Contraception, Sterilization and

Family Planning
BY: Hafiz Saadon
 Aims
To avoid unwanted pregnancies
To bring about wanted pregnancies
To regulate the intervals between pregnancies
To control the time at which birth occurs in
relation to the ages of the parents
To determine the number of the children in
the family
Natural Family Planning (NFS)

Mohd Hafiz Saadon

 Natural Family Planning
Without identifying physiological Identifying physiological changes during
changes during menstrual cycle menstrual cycle
Abstinence Basal body temperature method

Coitus interruptus Cervical mucus method

Safe period method (rhythm method) Sympto-thermic method

How Do You Use Fertility Awareness?
First of all become familiar with your
menstrual cycle and to begin charting your
fertility pattern.
The average menstrual cycle is between 28 to
32 days, however there are two parts related
to your cycle: before ovulation and after
ovulation.
 Day 1: The first day of your menstrual flow is the
beginning of your cycle.
Day 7: By day seven your egg is preparing to be
fertilized by sperm.
Days 11-21: (based on 28-day cycle) Hormones in
your body cause the egg to be released from the
ovary around this time. This process is known as
ovulation. The egg travels through the fallopian tube
towards the uterus. If sperm penetrates the egg, the
fertilized egg will attach to the lining of the uterus
and begin to grow. If fertilization does not happen
the egg breaks apart.
Day 28: Hormone levels drop around this day
causing the lining of the uterus to be shed making
up your menstrual flow.
 Calendar Method
Step 1: Plan on tracking your menstrual cycle for 8 to 12 months.
Step 2: Day 1 will be the first day you start menstruation.
Step 3: Pick the longest and shortest of the cycles from your monthly
tracking.
Step 4: The first day of your fertility period is determined by subtracting 18
days from the length of your shortest cycle.
Step 5: The last fertile day is determined by subtracting 11 from the length
of your longest cycle.

Example:
Shortest cycle: 24 days (minus 18)
Longest cycle: 32 days (minus 11)
Safe period: 6th 21st day of cycle
 Disadvantages
If the cycle is not regular difficult to predict
the safe period
Educated and highly motivated co-operative
and responsible couple
Half a month abstinence from intercourse
Not applicable during the postnatal period
Unreliable; failure rate: 9 per 100
 Coitus Interruptus
The man withdraws his penis from the vagina before
ejaculating

Effectiveness: depends upon the timing of withdrawing of

penis

High rate of failure (Typical User) > 19%, must be prepared

for unplanned pregnancy (perfect users about 4% failure
rate)

Even the pre-ejaculation secretions may contain sperms

Advantages
Natural method that does not require
devices or medicine in the body.
There are no known side effects.
No cost.
Is morally and culturally acceptable.
Better than not using any birth control
method.
Disadvantages
A high rate of failure
Requires self-control
Sex may not be as pleasurable
Not recommended if it is dangerous for
the woman to become pregnant.
No protection against sexually transmitted
infections
 Abstinence
Simply means not involving in any sexual
activities
Not effective and practical in young couples
for long period
Can occur at different levels
- Avoiding vaginal penetration only
- Avoiding any genital contact
Basal Body Temperature Method
Basal body temperature method (BBT) It depends
upon the identification of the rise of the BBT at
the time of the ovulation as a result of the
increase in the production of the progesterone
Indication: women who have irregular period
may benefit from this method
Drawback: Complete Abstinence of intercourse in
pre-ovulatory phase
Low failure rate: 0.3% in perfect user, 3.1% in
typical user
Basal Body Temperature Method
Step 1: Take your temperature orally each
morning before you become active.
Step 2: Use a basal thermometer which
recognizes small changes in your temperature.
Your body temperature will only rise between 0.3
and 0.5 degree Celsius when you ovulate.
Step 3: Record you temperature every day on
your fertility tracking calendar.
Reliable period: 3 days after the increase of
temperature until bleeding
 Cervical Mucus Method
Step 1: Collect the mucus from the vaginal
opening with your fingers by wiping them from
front to back.
Step 2: Record it daily on your fertility calendar by
making note of the colour (yellow, white, clear or
cloudy), the consistency (thick, sticky, or stretchy)
and the feel (dry, wet, sticky, slippery, stretchy).
Step 3: Ovulation is recorded on the day that your
mucus is wettest, clearest, slippery and most
stretchy (like egg white)
 Physiology of Cervical Mucus
In the early non-fertile phase of a womans cycle, the
passageway from the vagina to the uterus is closed by thick
mucus. Sperm are unable to pass through the cervix.

