CONTRACEPTIVE METHODS

Dharmesh Singh Thakuri

D.Ph./BPH/M.Psychology
CONTRACEPTIVE METHODS
 Contraceptive methods are ways to prevent pregnancy and also protect from
sexually transmissible infections (STIs).
 Contraceptive methods is the use of methods or devices to prevent
unintended/unwanted pregnancy. Birth control has been used since ancient times,
but effective and safe methods birth control only became available in the 20th
century.
 They include all temporary and permanent measure to prevent pregnancy
resulting from coitus (sexual intercourse).
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An ideal contraceptive is one that meets the following criteria:
 It should be easily usable by both males and females.
 It should be easily removable.
 It should not have any side effects.
 It should be inexpensive and cost-effective.
 It should be effective for preventing pregnancy and sexually transmitted
infections (STIs).
 It should not interfere with the normal sexual drive or libido of the couple.
 It should not affect the future fertility of the couple.

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 CLASSIFICATION
A. Spacing Method (Temporary Methods) B. Terminal method (Permanent Methods)
1. Barrier Methods 1. Male Sterilization (Vasectomy)
i) Physical method (Condom, female condom, 2. Female sterilization (Minilap and
Diaphragm)
Laparoscopy) .
ii) Chemical method (Spermicides)
2. Intra uterine Devices (Copper T)

3. Hormonal method (Oral Contraceptives Pills)

4. Post –Conceptional Methods
5. Miscellaneous

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A. Spacing Method (Temporary Methods) :
1. Barrier Methods
 Barrier methods are Suitable both men and women.
 The aim of these methods is to prevent live sperm from meeting the ovum.
 Major contraceptive advantage is the absence of side effects associated with Pill & IUD.
Some benefits of barrier methods are:
 They are easy to use and can be bought without a prescription in most drugstores.
 They have no effect on your natural hormones or your future fertility.
 They can protect against some STIs, especially condoms.
 Encourage male participation in contraception.

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Barrier Methods
i.) Physical method (Condom, female condom, Diaphragm)

Sub UNIT 4.5

Condom :
 A condom is a type of barrier method of contraception that prevents
sperm from entering the vagina.
 Condom is a rubber sheath fitted onto the erect penis before
intercourse.
 Condoms can be worn over the penis (male condoms) or inserted
into the vagina (female condoms) before sex.
 It is very effective when used correctly every time a couple has sex.
 It is most widely known and used device by male .
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Mechanism of Action
Blocks the man’s sperm from entering the vagina.
Effectiveness
Very effective when used correctively every time a couple has sex.
Advantages
 Effective immediately.
 Inexpensive, generally available.
 No prescription, medical examination or supervision necessary.
 Encourage male participation in contraceptive use.
 Fairly effective if used properly and with each intercourse.
 Protects against HIV/AIDS, Hepatitis B virus, STIs.
 They are easy to use.
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Disadvantage :
High user failure rate (3-5 pregnancies/100 women).
May reduce penis sensitivity.
 Requires use of a new condom with each episode of intercourse.
 May diminish sexual pleasure.
 Requires supplies to be present when intercourse occurs.
 Problem of disposal after use.
Allergy.

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Non-contraceptive Benefits:
Latex condom help to prevent the spread of AIDS/STIs.
Lubricated condom facilitates intercourse if the vagina is dry (Example Older
women or women who are breastfeeding).
It may help to decrease premature ejaculation in males.
Can be used by men whose partner is allergic to sperm.

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Indication:
Women of any age, including adolescents.
Single people who need occasional contraception.
Couples who want to space children.
Couples who have agreed together to use condoms.
Couples who are worried about side effects of other methods.
Couples who have sex only once in a while.
Individuals with more than one sexual partner.

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 Management of side effect of condom
Side Effects/ problems Management

Condom breakage  Use a new condom or use spermicidal.

 Consider emergency contraceptive.

Local irritation to the penis If allergic reaction apparent and persists

switch to another.

Diminished sexual pleasure Decreased sensitivity is not tolerable

switch to another method.

