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7/31/2019 physiology behind contraceptive methods.pptx
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Dr. Niranjan Murthy HL
Associate Professor
Department of Physiology
SSMC, Tumkur
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Preventive methods to help woman avoidunwanted pregnancies
A method or a system which allows intercourseand yet prevents conception
Include temporary and permanent methods
Cafeteria choice
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Barrier Methods
(a) Physical methods:(i) Condom:
Nirodh
Failure rate of 2-3/100 women years
Advantages: Safe, inexpensive, easy to use,
prevent STD, no side effects
Disadvantages: May slip off or tear, Interferes
with sexual sensation
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(ii) Diaphragm:
Dutch capSynthetic rubber or plastic
Spermicidal jelly is used
Failure rate 1.9/100 women-yearsAdvantages: no risks and no medical
contraindications, prevents STDs
Disadvantages: needs practice at insertion,privacy, cant be used immediately after childbirth, Toxic Shock Syndrome
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(iii) Vaginal sponge:
Today
Polyurethane foam sponge soaked in
nanoxynol-9
Less effective than diaphragm
Prevents STDs
Toxic Shock Syndrome
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(b) Chemical methods:
Spermicides were widely used in 1960s
Foams, Pastes, Jellies, Creams, Suppositories,
Soluble films
Modern spermicides are surface active
agents- inhibit oxygen uptake of sperms
Disadvantages: must be applied immediatelybefore intercourse, high failure rate, may
cause irritation
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(b) Intrauterine Devices:
On-medicated and Medicated
(i) First generation IUDs: inert Lippes loop
spirals, coils, rings, bows, loops
Barium sulphate Tails made of nylon
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(ii) Second generation IUDs:
Metallic copper was added
Smaller devices which fit into nulliparous copper-7; Copper T-200; T Cu-220 C; T Cu-
380 A; Nova T, ML-Cu-250
low expulsion rate, easier to fit, nulliparous,post-coital, more effective
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(iii) Third generation IUDs:
Release of hormoneProgestasert
Mechanism of action of IUDs:Foreign body reaction
Copper alters biochemical composition ofcervical mucus
Hormonal devices maintain sustained high levelsof progesterone
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Failure rate of 3-5/100 women-years
Maintained for 2-4 yearsAdvantages: simple, Inexpensive, no systemic side-
effects, high continuation rate
Contraindications: suspected pregnancy, PID,Cancer of cervix, uterus
Timing of insertion: during menstruation or 10 dayswithin the beginning; 6-8 weeks after delivery
Disadvantages: Bleeding, Pain, Pelvic infection,Uterine perforation, Pregnancy, Ectopicpregnancy
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(c) Hormonal contraceptives:
I. Oral pills:
A. Combined pill
B. Progestogen only pill
C. Post-coital pill
D. Once-a-month pill
E. Male pill
II. Depot formulations:
A. Injectables
B. Subcutaneous implants
C. Vaginal rings
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Combined pill:
Mala- N: Levonorgesterol + Ethinyl Estradiol
Mala- D: Levonorgesterol + Ethinyl estradiolPackage of 28 pills
Progestogen-only pill:Minipill or micropill
Norethisterone or levonorgesterol
Poor cycle controlMay lower HDL
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Post-coital contraception:IUDs
Hormonal pills
I pillOnce-a-month pill:
Failure
Male pill:
Gossypol a derivative of cotton-seed oil
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Mechanism of OCP action:
Inhibit ovulation by feedback inhibition of LH
& FSH
Progestogen render cervical mucus thick
Progestogens inhibit tubal motility
Failure rate: < 1 per 100 women-years
Adverse effects: Cardiovascular side effects,
cervical cancer, hypercoagulability of blood,
weight gain, liver disorders, breast tenderness
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(d) Postconceptional methods:
(i) Menstrual regulation
(ii) Menstrual induction: prostaglandins
(iii) Abortion
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(e) Miscellaneous:
(i) Abstinence
(ii) Coitus interruptus
(iii)Safe period or rhythm method
(iv)Natural methods
- Basal Body Temperature
- Cervical mucus method
(v) Breast feeding
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Rhythm method (Calendar method):
Ovulation in 28 day cycle between 12-16 days
Ova can survive for 1 day
Sperms can survive for 3 days
Unsafe period is between 9 and 17 days in 28
day cycle
Shortest cycle minus 18 days and longestcycle minus 10 days
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Basal body temperature:
Reliable for post-ovulatory period
increase in BBT by 0.5 C during ovulation
Billing method:
Cervical mucus becomes slippery and wateryclear during ovulation
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Terminal methods
(a) Male sterilization: Vasectomy
Simple and short duration surgery
Spermatogenesis and hormonal production
are not affected
Sperms are phagocytosed
Not sterile till 30 ejaculations
Complications: operative complications;spontaneous recanalization; sperm granules;autoimmune response
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(b) Female sterilization: Tubectomy
Laporoscopy, minilaparotomy
6 weeks after delivery