periods or signs of pregnancy
 Use
Consult your health care provider about a starting date.
If you use the quick-start method, you can take the first pill in the
pack immediately. If you use the Sunday start, you'll take your
first pill on the first Sunday following the start of your period.
When using the quick start or Sunday start, use a backup method of
contraception for the first seven days you take combination birth
control pills. If you use the first-day start, you'll take your first pill
on the first day of your next period. No backup method of
contraception is needed.

Pick a time to regularly take the pill.

Follow your health care provider's instructions carefully.
 Be cautious with missed pills.
If you miss an active pill, take it as soon as you remember even if it means
taking two active pills in the same day. Take the rest of the pack as usual
and use a backup method of contraception for seven days if you missed
your pill by more than 12 hours.
If you miss more than one active pill, take the last pill you missed right away.
Take the rest of the pack as usual and use a backup method of
contraception for seven days.
If you've had unprotected sex, consult your health care provider about
emergency contraception.
Don't take breaks between packs. Always have your next pack ready
before you finish your current pack.
If you vomit within two hours after taking a combination birth control pill or
have severe vomiting and diarrhea for two or more days, proceed as if
you've missed a pill.

Success rate: 99%

 Advantages
It is convenient, simple to take and doesnt interfere
with sexual intercourse.

You can choose to have periods or to have no periods.

Tell the doctor or nurse what option you prefer.

It is not permanent. As soon as you stop taking the pill

you can get pregnant.

The COC pill reduces risk of cancer of the ovary and

endometrium by 50%.

Some pills can improve acne.

 Disadvantages
You must remember to take it.
It must be taken every day whether you have sex on that day
or not.
Some irregular bleeding may occur for a month or two after
starting the pill. This does not mean the pill is less effective as
long as you have not missed pills. If the bleeding continues,
keep taking your pill but check with your doctor.
Your skin may change as dark patches on the face may occur.
Research does NOT show that the pill causes weight gain,
headaches, breast tenderness, nausea or change in libido.
Requires education & motivation.
 Single preparation
Emergency pills
Drugs commonly used:
Levonorgesterel 0.75 mg
Ethinyl estradiol 2.5 mg
Overview:
The morning-after pill is a type of emergency birth
control. The purpose of emergency contraception is to
prevent pregnancy after a woman has had unprotected
sex or after her birth control method has failed.
The morning-after pill is intended for back-up
contraception only, not as a primary method of birth
control. Morning-after pills contain either
levonorgestrel (Plan B One-Step) or ulipristal acetate
(ella).
 Can help prevent pregnancy if had
unprotected sex.

do not end a pregnancy that has implanted.

Depending on where you are in your menstrual
cycle.

Recent evidence strongly suggests that

levonorgestrel doesn't keep a fertilized egg from
implanting.

morning-after pill isn't the same as

Mifepristone.
Contraindications
taking certain
allergy to any medications that
may decrease
component of
the effectiveness
the morning- of the morning-
after pill after pill, such as
barbiturates

overweight or breast-feeding
obese, & pregnancy
 Side effects
Nausea or
Dizziness Fatigue
vomiting

Bleeding between
Headache Breast tenderness periods or heavier
menstrual bleeding