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Diaphragm
 A diaphragm is a reusable, hormone-free device that women
insert into their vaginas to block sperm from reaching their uterus
and fertilizing an egg.
 It is a barrier method of birth control that should be used with
spermicide, a chemical that kills or immobilizes sperm.
 It is a shallow, dome-shaped, silicone cup that covers the cervix. It
gives women control over their birth control, as they only need to
use it when they have sex.
 A diaphragm must be inserted before sex with spermicide and left
in place for at least six hours after sex.

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Advantages:
It is a non-hormonal method, which
means it does not interfere with your
natural cycle or have hormonal side
effects.
It has a low cost and can be used for up
to 2 years with proper care.
It is effective right away and you can get
pregnant as soon as you stop using it.
The association with spermicide may
protect against cervical cancer.
DHARMESH- BPH/M.PSYCHOLOGY
Disadvantages:
• It requires your ability and practice
for insertion and removal.
• It should be placed before and
removed after intercourse, which can
cause discomfort or inconvenience
for some people.
• It is not recommended for use during
the menstrual period.
• It does not protect against sexually
transmitted infections (STIs).
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 SUB UNIT- 4.6
2. CHEMICAL METHOD (FOAMING TABLETS AND SPERMICIDES)

 Chemical methods are a type of birth control that use spermicides to prevent
pregnancy. Spermicides are substances that kill sperm or stop them from moving.
 Foaming tablets: These are tablets that dissolve in the vagina and create a foamy
substance that blocks and kills sperm. They should be inserted at least 10 minutes
before sex and can last up to one hours.
 Spermicides: These are gels, creams, foams, films, or suppositories that contain a
chemical called nonoxynol-9 that kills sperm. They should be applied inside the
vagina before sex and can last up to one hour. Some spermicides may also protect
against cervical cancer.
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It is available in different forms as;
Foam tables, foam aerosols.
Cream, jellies and pastes.
Suppositories (inserted manually).
Soluble film-C (film inserted manually).

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 MECHANISM OF ACTION

Modern spermicides are ‘Surface active agent” which attach

themselves to sperm & inhibits oxygen intake by sperm & kill
it.

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 PROCEDURE

 A woman places spermicide into her vagina 7-10 minutes before intercourse.
 Then women’s body heat help to melt the foaming tablet and changes into a
foam.
 Spermicides affect the sperm’s ability to fertilize the egg.
 For a spermicide to be effective, it must be placed correctly in the vagina and
intercourse must take place within 1 hour.

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 ADVANTAGES
 No method –related health risks.
 Available without prescription.
 Some spermicidal is effective immediately.
 Simple to use.
 No medical examination & supervision is needed.
 No side effects.
 Can be used as an emergency measure if a condom breaks.
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 DISADVANTAGES
 High user failure rate.
 Requires use with each episode of intercourse.
 Messy and may interfere with sexual pleasure.
 Some people may feel burning & irritation of their genitals.
 Supplies may be hard to find & relatively expensive.
 Only effective for 1-2 hours.
 Need high motivation for the couple.

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Health Benefits
Some protection against STDs including HIV/AIDS ep. when used with condoms.

Non contraceptive Benefits:

 Spermicides kill some organisms responsible for STDs & PID.

 Spermicides can be used as a lubricant. This may be helpful when using a
condom.

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 INDICATION
 Women of all ages, including adolescents and women over 35 yrs.
 Wants to space her children for a limited time and is not opposed to having
another child.
 Want to have some protection against sexually transmitted diseases.
 Has contraindications to , or cannot use more effective methods ( IUDs or
hormone containing methods).
 Post abortion and post partum, especially until a more effective method can be
started.
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 SIDE EFFECTS AND MANAGEMENT

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 THANK YOU

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 SUB UNIT 4.7
NATURAL METHODS AND COITUS INTERRUPTS
Natural Family planning:
 The term Natural Family planning refers to the contraceptive methods which do
not use external chemicals, hormones or barriers.
 It relies on the self recognition of certain physiological signs and symptoms
associated with ovulation to determine when the fertile period begins and ends.
 WHO defines a natural family planning method as methods for planning and
preventing pregnancies by observation of the naturally occurring signs &
symptoms of the fertile and infertile phases of the cycle, with the avoidance of
intercourse during the fertile phase if pregnancy is avoided.

