Contraception

By: Hasvini Sivam Shalini Soorya Harmeet Kaur

Classification
Hormonal
Combined hormonal contraception The pill Patches The vaginal ring Progesterone-only prep Progesterone-only pills Injectables Subdermal implants

Non-hormonal
Intrauterine Contraception copper IUD & hormone releasing IUS Barrier methods Condoms Female barriers Coitus interruptus Natural family planning

Hormonal emergency contraception

Sterilization - Female sterilization & Vasectomy

NON HORMONAL CONTRACEPTION

Females

Intrauterine Contraception
Characteristics Failure rate in first year of use Mode of Action 0.8% Copper IUD Mirena Hormone releasing intrauterine system 0.1% Toxic effect on both sperm & egg Local hormonal effect on the acting prior to fertilization cervical mucus and endometrium has a capsule containing levonorgestrel which releases a daily dose of hormones

Duration of use
Effect on menstrual cycle Menstrual Spotting Hormonal Side Effects

10 years
Periods can become heavier with more pain Often more days of spotting before & after periods None

5 years
Irregular but much lighter usually become amenorrheic Erratic spotting very common initially but usually settles May cause greasier skin ad acne, breast tenderness, mood swings normally resolve with time Helps heavy and painful periods More expensive

Therapeutic benefits Average cost

None cheaper

Intrauterine Contraception
Advantage a medium to long term method of contraception independent of intercourse regular compliance is not required Disdvantages risk for infections (PID esp) for promiscuous women will not protect against chlamydia & gonorrhea Risk for ectopic pregnancy - 3-5%

Contraindications: Current STI/PID, including post abortion & following childbirth Malignant trophoblastic disease Unexplained PV bleed Endometrial & cervical ca Known malformations of uterus, e.g fibroids Copper allergy

Female Barrier Methods - Diaphragm

Advantage Easy to use inserted immediately prior to intercourse and removed 6 hours later Offers protection against PID Disadvantage Requires careful teaching and fitting Increases risk of UTI and vaginal irritation

Female Barrier Methods Natural Family Planning

Involves Abstaining from intercourse during the fertile period of the month by

calculating: Changes in basal body temp Changes in cervical mucus Tracking cycle days Breastfeeding mothers use lactational amenorrhoea method (LAM)

Advantages No physical side effects natural No cost Reversible

Disadvantage Failure rates quite high as couples find it hard to abstain from intercourse when required

Sterilization For Women

Normally chosen by older couples who are sure they have completed their families Involves mechanical blockage of both fallopian tubes to prevent the sperm reaching & fertilizing the oocyte Also can be achieved by hysterectomy or total removal of both fallopian tubes Most commonly done by laparoscopy under GA

Techniques: Clips occasionally might not occlude whole tube Fallope rings easy to apply, damages 2-3cm of tube reversal is difficult Ligation suitable for postpartum mini laparotomy high failure rate Electrocautery may damage surrounding structures bowel and bladder, high failure rate Essure inserted via hysteroscope under LA, expanding metal springs placed into fallopian tube proximally scar tissues grows round the metal springs and blocks the tubes

Sterilization
Advantage Highly effective Will not alter subsequent menstrual patterns Disadvantages Reversible but pregnancy rates reduced to 25% Many regret doing it May experience anaesthetic problems or there might be damage to intraabdominal organs during the procedure Can get ectopic pregnancy if this fails