In the fertile phase, the passageway from the vagina to the

uterus is open. A slippery-type mucus assists the
movement of sperm through the cervix and nourishes the
sperm. The cervix is completely open during the
preparation stage of the fertile phase

After the fertile phase ends, the cervix is again closed off by
a thick-mucus plug, blocking the cervical canal. Sperm are
unable to pass through the cervix.
 Lactational Amenorrhoa
Indicated to breastfeeding mothers, the most
reliable period is 6 months after delivery
 Criteria
Amenorrhea
Fully breastfeed their infant until 6 months
Breastfeed about 4-hourly during the day and
6-hourly throughout the night
 Efficacy
The perfect-use failure rate within the first 6
months is 0.5%. The typical-use failure rate
within the first 6 months is 2%.
Barrier Contraception

Robithah Razali
2010415494
 Its prevent pregnancy by creating physical barrier to sperm
reaching and fertilizing the egg
It beens used before sexual intercourse
Its includes
Condoms

Spermicides Diaphragm

Cervical cap
 Effective protection against STD
They can be used in conjunction with
hormonal method or IUD for protection
against infection and increase contraceptive
efficacy.
 Effectiveness of preventing pregnancy and STD.

EFFECTIVENESS IN
BARRIER FAILURE RATE*
PREVENTING STIS
Male condom 15 (spermicide further lowers Most effective
this failure rate)
Female condom 21 Somewhat effective

Diaphragm with spermicide 16 Limited effectiveness

Spermicide 29 Not effective if used alone;

may actually increase risk of
getting HIV/AIDS

Sponge with spermicide 16 (no past vaginal childbirth) Limited effectiveness

32 (past vaginal childbirth)

Cervical cap with spermicide 16 (no past vaginal childbirth) Limited effectiveness
32 (past vaginal childbirth)

http://www.webmd.com/

Condoms
Male condoms : is a thin covering made of
latex,or plastic and flexible sheath or
cover placed over the penis

Preventing semen from entering the

vagina during SI and ensure optimal
effectiveness and protection
People who allergic to latex condoms,
can use the hypoallergenic latex
condom or plastic male condom
Condoms are varying in size, shapes
textures and also flavours. They are
cheap and widely available.
Risk of tear when wear too tight or fall
off when wearing too loose, so
emergency contraception can be used
during this event.
Healthcare professional may need to
teach them to use condoms
Reduced risk of STD

Female
It is a lubricated
condoms
polyurethane (plastic)
tube that has a flexible
ring at each end.
Good protection against
infection (can be
inserted up to 8 hours
before intercourse)
The edges of the ring at
the closed end of the
sheath are squeezed
together, inserted into
vagina
Prevent STD
 Vaginal Diaphragm
Dome-shaped device
made of silicone that put
into womans vagina
Inserted immediately
before intercourse and
should be removed no
earlier than 6 hours later.
Require careful teaching
and fitting due to various
sizes.
Effectiveness increase if
spermicide is used at the
same time.
Effectiveness against STIs
not yet known.
 Cervical Cap
Silicone cup-shaped
Used in conjunction
with spermicidal
cream or gel to be
more effective
Insert into vagina
and put over the
cervix
Difficult to insert
and easily displace
from its position
that depends in
penis sizes and
certain sexual
position
 Spermicide
Gel, creams, films or foams
types.
Contain the active
ingredient nonoxynol-9
that some people are
allergic to it.
Used with another barrier
method to make them
more effective.
FDA warns that nonoxynol-
9 in spermicides may
irritate the lining of the
vagina or rectum, hence
increase risk of getting
HIV/AIDS from infected
partner.
 Advantage of barrier Methods
Do not affect a
woman's or
man's future
Are less fertility.
expensive than
hormonal Are only used
methods of at the time of
birth control, sexual
and some are intercourse.
available
without a
prescription.
Do not affect
other health Are safe for a woman
conditions, to use while she is
such as high breast-feeding.
blood
pressure or
diabetes.
Disadvantage of barrier methods
Must be comfortable
for both partner,
prepare prior to use
before SI

