FAMILY PLANNING
Natural family Planning
ABSTINENCE
 Refraining from sexual relations, most
effective wat to prevent STI’s
 Has the highest failure rate
CALENDAR METHOD
 Couple abstain from coitus on the days of a
menstrual cycle when the woman is most
likely to concieve such as during ovulation
 Ovulation occur 14 days before the 1st
menses
 Document six menstrual cycles
 Subtract 18 from the shortest cycle
she documented and this will predicts
her 1st fertile day
 Subtract 11 from the longest cyles she
documented and this will predicts her
last fertile day
Example: Shortest cycle is 25--- 25 - 18= 7
Longest cycle is 29----- 29 - 11= 18
Ovulation
Abstinence
Menstrual flow
BASAL BODY TEMPERATURE
 Recommended to combined with calendar
method
 Take body temperature each morning after
waking up or before taking any activity.
 BEFORE ovulation, the body temperature
FALLS about 0.5 F due to low level of
progesteroen, and high level of estrogen.
 AT THE TIME OF OVULATION, the body
temperature RISES about 1F because of
the influence of high level proegesterone.
Refrains from having coitus for at least 4
days.
CERVICAL MUCUS METHOD “Spinkerbiet”
 BEFORE ovulation, cervical mucus is thick,
does not strech when pulled between the
thumb and fingers, and increases
 AT THE OVULATION, cervical mucus is
copious, thin, watery, slippery, and
stretches at least 1inch before strand
breaks “spinnbarkeit”
SYMPTOTHERMAL METHOD
 Birth control combines the cervical mucus
and body temperatue methods and other
signs of ovulation such as
Mittelschmerz(midcycle abdominal pain)
LACTATION AMENORRHEA
 When a woman is breastfeeding, there is a
natural suppression of both ovulation and
menses.
 Has a failure rate of 1% to 5% if an infant
is:
 Under 6 months of age
 Being totally breastfed atleast
every 4hrs during the day, and
every 6 hours during the night.
 Menses has not returned
 Exclusively breastfeeding
Hormonal Contraception
Combination Oral Contraceptives
 Not effective for the 1st 7 days, so take
another contraceptive during the 1st 7 days
that they take pills.
 28 pills= 21 active pills + 7 placebo
pills( menstrual flow)
 if your miss two consecutive active pills,
take two pills as soon as you remember
and two pills again the following day.
 If miss 3 or more pills in a row, throw out
the rest of the pack and start a new pack.
 Side effects of Pills
 Nausea
 Weight gain
 Headache
 Breast tenderness
 Breakthrough bleeding(spotting
outside menstrual period)
 Mild hypertension
 Depression
 Monilial vaginal infections
Mini Pills
 Cotaining only Progestins
 Progesterone thickens cervical mucus and
helps prevent sperm entry into uterine
cervix.
 Without estrogen, the ovulation may
occur, but fertilization and implantation
will not take place
 Disadvantage: Causing more breakthrough
bleeding than combination pills
Morning Pills
 Emergency postcoital pills, used after
unprotected sexual intercourse
 It is take within 72 hrs of unprotected
coitus to prevent pregnancy(levonogestrel)
or as late as 120 hrs of unprotected
sex(ulipristal acetate”ella)
Two types of emergency contraceptives:
 High-dose of progestin based pills. It
inhibits the ovulation and interfering
w/fertilization by slowing the transport of
sperm
 Insertion of coppper IUD. It slow/prevent
sperm transport
Transdermal Route
 Patches slowly but continiously release a
combination of estrogen and progesterone
 Applied each week for 3 weeks on upper
arm or torso or abdomen or buttock
 Patch free= menstrual flow will occur
Vaginal ring “ NuvaRing”
 Silicone ring surrounds the cervix and
release combination of estrogen and
progesterone
 Inserted vaginally and left in place for 3
weeks, then remove for 1 week(menstrual
bleeding occurs)
Implants
 etonogestrel implant (Nexplanon)
embeded just under the skin on the
inside of the upper arm where it will
slowly release progestin over a period of
3 years
 renewed every 3 to 5yrs
 suppress ovulation, thicken cervical
mucus, and change the endometrium
lining, making implantation difficult.