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Effectiveness:
 When taught and used perfectly the effectiveness of the NFP method can be as high as 95% to
98%.
 However, few couples are able to use these methods perfectly.
 So its effectiveness is low compared to others.
 Effectiveness reported 70-95% .

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 Advantages:
 No physical side effects.
 Increase self-awareness and knowledge of the human reproductive function.
 Develop self reliance, not dependent upon contraceptives.
 Can be provided as a part of family planning or community based educational program.
 Not dependent on medically qualified personnel.
 Economical- no contraceptives supplied

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Disadvantages:
• They require continuing cooperation and commitment of both partners.
• To be optimally effective, they must be taught by someone trained to teach natural family
planning.
• They do not protect against sexually transmitted infections (STIs), such as herpes or HIV.

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 TYPES OF NATURAL METHODS

1. Abstinence.
2. Coitus interrupts (Withdrawal).
3. Calendar method.
4. Cervical mucus method (Billing method).

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 1. ABSTINENCE

 Abstinence is complete sexual absence.

 It is highly effective but not practicable in real life.

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 2. COITUS INTERRUPTS (WITHDRAWAL)

 It is traditional family planning method, widely practiced from ancient time.

 In this method, male withdrawal before ejaculation and thereby tries to prevent
deposition of semen into the vagina.
 Thus, sperm doesn’t enter the vagina and fertilization is prevented.
 The failure rate of this method is as high as 25% making it less reliable.

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 3. CALENDAR/ RHYTHM METHOD
 This method is based on the fact that ovulation occurs from 12 to 16 days before
the onset of menstruation.
 The day on which conception is likely to occur is known as an unsafe period or
fertile period, and couples should avoid unprotected sexual intercourse during
the unsafe period.
 When menstrual cycle is irregular, then the unsafe period is determined by
subtracting 18 days from shortest cycle and 10 days from longest cycle.
 If such calculation is not possible, the couple can be advised to avoid sexual
intercourse from the 8th to the 22nd day of menstruation.

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 On day 1-7:- Not considered to be fertile days and can have unprotected sex,
though may have menstrual bleeding these days.
 On day 8-19: considered fertile days. Avoid unprotected sex.
 On day 20- end of cycle: considered no longer fertile and can have unprotected
sex.

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 4. CERVICAL MUCUS METHOD (BILLING METHOD

 It is also known as “Billing method “or ovulation method.

 It is based on the observation of changes in the characteristics of cervical mucus
(quality and quantity) at vaginal opening.
 At the time of ovulation, cervical mucus became watery clear resembling raw
egg white, smooth, slippery and profuse.
 After ovulation the mucus thickens and lessens in quantity.

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 THANK YOU

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 SUB UNIT 4.8
HORMONAL CONTRACEPTIVES
Hormonal contraceptives
 A type of birth control that uses hormones to prevent pregnancy.
 Hormonal methods are most effective spacing method when used properly.
 Hormonal contraceptives contain estrogen and progesterone, or progesterone
only.
 Combined oral contraceptive are almost 99.99 percent effective in preventing
pregnancy.
 They are reversible methods, available in government health facilities and are
free of cost.

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Classification:
1. Oral Pills.
 Combined oral pills.
 Progesterone only pills.
2. Depot (Slow Release) Formulations.
 Injectable (Depo Provera).
 Subcutaneous Implants (Norplant).
 Vaginal Rings.