High failure
rates compare
to other
method
Diaphragm Allergies to
and cervical spermicide,
cap increase latex
risk UTI
Oral Contraception

By: Qurratu Aini

 Combined oral contraceptive pills
The pill that consists of:
synthetic female estrogen
synthetic female progesterone (progestin@
progestogen).
Most combination pills come in a 21-day or
28-day package (both take 1 pill for each day).
Efficacy may be decrease by severe vomiting
or diarrhea and concurrent use of enzyme-
inducing medications.
 Mechanisms of action
Exerts inhibitory effect on the release of FSH and
LH from anterior pituitary gland causing:
inhibition of growth of primary follicles in the
ovary.
inhibition of ovulation process.
increase in thickening of cervical mucus which
cause difficulty in penetration by spermatozoa.
changes the endometrium which make it less
conducive for implantation of an embryo
(pseudo-atrophy).
 Advantages
High degree of protection against pregnancy
(failure rate 0.1-1%).
Independent of intercourse.
Can be stop at anytime.
Light, pain-free, regular period.
Reduces risks of ovarian, endometrial cancer and
ovarian cysts.
It may help symptoms of premenstrual syndrome.
 Disadvantages
User-dependent method, relies on remembering
to take it regularly.
Increased risks of venous thromboembolism by 3
to 5 folds.
Increase risks of stroke and myocardial infarction.
Increased risks of breast cancer.
Increased in blood pressure.
Doesnt protect against sexually transmitted
infections.
 Side Effects
Reproductive system: breakthrough bleeding,
vaginal discharge, dry vagina, post-pill
amenorrhea.
Central nervous system: depression,
headache, loss of libido.
Gastrointestinal system: nausea, weight gain.
Breasts: breasts pain, enlarged breast.
UK Medical Eligibility Criteria (UKMEC)
Adapted from WHO which classified conditions for
users of contraception:
category 1: no restriction to use
category 2: advantages of contraception outweigh
the risks.
category 3: risks generally outweigh advantages. Use
not usually recommended.
category 4: use of contraceptive methods result in
unacceptable risk to health.
Conditions of UKMEC Category 3 or 4 means COCP
should not be prescribed.
 Contraindications
Heavy smoking.
Breastfeeding up to 6 months postnatally.
Hypertension (>140/90 mmHg).
Breast cancer.
Hepatitis.
Liver cirrhosis and liver cancer.
Major surgery with prolonged immobilization.
History of DVT, stroke, IHD, pulmonary
embolism.
SLE with positive antiphospholipid antibodies.
 Progestogen only pill
Consists of only synthetic female progesteron
without estrogen.
Can be used in women who cant use
contraception that contains estrogen.
Take the pill everyday without break in
between packs of pills.
Take the pill at same time each day, if take
>3hours, its no longer effective.
 Types of POP
3-hour progestogen only pill must be taken
within 3 hours of the same time each day.
Examples: Femulen, Micronor, Norgeston,
Noriday.
12-hour progestogen only pill must be taken
within 12 hours of the same time each day.
Example: Cerazette.
Missing pills can reduce its affectiveness.
 Advantages
Breastfeeding.
It can reduce premenstrual syndrome.
Can be used for women at any age.
Its useful if she couldnt take hormone
estrogen which is in the combined pill,
contraceptive patch and vaginal rings.
 Disadvantages
It doesnt protect against sexually transmitted
infections.
Need to remember to take it at the same time
every day.
Some medications including certain types of
antibiotic can make it less effective.
Injectable Contraception
MOHD HAFIZ B. MOHD HANIFFA
 What is injectable contraception?