 Inserted during menses or no later than
day 7 of menstrual cyle or 6 weeks after
birth of baby
 Within 2 yrs= Effective 98%-99%
 Every year minus 1%
Depo Provera Injection
 Intramascularly injection of 150mg of
medrocyprogesterone acetate every
12weeks or 3months
 Effective 100%
 Adverse effect: Impair glucose tolerace or
increase risk for osteoporsis
Intrauterine Device “IUD”
 Healthcare provider inserted a Small
plastic device that is inserted in uterus
through vagina.
 Prevent Fertilization and implamantation
through:
 Local inflammatory response
 Local production of prostaglandin
 Immobalize the sperms as they
pass through uterus
 Failure rate of 0.1%
Copper T380(ParaGard): T-shaped plastic device
wound with copper. It last for 10 yrs
Levonogestrel-releasing IUD(Mirena): It
contains progestin which last for 5 years.
Side effects
 Heavier than usual menstraul flow
 Experience Dysmenorrhea
 Spotting or uterine cramping
 Place woman at risk for pelvic
inflammatory disease
Contraindications
 Woman whose uterus is distorted
 Woman have dysmenorrhea or
menorrhagia or ectopic pregnancy
 Woman with increased risk for contracting
STI’s
 Woman withVulvar Heart disease
Barrier methods
Diaphragm
 Circular rubber disk that is placed over
cervix
 Should be wear 2hrs bebfore coitus and
remain 6hrs after coitus or may be left for
as long as 24hrs.
 WIth use of spermicide, failure rate is 6%
to 18%
Proper insertion of diaphragm
 Apply spermicide jelly or cream to the rim
 Pinched between the finger and thumb
 Folded diaphragm is then inseted into the
vagina and pushed backward as far it will
go
*It should feel the cervix to be certain it is
completely covered by diaphragm
Cervical cups
 Soft rubber, shaped like a thimble with a
thin brim, and fit snugly over the uterine
cervix
 Can be kept in place up to 48hrs, longer
than 48hrs can develop infection>toxic
shock syndrome
 Failure rateof 23 to 35%
Contraindications
 Abnormally short or long cervix
 History of toxic shock syndrome
 Current abnormla pap smear
 Allergy to latex or spermicide
 History of cevrical infection or cancer
Male condom
 Latex rubber or synthetic sheath is placed
over the erect penis before coitus to trap
sperm
 Failure rate of 5% to 15% due to breakage
or spillage
 Protect against STI’s or HIV
Female Condom
 Sheath made of latex or polyurethane,
prelubricated with spermicide
 Failure rate of 5 to 15%
 Protect against STI’s or HIV
*maleand female condom should not be used
together
Permanent Contraception”Irreversible”
TUBAL LIGATION
 Sterilization of women include removal of
uterus(hysterectomy) or ovaries
(oophorectomy) or where fallopian
tube(isthmus) is occluded by cautery,
crushing or clamping or blocking, thereby
preventing passage of both sperm and ova
 Fimbriectomy, or removal of the fimbria at
the distal end of tubes
 Best tiem to perform is after delivery
because uterus is found in the abdominal
cavity
 99.5% effective
VASECTOMY
 Small incision or puncture wound is made
on each side of scortum. Vas deferens at
that point is cut tied, cauterized, blocking
the passage of spermatozoa.
 Spermatozoa in vas deferens remain viable
as long as 6months
 Consume sexual intercourse within 1 week
 Add another birth control until Two
negative sperm reports, requiring 10-20
ejaculations
* Contraindication to Breastfeeding:
 Pills that contain estrogen, because
estrogen shuts down prolactin
*Depo-provera is ok for breastfeeding