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 COMBINED ORAL CONTRACEPTIVES (COCS)
 It is reliable method and most popular form of reversible contraceptive.
 All combined pill contains the hormones estrogen and progesterone.
 Estrogen in the pill usually prevents the release of the ovum from the ovary,
whereas progesterone in the pill causes thick and scanty cervical mucus to
prevent sperm traveling to the uterus.
 The pills are given orally for 21 consecutive days beginning on the 5th day of the
menstrual cycle, followed by a break of 7 days during which period
menstruation occurs.
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Types of CoCs in Nepal:
 Most common CoC is in the form low
dose pill in 28 day packages.
 Available all government health facilities.
 Contains estrogen-0.03mg and
progesterone- 0.3 mg.
 In commercial Sectors, COC is available
in the trade name like sunaulo Gulaf,
Nilocon, Kanchan etc.

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 MECHANISM OF ACTION

Two synthetic hormones estrogen and progesterone prevent the

pregnancy by suppressing ovulation and making women’s naturally
occurring cervical mucus so thick that fewer sperm can pass through
it.

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Advantages
 Highly effective.
 Few methods-related health risks.
 Does not interfere with intercourse.
 Easy to use.
 Easily discontinued at any time.
 Easily available for free at health facilities or at low cost from medical shops.

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Disadvantages:
 Must be taken daily.
 Forgetfulness increases failure.
 Some drug interactions (rifampicin for tuberculosis and medications for seizure
disorders).
 Offers no protection against STDs and HIV/AIDS

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 SIDE EFFECT
 Nausea.
 Breast tenderness.
 Amenorrhea (failure to have periods).
 Mood changes
 Dizziness
 High BP
 Decreased milk supply if initiated breastfeeding
 Weight gain (an advantage for some women)

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 DEPO-PROVERA
 Depo-Provera is a brand name for medroxyprogesterone acetate, a
contraceptive injection that contains the hormone progestin.
 Depo-Provera is given as intramuscular injection of 150mg depo is given every 3
months interval time period. (SANGINI SUIEE)
 Depo-Provera typically suppresses ovulation, keeping ovaries from releasing an
egg.
 It also thickens cervical mucus to keep sperm from reaching the egg.

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Mechanisms of Actions
 Progesterone creates thick scanty mucus in the cervix which decreases the
ability of the sperm to travel through cervix into uterus.
 Also stop releasing an ovum.
Effectiveness
• Proven extremely effective more than COCs.
• Failure rate 0.3%.

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Procedure for Depo Injection:
 It should be administered during the first 5 days of menstrual cycle.
 The injection site should never be massaged following injection.
Advantage:
 Reversible.
 Highly effective (over 99%).
 Easy to use (women can decide).
 Can provide long term protection.
 Convenient, only action requires of the user is to go for her injection every 3 months.
 Effectiveness continues even if the client is up to 2 weeks late for her return visit.

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Disadvantages:
 Does not protect against most STI, including HIV/AIDS.
 Causes menstrual changes in most users:
Amenorrhea in 50-80 % of users
Irregular bleeding, including spotting.
 Possible delay in return to fertility after discontinuation.
 Client cannot discontinue the method on her own before the next injection.
 Weight gain a common side effect.
 Dependent to Health service provider.

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 ECTOPIC
PREGNANCY IS A
COMPLICATION
OF PREGNANCY IN
WHICH THE
EMBRYO
ATTACHES
OUTSIDE THE
UTERUS.

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 SUB DERMAL IMPLANTS (NORPLANT)

 Norplant is new generation of long acting contraceptive which consists 6

Silicone rubber capsules (34mm long and 2.4 mm diameter).
 Six capsules contain 36 mg Progestin (Levonorgestrel), released at a slow and
steady rate.
 It is inserted under the skin inside of a woman’s upper arm using a simple
forceps.
 It protects from pregnancy for up to 7 years.

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 Types of Implants:
I. Jadelle: 2 rods, Effective for 5 years.
II. Sinoplant: 2 rods, effective for 5 years.
NORPLANT
III. Implanon: 1 rod, effective for 3 years.
IV. Norplant: 6 rods, Effective for 5 years.

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 Effectiveness:
 95% to 99% within one year of use.
 Failure rate of 0.2 pregnancies per 100 women.

Mechanism of Action:
 Thicken cervical mucus preventing sperm penetration.
 Progestin released at slow steady rate suppress ovulation.