It's a form of contraception that

is injected into a muscle to
prevent pregnancy by releasing
progestogen into the body.
 Types of injection
Two types:

1. depot medroxyprogesterone acetate (DMPA)

150mg every 3 months

2. norethisterone enanthate (NET-EN)

200mg every 2 months

DMPA, the most widely used progestin-only injectable, is also known as

Depo-Provera.

NET-EN is also known as norethindrone enanthate, Noristerat, and

Syngestal.

99% effectiveness in preventing pregnancy. This means less than four

sexually active women in every 1,000 will get pregnant over two years.
 How does it work?
They contain only progestogens that are
similar to the hormone, progesterone.
Cause thickening of mucus in cervix, thereby
preventing sperm from entering uterus
Make the lining of uterus thin and atrophic,
thus making it less receptive for implantation
Prevent ovulation
 Injection sites

Hip (ventrogluteal muscle), the upper arm

(deltoid muscle), buttocks (gluteal muscle,
upper outer portion)
Do not massage on the site of injection
 When should it be taken?
The first injection within the first 5 days of
menstruation
Next injection, for Depo-Provera every 3
months, while Norethisterone every 2 months
For postpartum patient, who is not breast
feeding can be given any time up to 21 days
postpartum or at 6 weeks postpartum if the
patient is breast feeding.
 Side effects
Irregular menstrual periods
Weight gain
Headache
Dizziness
Acne
Loss of bone mineral
density
Advantages vs Disadvantages
 INTRAUTERINE CONTRACEPTION
DEVICES

Siti Nadiah Mohamad Nawi

 Small device, often T shaped made of
flexible plastic may be added a bioactive
substance like copper or progesterone,
which is inserted in uterus.

They are one form of long-acting reversible

contraception which are the most effective
types of reversible birth control.

Protects against both intrauterine &

ectopic pregnancy,but if pregnancy
occur,there is a higher chance than normal
that it will be ectopic.

Fitting IUCD is performed by trained

healthcare personnel,it is a brief
procedure,a/w mild-moderate discomfort.
2 Types:
1) Hormone releasing intrauterine system/
Levonorgestrel-releasing system
(Mirena IUS)-(last 5years)
2) Copper IUD (paragard)-(last 10 years)
 Questions
Is IUD effective?
Is IUD permanent?
Do IUD protect against sexually transmitted
diseases?
How safe is IUD?
 Is IUD effective?
- IUD is among the most effective forms of birth
control available.
- Efficacy : 96-99%

Is IUD permanent?
- It is reversible!

Do IUD protect against sexually transmitted diseases?

- NO!
MOA
Has local effect on cervical mucus (making it hostile to
ascending sperm) & endometrium (making it thin & atrophic).
Preventing implantation & sperm transport
 Copper IUD
Available in various sizes & shapes.
Can be used for 10 years
The more copper on the device, the more
effective it is.
Toxic to sperm.
Prevents fertilization by:
-Impairing the viability
of the sperm
-Interfering with sperm movement

It makes the uterus & fallopian tubes produce

fluid that kills sperm.
This fluid contains white blood cells, copper
ions, enzymes, and prostaglandins
Hormone releasing intrauterine system (Mirena)
Has capsule containing
levonorgestrel around its stem
which releases daily dose of 20g
of hormone.

Effect:
Inhibit endometrial thickening
prevent implantation
Thickened cervical mucus
Used for contraception, treatment
of heavy menstrual bleeding
(menorrhagia), & as a part of
hormone replacement therapy
(HRT).
Progesterone IUD:

70
 COPPER IUD VS MIRENA
COPPER IUD MIRENA
Failure rate in 1st year 0.8% 0.1%
of use
Mode of action Toxic to both sperm and Local hormonal effect on
oocyte cervical mucus and
endometrium
Effect on menstrual Periods can become heavier Periods more irregular but
cycle with increase pain much lighter. Tend to become
amenorrhoeic
Menstrual spotting Often more days of spotting Erratic spotting very common
before and after periods initially, settles later
Hormonal side effects None May cause greasier skin and
acne, breast tenderness and
mood swings. Symptoms settle
with time
Therapeutic side effect None Helps heavy and painful
periods, can use as HRT
regimen
Average cost +/- RM100 RM760/box
 Advantages Disadvantages

