Dr. Mona A. AlmushaitDr. Mona A. Almushait

Methods of ContraceptionMethods of Contraception

I. Combined Hormonal Products

Oral contraceptive pillsDepot medroxyprogesterone acetate injections

Transdermal patches and Vaginal rings

II. Barrierand

Behavioral Methods

Male condoms, DiaphragmsCaps, Female condoms, Spermicides

Withdrawal, Fertility awareness method, Natural family planning

III. Longer Term

Progestin implants and Intrauterine devices

IV. Sterilization

Female sterilization and Vasectomy

Combined Estrogen and Progesterone Contraceptives

Oral contraceptive pills Monthly injections

Transdermal patches Vaginal rings

1. Combined Hormonal Products

Mode of action: Suppression of the LH surge (to prevent

ovulation) → to inhibit ovulation

Thickening of the cervical mucus (to prevent sperm entering the upper genital

tract)

Other mechanisms:→ slowing of tubal transport

→ atrophy of the endometrium  

Thromboembolism Post pill amenorrhea Cerebrovascular accidents Increased in Cholelithiasis (cholestatic jaundice)

HTN Benign hepatic tumors (Hepatoma)

Headache in the week off

Complications of Estrogen–Containing Contraceptives:

Contraindications to the Use of Estrogen–Containing Contraceptives

ABSOLUTE

Arterial thrombosis

Venous thrombus (Thromboembolism)

Pulmonary embolism

Coronary vascular disease, IHD → cardiomyopathy, vascular heart disease

Past cerebrovascular accident

Pulmonary HTN

Current pregnancy

Breast cancer within the last 5 years

ABSOLUTE Cont’d Endometrial cancer

Hepatic tumor or abnormal liver function, Dubin–Johnson or Rotor syndrome, known

gallstones

Unexplained abnormal uterine bleeding

Age >35 and cigarette smoking

Uncontrolled hypertension

History of melanoma

Hyperlipidaemia, focal and crescendo migraine

Trophoblastic disease

RELATIVE Risk factor for arterial disease

Complicated prolonged Diabetes

Estrogen–dependent neoplasm

Depression, Hyperprolactinemia

Severe varicose veins

Hypertriglyceridemia

Increasing age, smoking, obesity, migraine

PoPs are taken as a continuous preparation, in 28 day packs.

Taken at the same time each day

Mode of action: Thicken the cervical mucus Inhibit ovulation Twining the endometrium

Progestin–Only Hormonal Methods of Contraception

(POPs)

Safe → when oestrogen–containing pills cause side effects, or contraindicated

Smokers, immediately post–partum, breastfeeding, risk of DVT, hypertension, migraine, or diabetes,

PMS Pills most frequently used by breastfeeding women

Side effects: Menstrual changes

Amenorrhea ↑ functional ovarian cyst

↑ risk of ectopic pregnancy Acne, headache, breast tenderness, nausea,

irregular bleeding Weight change

↑Breast cancer diagnosis

DMPA (Depo–Provera) 150 mg every 3 months, I.M.

Suppresses gonadotropins to inhibit ovulation

Change cervix mucus (thickening)

Twining endometrium

Advantages:

High efficacy

No need to remember to take a pill

Use when oestrogen contraindicates

No increased in ovarian cyst or risk of ectopic pregnancy

Disadvantages:

Delayed of fertility, weight gain, irregular bleeding and amenorrhea

↑ risk of Osteoporosis due to long term Medroxy progesterone acetate

Contraindications:

Pregnancy

Severe arterial disease

Undiagnosed vaginal bleeding

Liver disease

Applied once a week to the abdomen, buttock, upper outer arm.

The patch releases 150 µg of norelgestromin and 20 µg of ethinyl estradiol to inhibit ovulation.

3-consecutive 7-day pathches (21 days) are applied followed by 1 patch free week per cycle.

Transdermal Patch

Advantages: Very effective Rapidly reversible

Disadvantages: Requires a prescription Skin reactions Slight increase in risk of VTE

compared with COCs

A thin, transparent, flexible ring that contains oestrogen/progestogen hormones.

It stops ovulation and thickens the cervical mucus.

Advantages: Easy to use Can be worn for 3 weeksDisadvantages: Does not protect against STD Spotting Increased vaginal discharge

Vaginal Ring

II. Barrier and Behavioral Methods

Advantages: ↓transmission of STD, HIV,

Chlamydia and Gonorrhea Easily obtained

Disadvantages: Allergy Loss of sensation Slippage/breakage

Male Condom

To be filled and coated with spermicide 84% to 94% effective for pregnancy

prevention Must be left in place for at least six hours.