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 ADVANTAGES
 Rapidly effective (< 24 hours).
 Long term protection (Up to five years).
 Immediate return of fertility upon removal.
 Does not interfere with intercourse.
 Offers continuous protection.
 Does not adversely affect breastfeeding.
 Easy to use –once inserted the women only has to return to the clinic for follow
–up visits and to have the implants removed.

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 DISADVANTAGES

 It can cause harmful side effects such as menstrual disturbances, headaches,

acne, weight gain, nausea, anxiety, hair loss, and ovarian cysts.
 It does not provide protection against sexually transmitted diseases.
 Menstrual periods are irregular.
 Removal may be difficult.

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Contra Indication:
 Known or confirmed pregnancy.
 Unexplained vaginal bleeding.
 Active liver disease.
 Breast lumps and know or suspected breast cancer.

Time of Insertion:
 Anytime-sure that the client is not pregnant.
 During menstruation within 7 days (1-7 days).
 Post abortion – immediately or within 7 days.
 Postpartum – after 6 month.

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 SUB UNIT- 4.9
INTRA UTERINE CONTRACEPTIVES DEVICE (IUCD/ IUD)

 An intrauterine contraceptive device (IUD) is a small, T-shaped device that is

inserted into the uterus by a health care provider to prevent pregnancy.
 An IUD is a non-permanent (reversible) method of female contraception and it
can work for upto 10 years.
 There are two types of IUDs: copper and hormonal. Both types work by making
it hard for sperm to reach and fertilize an egg.

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There are two main types of intrauterine contraceptive devices:
1. Non-hormonal
• copper: pure copper or alloyed with gold/silver
• stainless steel: also known as Chinese ring (manufacture ceased in 2000)
• polyethylene plastic: Lippes loop (discontinued in 1980s).
2. Hormonal:
• In this IUD, Progestasert hormone is use.
• Example Progesterone IUD and Levonorgestrel IUD.
• It is a T-shaped plastic frame that releases a type of the hormone progestin to
prevent pregnancy.
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 AVAILABLE IN NEPAL

There are different types of intrauterine contraceptive devices (IUCD) available in

Nepal. The most widely available IUCD is the TCu-380A (Copper T), which is a non-
hormonal device that can prevent pregnancy for up to 10 years and Hormonal IUD
(Mirena, Kyleena, Liletta, or Skyla).

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 MECHANISM OF ACTION

 Copper-releasing IUCDs work by releasing copper ions, which are toxic to sperm
and impair their motility and viability.
 IUDs act only at the uterine level, either to prevent implantation or destroy
developing embryos in the uterus before implantation.
 IUDs act primary as contraceptive, preventing fertilization and decreasing the
number of sperm reaching of the fallopian tube.

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Time of insertion:
 During or toward the end of menstruation.
 Post abortion, immediately for first trimester abortions and provided there is no
evidence of infection.
 6-8 weeks after delivery
 For the second trimester abortions after involution of the uterus ( 6-8 weeks).

Effectiveness:
• Effective between 97-99%

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Advantages:
 More than 99% effective in preventing pregnancy.
 Cost effective method.
 Easy to use.
 Safe to use while breast feeding.
 Long intrauterine life (5 -10 Years).
 It is suitable for breastfeeding women.
 It is a suitable method for a woman of any age.
 Does not interfere with intercourse.

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Disadvantages:
 May increase the risk of PID(Pelvic Inflammatory Disease) and subsequent
infertility in women at risk for STIs.
 Requires minor surgical procedure to insert and remove.
 Need to check strings after every menstrual period.
 Increase menstrual bleeding and cramping during the first few months in many
users.
 Client cannot discontinue on her own.
 No protection against STDs, AIDS/HIV.

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Warning Signs for IUD
 P = Period Late (Pregnancy)
 A = Abdominal pain
 I = Infection exposure (such as gonorrhea)
 N = Not feeling well, fever chills
 S = String missing

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Contraindications:
 Known or confirmed pregnancy, or
 PID or STI currently or within the last 3 months.
 Unexplained vaginal bleeding.

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