Family Planning

Gynecology
Ahmad Soboh
Family Planning: An
Overview
Family planning encompasses a range of strategies and methods to help
individuals and couples plan, space, and limit the number of children they
have. It is a crucial aspect of reproductive health, empowering people to make
informed choices about their family size and timing.
Efficacy of Contraception
• Safety: Contraceptive methods must be rigorously tested for safety,
considering short-term and long-term side effects. Optimal safety
ensures users can confidently rely on these methods without
jeopardizing their health.
• Cost: The affordability of contraceptives is crucial, as access to family
planning services should not be limited by financial barriers. Cost-
effective options promote widespread use and empower individuals to
make informed choices.
 Nonhormonal Methods
Coitus Interruptus Lactation Amenorrhea Fertility Awareness

Condoms Vaginal Spermicides Vaginal Barriers Intrauterine Devices

Coitus Interruptus
• Coitus interruptus is withdrawal of the penis from the vagina
before ejaculation.
• This involves the male partner withdrawing before ejaculation to
prevent sperm from entering the female reproductive tract.

Less Effective: 68–74%

 Lactation Amenorrhea
• The suckling of the infant elevates prolactin levels and reduces
gonadotropin-releasing hormone (GnRH) from the hypothalamus,
reducing luteinizing hormone (LH) release and thus inhibiting
follicular maturation.

98% effective against

pregnancy for the first 6
months after giving birth.
 Fertility Awareness
• Sexual intercourse is avoided on days in the menstrual cycle on
which conception is likely (near the time of ovulation)

Moderately Effective: 75–90%

 Condoms
Male condom Female condom
A latex sheath covers the A barrier sheath is inserted
Mechanism
penis into the vagina

The only method that

effectively protects against Some protection against
Advantages
pregnancy and STDs, STDs
including HIV

Possible allergy to latex or

Disadvantages Can be difficult to use
spermicides

Moderately Effective: 75–90%

 Vaginal Spermicides
• Vaginal spermicides combine a spermicidal chemical, either N-9
or octoxynol, with a base of cream, jelly, aerosol foam, foaming
tablet, film, suppository, or a polyurethane sponge.

Moderately Effective: 75–90%

 Vaginal Barriers
• A barrier is inserted over the cervix to prevent entry of sperm.
• Some protection against STDs.
• Must be fitted by the provider.

Moderately Effective: 75–90%

Intrauterine device
• Intrauterine contraception is a long-acting reversible contraceptive
method that involves placement of a small T-shaped object inside the
uterus.
• Mechanisms of Action:
- These include inhibition of sperm transport;
- Increased tubal motility causing failure of implantation of immature
zygote;
- Inhibition of implantation secondary to endometrial inflammation;
- Phagocytic destruction of sperm and blastocyst;
- and alteration of cervical mucus (only progesterone IUSs).
 IUD Uterus

Most Effective: > 99% String

Vagina Cervix
Hormonal Contraception
• Hormonal contraceptives are female sex steroids, synthetic
estrogen and synthetic progesterone (progestin), or progestin only.
They can be administered in the form of OCs, implants, and
injectables
Steroid Hormone Action
Very Effective: 90–99%
 Oral Contraceptive Pills
(combination estrogen and progestin)
• Mechanism: Inhibit FSH/LH, suppressing ovulation; thicken cervical
mucus; and alteration of endometrium inhibiting blastocyst implantation.

Advantages: Disadvantages:
-Reduce risk for ovarian and endometrial cancers -Requires daily compliance
-Predictable, lighter, less painful menses -Breakthrough bleeding (10–30%)
-Can improve acne -Thromboembolism risk (especially in smokers > 35
-Varied fertility upon cessation years of age)
-Cannot be used in patients of any age who have
migraines with aura
-Hypertension
-GERD (progesterone relaxes the lower esophageal
sphincter)

Very Effective: 90–99%

 Progestin-only “minipills”
• Mechanism: Thicken cervical mucus
• Advantages: Safe with breastfeeding
• Disadvantages: Requires strict compliance with daily timing

Very Effective: 90–99%

 Injectable Hormonal
Contraceptives
1. Depomedroxyprogesterone Acetate
(Depo-Provera): This injectable progestin-
only contraceptive is administered every 3
months, providing long-acting pregnancy
prevention by suppressing ovulation and
thickening cervical mucus to block sperm.
2. Subdermal Implants: Small, matchstick-
sized rods inserted under the skin release a
steady dose of progestin for up to 5 years,
delivering highly effective, long-term
contraception with minimal user
intervention.

Very Effective: 90–99%

 Sterilization
Surgical sterilization is the most common method of fertility control used
by couples worldwide, with more than 250 million women and men relying
on female sterilization or vasectomy for contraception.

• Female Sterilization: Surgical procedures like tubal ligation or

bilateral salpingectomy permanently block or remove the fallopian
tubes, preventing fertilization and future pregnancies. This method
offers a highly effective, long-term contraceptive option.
Most Effective: > 99%

• Vasectomy: A simple outpatient procedure where the vas deferens,

the tubes that carry sperm, are cut or blocked, preventing sperm
from being ejaculated. Vasectomy is a safe, reliable, and minimally
invasive form of permanent male sterilization.
Thank You