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1. Barrier Methods:2. a. Natural methods
b. Physical methodsc. Chemical methodsd. Combined Methods
2. Intra-Uterine Devices3. Hormonal Methods4. Post-Conceptional Methods5. Miscellaneous
Coitus interruptus Rhythm method or safe period
methods This method is to abstain from sex during
fertile period. Temperature change method The basal body temp in a fertile women
rises by 0.4 to 1.0 F during ovulation. Lactation Ammenorrhea method Exclusive breast feeding in Lactation
Ammenorrhea offers saves from pregnancy
Advantages:a. Easily available b. Safe and inexpensivec. Easy to used. No side effectse. Light, compact and disposable f. Provides protection against STDs &
cervical cancer Disadvantages:a. It may slip off or tear during coitus due to
incorrect use, b. Interferes with sex sensation locallyc. Can cause irritation or allergic reaction.
Vaginal spermicidal agentsFailure rate of spermicides when
used alone is 10 to 20 percent. Vaginal contraceptive sponge
‘Today’ is the name given to vaginal contraceptive sponge available in USA and UK.
IUD is a device based on spacing method of contraception , requiring one time insertion procedure and is effective for long duration
( 3-10 yrs depending on the type of IUD used).
Types of IUCDNon-medicated:
Lippies loop, spirals, coils, ringsMedicated:
Copper, silver core, Multi load Devices Release of hormones▪ Progestasert▪ Levonorgestril
Foreign body, cellular and biochemical changes in endometrium - impair viability of gametes
Hormone releasing devices increase viscosity of the cervical mucus
High level of progesterone – unfavorable for implantation.
Most effective methodSimple, in a few minutes Long acting, may be for 5-10
yearsInexpensiveReversible Lower incidence of side-effects,
free of metabolic side effects
Highest continuation rateNo need for continued motivation
Easier to fit even in nulli parous women
Better tolerated by nulli para Effective as post-coital contraceptive
At present, the most widely accepted view is that the IUCD causes a foreign-body reaction in the uterus causing cellular and biochemical changes in the endometrium and uterine fluids, and it is believed that these changes impair the viability of the gamete and thus reduce its chances of fertilization, rather than its implantation.
Suspected pregnancy Pelvic inflammatory diseasesVaginal bleeding of undiagnosed
aetiologyCancer of the cervix, uterus or
adnexiaPrevious Ectopic pregnancy
AnaemiaMenorrhagia H / O PID since last pregnancyPurulent cervical dischargeMalformations,FibroidsUnmotivated client or person
Who has borne at least one child
Has no history of pelvic disease Has normal menstrual periods Is willing to check the IUD tail Has access to follow-up and
treatment of potential problems
Any time during reproductive ageDuring menstruation or within 10
days of the beginning of menstrual cycle
First week after delivery-immediate postpartum insertion
Better time is at 6-8 weeks after delivery-post puerperal insertion
1. Bleeding, greater loss, prolonged period 2. Pain 3. Pelvic infection 4. Uterine perforation 5. Pregnancy 6. Ectopic pregnancy 7. Expulsion 8. Fertility after removal 9. Cancer and teratogenesis 10. Mortality
Most effective spacing method 100% effectiveSynthetic estrogens
▪ Ethinyl oestradiol▪ Mestranol
Synthetic progesterone▪ Pregnanes▪ Oestranes▪ Gonanes
A. Oral Pills1. Combined pill2. Progestogen only pills (POP)3. Post-coital pills4. Once-a-month (long-acting) pill5. Male pills
B. Depot (slow release) formulations1. Injectables2. Subcutaneous implants3. Vaginal rings
Major spacing method 30-35 microgram of synthetic
estrogen0.5-1.0 microgram of progestogen.Pill is given orally for 21 consec.
Days, starting on 5th day of menstrual cycle
Pill is taken every day at a fixed time
Morning afterWithin 48 hours of unprotected
intercourse IUCDHormonal: high doses of estrogen
and progesterone2 pills immediately & 2 pills after 12
hours
Prevents the release of ovum from ovary by locking pituitary secretion of gonadotropin.
Progesterone only pills renders the mucus thick, scanty that inhibits sperm penetration.
Progesterone also inhibits tubal motility
OCP are 100 % effective if taken regularly
Certain drugs affects the effect of OCP
100 % effective contraceptionProtection against
Benign breast disorders Ovarian cysts Iron deficiency anaemia PID Ectopic pregnancy Ovarian cancer
Cardiovascular effects Carcinogens Metabolic effects
▪ Elevation of BP, decrease in high density lipoprot.▪ Blood clotting, increase sugar level▪ Increase in atherogenesis▪ Increase in myocardial infarction & stroke
Others: Liver disorder, lactation, fertility, ectopic preg. Breast tenderness, weight gain, headache, Bleeding disturbances , Foetal development
Cancer of breast & genitals Liver disease Cardiac diseases, DVT Congenital hyperlipideamia Undiagnosed abnormal uterine bleeding Age above 40 & smoker at age 35 Hypertension, migraine, headache,
epilepsy, diabetes, gall bladder disease Nursing mother in first 6 months
Above 40 years of ageAbove 35 years of age & heavy
smokerH / O SeizuresSevere pain in the calves or thighsSymptomatic varicose veins in the
legsSevere chest pains, shortness of
breathSevere headacheVisual problems
Lactating less than 6 months Inter menstrual bleeding Bleeding after sexual intercourseAmenorrhoeaAbnormally yellow skin & eyesHigh Blood pressureMass in the breastOedema - legs
Injectables: DMPA 150 mg every 3 months 99%, safe, effective, acceptable during
lactation Wt. gain, irregular menstrual bleeding prolonged infertility NET-EN 300 mg 2 months Inj. During first 5 days of menstruation Deep intramuscular into gluteus maximus. Never massage ± 2 weeks
Sub dermal implants Norplant ▪ 6 silicone rubber capsules containing 35 mg
of Levonorgestril▪ Implanted under the skin of left upper arm
Permanent methods1.Male sterilization2.Female sterilization
Females 90 – 95%Males 5 – 10%One time method, no sustained
motivationRisk of complications is rare
Post-operative advice1. Patient is not sterile immediately after the operation2. At least 30 ejaculations may be necessary before the
seminal examination is negative3. To use contraceptives until aspermia has been
established 4. To avoid taking bath for at least 24 hours after the
operation.5. To wear a T-bandage or scrotal support for 15 days
and to keep the site clean and dry6. To avoid cycling or lifting heavy weights for 15 days7. Remove stitches on the 5th day after the operation.
It is the most widely used contraceptive method. The procedure can be carried out in the immediate post menstrual and post partum period.
Laparoscopic sterilization is most commonly employed method.
Failure and complications only due to surgical skills.
Thread attached with IUCD is meant for Anti inflammatory effect Device can be pulled out when needed Shape of loop Assurance of loop’s presence Blocking of sperm penetration
Most effective contraceptive method for spacing between pregnancies is IUCD Oral pills Condom Vasectomy Abstinence from sexual intercourse