Lower abdominal
pain or cramps
 Use
Follow the morning-after pill's instructions. If you use
Plan B One-Step, take one Plan B One-Step pill as soon
as possible and less than 72 hours after unprotected
sex.
If you vomit within two hours after taking the morning-
after pill, contact your health care provider to discuss
whether to repeat the dose.
Don't have sex until you start another method of birth
control. The morning-after pill doesn't offer lasting
protection from pregnancy.
If you have unprotected sex in the days and weeks
after taking the morning-after pill, you're at risk of
becoming pregnant. Be sure to begin using or resume
use of birth control.
 Risks
Emergency contraception is an effective option
for preventing pregnancy after unprotected sex,
but it isn't as effective as other methods of
contraception and isn't recommended for routine
use.
Also, the morning-after pill can fail even with
correct use, and it offers no protection against
sexually transmitted infections.
Success rate: if taken within 24 hours,
effectiveness is 65% & if taken within 72 hours,
effectiveness is 42%.
Progesterone only contraceptive pills:
Overview:
The minipill, also known as the progestin-only birth
control pill, is an oral contraceptive that contains the
hormone progestin.
Unlike combination birth control pills, the minipill
doesn't contain estrogens. The progestin dose in a
minipill is lower than the progestin dose in a
combination oral contraceptive pill.
The minipill thickens cervical mucus and thins the
lining of the uterus preventing sperm from reaching
the egg. The minipill also sometimes suppresses
ovulation. For maximum effectiveness, must take the
minipill at the same time every day.
 Mechanism
Although such pills are sometimes called "progesterone-
only pills", they do not actually contain progesterone, but
one of several chemically related compounds; and there
are a number of progestogen-only contraceptive
formulations.
The mechanism of action of progestogen-only
contraceptives depends on the progestogen activity and
dose.
Very low dose progestogen-only contraceptives, such as
traditional progestogen-only pills inconsistently inhibit
ovulation in ~50% of cycles and rely mainly on their
progestogenic effect of thickening the cervical mucus and
thereby reducing sperm viability and penetration.
 Contd..
Intermediate dose progestogen-only contraceptives,
such as the progestogen-only pill Cerazette (or the
subdermal implant Implanon), allow some follicular
development but much more consistently inhibit
ovulation in 97 - 99% of cycles. The same cervical
mucus changes occur as with very low dose
progestogens.
The theoretical efficacy is similar to that of
the combined oral contraceptive pill (COCP). However,
this pill is taken continuously without any breaks
between packets, and traditional progestogen-only pills
must be taken to a much stricter time every day (within
3 hours vs. a COCP's 12 hours).
Indication

breast-feeding.

certain health
problems.

concerned about
combination birth
control pills.
 Contraindications:
have or have had breast cancer

liver disease

had weight loss (bariatric) surgery

unexplained uterine bleeding

taking medications for tuberculosis, HIV/AIDS or to control seizures

have trouble taking the pill at the same time every day due to a
changing work schedule or other factors
 Side effects

Irregular
Breast Decreased
menstrual Acne
tenderness libido
bleeding

Depression Fatigue Headache Nausea

Weight gain
Ovarian cysts
or loss
 Use

Failure
Consult rate
health Pick a Be Don't 0.3%
care time to cautious take with
provider regularly with breaks perfect
about a take the missed between use &
starting pill. pills. packs. 9% with
date. typical
use.
 Risks
It's estimated that as many as 13 out of 100
women who use the minipill will get pregnant
in a year of use.
The failure rate of the minipill is thought to be
higher than that of other hormonal
contraceptive methods.
In addition, the minipill won't protect from
sexually transmitted infections.
 Advantages
Decreases menstrual bleeding
Decreases menstrual cramps
Helps prevent against serious health risks such as:
Pelvic Inflammatory Disease
Ovarian and endometrial cancer
Is a good option for women who cannot take
estrogen because they are breastfeeding, or for
whom estrogen-containing products cause severe
headaches or high blood pressure
Easy to take as there is no on & off system
 Disadvantages

You have to
It doesn't remember
Its slightly It may not Does not
control your to take it at
less be as protect
periods, in roughly the
effective effective in against sexu
the way same time
than the women ally
that the each day
ordinary who weigh transmitted
combined (within
Pill. over 154 lbs diseases
Pill does. three
hours).
 Parentral contraception
Injectable:
Combined injectable contraceptive (CIC) is a monthly
injection of progestin and estrogen to suppress fertility.
Depot medroxyprogesterone acetate (DMPA) is a
different injectable contraceptive, containing just a
progestin, given every three months. It is
a progestogen-only injectable contraceptive.
Hormonal contraception works primarily by preventing
ovulation, but it may also thicken the cervical mucus
inhibiting sperm penetration.
Hormonal contraceptives also have effects on the
endometrium, that theoretically could affect
implantation.
 Indications
Don't want to take a birth control pill every day
Want or need to avoid using estrogen
Have health problems such as anemia, seizures, sickle
cell disease, endometriosis or uterine fibroids
Among various benefits, Depo-Provera:
Doesn't require daily attention
Eliminates the need to interrupt sex for contraception
Decreases menstrual cramps and pain
Lessens menstrual blood flow, and in some cases stops
menstruation
Decreases the risk of endometrial cancer
 Contraindications
Unexplained
vaginal
bleeding

Breast cancer

A history of
Liver disease
depression

Sensitivity to
Risk factors for any
osteoporosis components of
Depo-Provera
 Side effects
Decreased
Abdominal Breast
Acne interest in
pain soreness
sex

Irregular
Headaches Dizziness Depression
periods

Nervousnes Weakness
Weight gain
s and fatigue
 Contact physician
Depression
Heavy bleeding or concerns about patterns of
bleeding
Trouble breathing
Pus, prolonged pain, redness, itching or
bleeding at the injection site
Severe lower abdominal pain
A serious allergic reaction
 Use
Consult health care provider about a starting date.
To make sure you're not pregnant when injected with Depo-
Provera, health care provider will likely do first injection
within five days of the start of period.