Prevent pregnancy very effectively

Long-lasting
Cost effective
Provides no protection
Hormonal IUD from sexually transmitted
Reduces menstrual bleeding and infections
cramps Requires a medical visit to
May prevent endometrial start or stop use
hyperplasia or endometrial Can cause irregular
cancer. bleeding throughout the
cycle or cramping
Copper IUD
Do not change level of hormone
in the body
 ABSOLUTE
CONTRAINDICATIONS
Current STI & PID,
including post-abortion &
following child-birth
Malignant trophoblastic
disease
Unexplained vaginal 3. Pregnancy
bleeding
Endometrial & Cervical Ca
Known malformation of
uterus or distortion of the
cavity (eg: Fibroid)
Copper allergy (but can use
Mirena)
COMPLICATIONS
1. Menstrual Loss
All IUCD except Mirena
increase menstrual
bleeding.
2. Infection
Occur at the time of
insertion of the device.
Risk of failure 1 to 1.5
per hundred woman-
years (most likely in the
first 2 years).
4. Expulsion (during
menstruation 5 -10%)
5. Translocation
Sterilization

By: Amirah Shakri

 Bilateral tubal
ligation
Female
sterilization
Surgical Hysteroscopy
sterilization
Male
Vasectomy
sterilization
 Bilateral Tubal Ligation
Both fallopian tubes are either clamped and blocked or
severed and sealed.
prevent eggs from being fertilized.

Efficacy:
Highly effective contraception
Failure rate 1-5 per 1000 cases
Efficacy 99.4%- 99.8%
Advantages
Highly effective
Permanent birth control
Immediately effective
Allows sexual spontaneity
Cost-effective in the long
run
Disadvantages
Requires surgery
More complicated than
male sterilization
Irreversible
Risk of ectopic pregnancy
Does not protect against
sexually transmitted
infections, including
HIV/AIDS
Contraindication
Cancer of the female pelvic organs
Disease in the pelvis requiring the need for a future major
surgical procedure

Complication

Ectopic pregnancy
Infection or uterine perforation
Post Tubal Ligation Syndrome (irregular and painful
periods, bleeding in a mid-cycle, or no menstrual periods
 Surgical Approach

Most common surgical approach

Laparoscopy A laparoscope is inserted through the incision into
the abdominal cavity

Opening of the abdomen

Laparotomy Another procedure also being performed such as a
Cesarean section

Mini- Abdomen is entered through a much smaller incision

Usually used when a tubal ligation is desired within 6
laparatomy weeks following delivery
METHODS
 Pomeroy tubal
ligation

(A), Tube is grasped with forceps; (B), a loop is ligated; (C), the loop is excised;
(D), several months later, the fibrosed ends of the tube separate.
Parkland method

Identification of avascular Window through mesosalpinx is created

region of mid-portion of tube. below the tube.

Rapidly absorbable sutures placed Ligated portion of tube excised.

proximally and distally.
Coagulation method
Spring clip
Filshie or Hulka clip

Filshie Hulka
Hysteroscopy /Essure
 Vasectomy
Surgery to clamped,cut or
sealed the vas deferens (tubes
that carry a sperm from
testicles to the urethra)
prevents sperm from mixing
with the semen that is
ejaculated from the penis.

Efficacy:
Highly effective contraception
Failure rate 1-2 per 1000 cases
Efficacy 99.85%
Advantages Disadvantages

High efficacy Does not protect STIs

Permanent method of
birth control
Less risk compare to tubal
ligation
Alternative contraception
is required until 2
consecutive clear sperm
count is obtained
Surgical procedure is
required
Not easily reversible
Contraindication

Serious illness
Urological problems

Complication
Infection
Hematoma
Sperm granuloma
Methods
Vas deferens can be blocked either by:
- Cautery
- Ligation
No scalpel vasectomy cause less pain and bleeding

Procedure
Vasectomy perform under local anesthetic or GA
Incisions are performed on each side of scrotum
Vas deferens are located, excised and ligated.
Vasectomy
Thank you