Advantages: Easy use Protection from sexually transmitted

infections

Disadvantages: Cystitis Skin irritation

Diaphragm and Cap

A lubricated polyurethaneA lubricated polyurethane

Advantages: Prevents the transmission of

infection No hormonal side effects

Disadvantages: Loss of sensation Can break or leak

Female Condom

Jellies come in tubes and are usually used with a diaphragm or cervical cap.

It allows for immediate protection, which lasts for about 1 hour.

Jelly

Small, donut-shaped foam Small, donut-shaped foam that contains a spermicidethat contains a spermicide

A non hormonal barrier A non hormonal barrier method of birth controlmethod of birth control

Vaginal Contraceptive Sponge

Advantages:Advantages:

It kills the spermIt kills the sperm

It blocks the semen fluids from It blocks the semen fluids from

entering the cervical canalentering the cervical canal

No hormones are involved No hormones are involved

Disadvantages:Disadvantages:

IrritationIrritation

No protection against infectionNo protection against infection

Vaginal Contraceptive Foam Vaginal Contraceptive Foam

A paper-thin translucent film that A paper-thin translucent film that contains a spermicidecontains a spermicide

Its is placed in the vagina or near Its is placed in the vagina or near the cervix where it dissolves in the cervix where it dissolves in secondsseconds

It is effective for about one hourIt is effective for about one hour

Film

Behavioral Methods  

Natural family planning Tracking basal body temperature

Checking the consistency of cervical mucus → Moist, sticky, white pre–ovulation, clear, copious

and stretchy spinnbarkheit → The most fertile time

Time in cycle

→ Ovulation occurs every 12–16 days before a period

→ Pain from ovulation, breast change → less

Lactational amenorrhea

Withdrawal or coitus interruptus

III. Longer Term Progestin Implants and

Intrauterine Devices

It is placed in the s/c layer of the medial aspect of a woman’s upper arm to release steady amounts of

Levenogestrel → 5 years Have low circulatory levels of

progestin Suppress ovulation and change cx

mucus Twining endometrium

Implant

Disadvantages:Vaginal spotting

Weight gainHair or skin changes

HeadachesDepression

Decreased libido

Contains 52 mg of Levenogestrel

20 µg of Levenogestrel every 24-hr.

T–shape

Effective for at least 5 years

Levenogestrel–Releasing Intrauterine System (LNG–IUS)

Mode of action: Thickens the cx mucus

Twins the endometrium→atrophic endometrium

Inhibition of ovulation

Disadvantages:

Amenorrhea

Irregular bleeding for the first 3 months

↑ functional ovarian cyst

Expulsion and perforation

Contraindications: Pregnancy

Active liver disease

Severe arterial disease

Undiagnosed irregular bleeding

Mechanical heart valves

Untreated STD

Hx of ovarian or endometrial carcinoma

Mode of action: Copper is spermicidal

It is inserted in the first 7 days of cycle with antibiotics cover

Inflammatory changes to prevent implantation

Disadvantages: Pregnancy with I.U.C.D.

Increased rate of Ectopic pregnancy ↑ Menorrhagia

↑ PID Perforation and expulsion Actinomycosis → cx smear

Lost coil

Copper T380A I.U.D.

IV. Female sterilization and Vasectomy

Advantages: Permanent birth

control Immediately effective Requires no daily

attention Not messy Cost-effective in the

long run

Disadvantages: Does not protect

against STD Requires surgery May not be reversible Possible regret Possibility of Post

Tubal Ligation Syndrome

Permanent sterilization is the most common method of birth control used.

Mini Laparotomy sterilization Laparoscopic sterilization

Sterilization

One common form of female sterilization is the use of Hulka clips to block the fallopian tubes.

One common form of laparoscopic (camera) sterilization is the use of Filshie clips to occlude both fallopian tubes.

FILSHIE CLIP TUBAL LIGATION

HULKA CLIP STERLIZATION

VASECTOMY (interruption of the vas deferens)

It is a minor surgical procedure wherein the vasa deferentia of a man are severed, and then tied/sealed in a manner which prevents sperm from entering the seminal stream.

Risks include: Infection

Bleeding

Scrotal pain or swelling at the time of the procedure