If you've just given birth and you're not breast-feeding, your

first injection will be done within five days of giving birth.
If you're breast-feeding, your first injection will be done six
weeks after you give birth.
You can start Depo-Provera at other times, but you may need
to take a pregnancy test first.

Prepare for injection. health care provider will clean the

injection site with an alcohol pad. After the injection, don't
massage the injection site.
 Use
Depending on when your start date is, your health care
provider may recommend that you use a backup
method of birth control for seven days after your first
injection.
Backup birth control isn't necessary after subsequent
injections as long as they're given on schedule.
Schedule your next injection. Depo-Provera injections
must be given every 12 weeks. If you wait longer than
13 weeks between injections, you may need to take a
pregnancy test before your next injection to verify that
you aren't pregnant.
Failure rate 0.2 % with perfect use & 6% with typical
use.
 Risks
You may have a delay in your return to fertility. After
stopping Depo-Provera, it may be 10 months or more
before you begin ovulating again. If you want to become
pregnant in the next one year or so, Depo-Provera might
not be the right birth control method for you.

Depo-Provera doesn't protect against sexually transmitted

infections.

There's a potential for loss of bone mineral

density. Research has suggested that Depo-Provera and
Depo-SubQ Provera 104 may cause a loss of bone mineral
density. This loss may be especially concerning in teens
who haven't yet reached their peak bone mass. And it's not
clear whether or not this loss is completely reversible.
 Advantages
Only have to get Depo Provera injections 4 times a year.
Depo Provera may make periods very light, and periods
may stop altogether after a few Depo injections.
It is a highly effective and reversible prescription birth
control option.
Depo Provera does not interfere with having sex, so it
allows for sexual spontaneity.
Is a private and discreet contraceptive choice.
Depo does not contain estrogen, so it can be a good
alternative if you who cannot tolerate estrogen or
use combination contraceptives.
Women who are breastfeeding or are 6-weeks postpartum
can safely use Depo Provera.
 Disadvantages
The package insert of Depo Provera contains a black box
warning about possible bone loss: "Women who use Depo
Provera may lose significant bone mineral density (BMD).
Because of this warning, Depo Provera may not be the
best contraceptive option for adolescent girls.
Many women stop using Depo Provera during the first year
of use due to spotting/irregular bleeding and/or continuous
bleeding. This side effect is especially common during the
first 3 months of Depo use.
In clinical studies, about 6% of women experienced skin
reactions in the area where they got their Depo shot. The
skin around the injection may also get dimpled or feel
lumpy.
It takes an average of 9 to 10 months (and sometimes even
a year or longer) to regain fertility and begin ovulating after
receiving the last shot.
 Disadvantages
During the first year of use, Depo Provera users typically
experience an average weight gain of 3.5 to 5 pounds.
Some women report mild pain associated with the Depo
injection.
You must remember to schedule your injection
appointment every 12 weeks. If its been more than 13
weeks since your last Depo shot (or 14 weeks since your
last Depo-subQ 104 shot), make sure to use a back-up birth
control method because you could be at risk for getting
pregnant.
Due to the possibility of bone density loss, it is also
recommended that it shouldn't be used for more than two
years.

Failure rate:0.2% with perfect use & 6% with typical use

 Implant
Contraceptive implants are a long-term birth control option
for women. A contraceptive implant is a flexible plastic rod
about the size of a matchstick that is placed under the skin
of the upper arm.

It releases a low, steady dose of a progestational hormone

to thicken cervical mucus and thin the lining of the uterus.
Contraceptive implants typically suppress ovulation as well.

One version of contraceptive implant Implanon was

recently discontinued by its manufacturer and replaced
with a newer version called Nexplanon.
Nexplanon is radio opaque, which means it can be seen on
X-ray, which is useful for checking the location of the
implant.
Indication
Can be removed at any time, followed
by a easy return to fertility

Eliminates the need to interrupt sex for

contraception or seek partner
compliance

Provides relief from menstrual pain and

pelvic pain caused by endometriosis

Contains no estrogen
 Contraindication
Are allergic to any components of the
implant

Have had serious blood clots, a heart attack

or a stroke

Have hepatic tumors or liver disease

Have known or suspected breast cancer or a

history of breast cancer

Have undiagnosed abnormal genital

bleeding
 Side effects
Abdominal or back pain
An increased risk of noncancerous ovarian cysts
Changes in vaginal bleeding patterns, including absence of
menstruation
Decreased sex drive
Dizziness
Headaches
Mild insulin resistance
Mood swings and depression
Nausea or upset stomach
Potential interaction with other medications
Sore breasts
Vaginal inflammation or dryness
Weight gain
During the procedure:
You'll lie on your back with the arm that will receive the implant bent
at the elbow and positioned near your head. The health care
provider will locate a groove between the biceps and triceps
muscles on the inner side of upper arm. He or she will inject a local
anesthetic and then use an applicator to insert the device just
beneath skin, above large blood vessels and nerves. Inserting the
device too deeply will make removal difficult.

After the procedure:

The health care provider will feel arm to confirm the presence and
have you do the same. If necessary, he or she may also use an
ultrasound or X-ray to confirm that the device has been inserted.
The health care provider will cover the insertion site with a small
bandage. He or she may also apply a pressure bandage to minimize
bruising. You can remove the pressure bandage in 24 hours, but
keep the small bandage clean and in place for three to five days.
It's common to experience some degree of bruising, pain, scarring or
bleeding at the insertion site.
 Removal
Nexplanon can prevent pregnancy for up to three years. It must be
removed and replaced at the three-year point to continue offering
protection from unintended pregnancy.
To remove the device, the health care provider will inject a local
anesthetic in your arm beneath the implant. He or she will make a
small incision in your skin and will push the implant toward the
incision until the tip is visible and can be grasped with forceps.
The health care provider will then pull out the implant, close the
incision and apply a pressure bandage. Contraceptive implant
removal typically takes less than five minutes.
If you choose, a new device can be implanted as soon as the original
device is removed.
Be prepared to use another type of contraception right away if you
don't have a new device inserted.

Failure rate is 0.05%

 Risks

Does not offer protection from

sexually transmitted infections.

Far fewer than 1 out of 100

women who use Nexplanon for
one year will get pregnant.
 Devices
An intrauterine device (IUD or coil) is a small,
often T-shaped birth control device that is
inserted into a woman's uterus to
prevent pregnancy.
IUDs are one form of long-acting reversible
birth control.
Among birth control methods, IUDs, along
with contraceptive implants, result in the
greatest satisfaction among users.
 Types
These IUDs are divided into 2 types: Copper IUDs (ParaGard)
and hormonal IUDs (Mirena, Kyleena, Skyla, and Liletta).
There are 5 different brands of IUDs that are FDA approved
for use in the United States: ParaGard, Mirena, Kyleena, Skyla,
and Liletta.
The ParaGard IUD doesnt have hormones. Its wrapped in a
tiny bit of copper, and it protects from pregnancy for up to 12
years.
The Mirena, Kyleena, Skyla, and Liletta IUDs use the
hormone progestin to prevent pregnancy. Progestin is very
similar to the hormone progesterone.
Mirena works for up to 6 years. Kyleena works for up to 5
years. Skyla and Liletta work for up to 3 years.
Paragard IUDs:
Non hormonal IUDs:
Most copper IUDs have a plastic T-shaped frame that is
wound around with pure electrolytic copper wire and/or has
copper collars (sleeves). The arms of the frame hold the IUD in
place near the top of the uterus Copper IUDs primarily work
by disrupting sperm motility and damaging sperm so that they
are prevented from joining with an egg.
Copper acts as a spermicide within the uterus, increasing
levels of copper ions, prostaglandins, and white blood cells
within the uterine and tubal fluids.
The increased copper ions in the cervical mucus inhibit the
sperm's motility and viability, preventing sperm from
travelling through the cervical mucus, or destroying it as it
passes through.
The Paragard TCu 380a measures 32 mm (1.26") horizontally
(top of the T), and 36 mm (1.42") vertically (leg of the T).
 Hormonal IUDs
IUD with progestogen:
Hormonal IUDs work by releasing a small amount
of levonorgestrel, a progestin.
The primary mechanism of action is making the inside
of the uterus fatal to sperm. They can also thin the
endometrial lining and potentially impair implantation
but this is not their usual function.
Because they thin the endometrial lining, they reduce
or even prevent menstrual bleeding, and can be used
to treat menorrhagia (heavy menses), once pathologic
causes of menorrhagia (such as uterine polyps) have
been ruled out.
The progestin released by hormonal IUDs primarily acts
locally.
 Time of insertion
Interval:
When the insertion is made in the inter conceptional
period beyond 6 weeks following delivery. It is
preferable to insert 2-3 days after the period is over.
But it can be inserted any time during the cycle even
during the menstruation phase has certain advantages
like open cervical canal, distended uterine cavity, less
cramps.
During lactation amenorrhoea, it can be inserted at any
time.
Postabortal:
Immediately, following termination of pregnancy by
suction evacuation or D & E, or following spontaneous
abortion, it may be inserted.
 Time of insertion
Postpartum:
Insertion of device can be done before the
patients are discharged from the hospital.
Because of high rate of expulsion, it is
preferable to withhold insertion for 6 weeks
when the uterus will be involuted to near
normal size.
Postplacental delivery:
Insertion immediately following the delivery of
placenta could be done. But the expulsion rate
is high.
 Technique of insertion
The patient should be shown her IUD prior to insertion and
receive an explanation of the insertion procedure.
A bimanual examination must first be performed to evaluate
uterine position, size, and mobility. If the clinician finds the
pelvic organs to be abnormal or there is excessive tenderness
on uterine or cervical manipulation, IUD insertion should be
postponed until further investigation ensures the absence of
infection.
The uterus must be sounded to ensure that its size is between
6 and 10cm, inclusive of the cervical canal (for a ParaGard, the
recommended upper limit is 9cm).
Immediately prior to insertion, the IUD should be loaded into
its plastic inserter according to the directions provided with
the package.
 Technique of insertion
The IUD should be inserted using aspectic technique. The
cervix is swabbed with an antiseptic solution and the anterior
lip grasped with a tenaculum.
Steady traction is exerted on the tenaculum to straighten the
cervical canal, and the inserter advanced through the cervical
os into the uterine cavity. The directions should then be
followed to place the IUD high in the fundus.
The retaining string is cut to a length of about 4cm from the
external os.
If the strings are cut too short initially, they will be difficult for
the inexperienced user to feel. The strings can always be cut
shorter later if they protrude from the introitus.
Since most women experience uterine cramping during and
immediately after insertion, NSAIDs should be administered
before insertion and as needed thereafter.
 After insertion
Following insertion, the woman should examine herself
vaginally to palpate the strings or should be given a
piece of the cut string to feel.
It can be helpful to use a mirror so that she can actually
see the cervix and protruding strings before feeling
them.
She should palpate the strings before each act of
intercourse until she returns for a follow-up
examination after her next menses.
Thereafter, self-examination following each menses is
adequate to ensure that her IUD is in place.
She should also be instructed to use another
contraceptive and return for evaluation if she fails to
feel the IUD strings.
 Side effects
Missed period Dizziness,
Bleeding and spotting Nausea & vomiting,
between periods, Breast tenderness or pain,
Heavier bleeding during the Weight gain,
first few weeks after device Changes in hair growth,
insertion, Acne,
Abdominal/pelvic pain, Depression,
Ovarian cysts, Changes in mood,
Back pain, Loss of interest in sex,
Headache/migraine, Itching or skin rash, and
Nervousness, Puffiness in the face, hands,
ankles, or feet.
 Follow up visit
Subsequent to insertion, the follow-up visit after the first
menses should include the patient's account of her
experience with the IUD, including her ability to feel the
string and changes in her menses.
The visit should also include a pelvic examination to
determine the intrauterine position of the IUD and to
assess for cervical or abdominal tenderness requiring
further workup for possible pelvic infection.
IUDs are discontinued by 10% to 20% of users in the first
year.
Approximately 5% of discontinuations are because of
expulsion; the other most common reasons are pain or
bleeding.

Success rate: 99.2-99.9%