FAMILY PLANNING AND

TYPES OF SEXUAL
CONTRACEPTIVES
By: Jhean Means
 Reproductive Life Planning
◦Includes all the decisions an individual or couple
make about whether and when to have children,
how many children to have, and how they are
spaced.
◦Examples are:
Counselling about how to avoid conception
Information on Increased fertility and ability to
conceive
Use of contraceptives
 Reproductive Life Planning
◦It is important for the health of all children
that pregnancies should be intended
because when a pregnancy is unintended
or mistimed, both short-term and long-term
consequences can result. This is common in
adolescents.
NURSING CARE PLANNING BASED ON
2020 NATIONAL HEALTH GOALS
◦ A number of 2020 National Health Goals speak directly to
reproductive life planning:
ᴥ Increase the proportion of adolescents who
receive formal instruction on abstinence before 18
years of age from a baseline of 87.2% to a target of
95.9%.
ᴥ Increase the proportion of females less than
15 years of age who have never had sexual
intercourse from a baseline of 82.9% to a target of
91.2%; of males, from 82% to 90.2%.
 NURSING CARE PLANNING BASED
ON 2020 NATIONAL HEALTH GOALS
ᴥ Reduce the proportion of females
experiencing pregnancy despite use of a reversible
contraceptive method from a baseline of 12.4% to a
target of 9.9%.
ᴥ Increase the proportion of intended
pregnancies from a baseline of 51% to a target of
56%.
ᴥDecrease the proportion of births occurring
within 18months of a previous birth from a baseline of
35.3% to a target of 31.7% (U.S. Dept. of Health and
Human Services,DHHS, 2010)
CONTRACEPTION
◦As many as 93% of women of childbearing age
in the United States use some form of
contraception.
◦Major benefits of this increase of contraception
include:
ᴥ decreases in unintended pregnancies
ᴥ the need for “morning after” medications
ᴥ elective terminations of pregnancy
CONTRACEPTION
◦Important things to consider when helping a couple
choose a method that will be right for them include:
ᴥ Personal Values
ᴥ Ability to use a method correctly
ᴥ If the method will affect affect sexual enjoyment
ᴥ Financial factors
ᴥ If a couple’s relationship is short term or long term
ᴥ Prior experiences with contraception
ᴥ Future plans
CONTRACEPTION
◦Understanding how various methods of
contraception work and how they compare in
terms of benefits and disadvantages is necessary
for successful counseling.

◦Assessing a woman for Possible Contraindications

to Contraceptive Use includes the ff:
CONTRACEPTION
ᴥ Poor Memory for compliance (OCs)
ᴥ Cigarette Smoker (OCs)
ᴥ Valvular Heart Disease (IUD)
ᴥ Diabetes (OCs)
ᴥ Retroflexed/ irregular shaped uterus ( IUD, cervical cap,
diaphragm)
ᴥ Undiagnosed Vaginal Bleeding ( all forms)
ᴥ Thrombophlebitis Varicosities ( OCs)
ᴥ Osteoporosis (DMPA)
ᴥ Infection, cystocele, rectocele diaphragm
ᴥ Liver Disease ( OCs, DMPA)
CONTRACEPTION
◦When counseling, in addition to assessing to
determine a best contraceptive option, be certain
to emphasize safer sex practices.
◦People differ greatly in the way they desire or
accept information on reproductive life planning,
depending on individual preferences and
sociocultural influences.
◦Consider each person’s lifestyle and overall health
CONTRACEPTION
◦ NO METHOD OF CONTRACEPTIVE, EXCEPT ABSTINENCE OFFERS 100%
protection against pregnancy.
◦ Paterno and Jordan states what an ideal contraceptive should be:
ᴥ safe
ᴥ effective
ᴥ Compatible with religious and cultural beliefs and personal
preferences of both the user and sexual partners
ᴥ free od bothersome effects
ᴥ convenient to use and easily obtainable
ᴥ affordable and needing few instructions for effective use
ᴥ free of effects ( after discontinuation) on future pregnancies
CONTRACEPTION
◦ Before a patient begins using a new contraceptive method,
information that should be obtained includes:
ᴥ Vital signs, possibly a Pap Smear, pregnancy test,
gonococcal and chlamydial screening, and perhaps
hemoglobin for detection of anemia.
ᴥ Obstetric history, including STIs, past pregnancies, previous
elective abortions, failure of previously used methods, and
compliance history of previously used methods.
ᴥ Subjective assessment of the client’s desires, needs, feelings,
and understanding of contraception
ᴥ Sexual practices, such as frequency, number of partners,
feelings about sex, and body image.
NATURAL FAMILY PLANNING
◦Natural planning methods, also called periodic
abstinence methods, are methods that involve no
introduction of chemical or foreign material into the
body. ( Hanson and Burke, 2011)
◦The effectiveness of these methods vary greatly from
a 2% ideal failure rate to about a 25% failure rate,
depending mainly on the couple’s ability to refrain
from having sexual relations on FERTILE DAYS (days
on which a woman has the most likely chance to
become pregnant)
ABSTINENCE
◦Abstinence, or refraining from sexual relations, has a
theoretical 0% failure rate, and is also the most
effective way to prevent STIs.
◦However particular adolescents find it difficult to
adhere to abstinence because of peer pressure.
◦Because it is difficult for many women to adhere to
abstinence, this method has a failure rate as high as
85%.
LACTATION AMENORRHEA METHOD
◦ As long as a woman is breastfeeding, there is both natural
suppression of ovulation and the return of menses.
◦ Lactation Amenorrhea Method (LAM) is a safe birth control
method (a failure rate about 1%-5%) if an infant is:
◦ Under 6 months of age
◦ Being totally breastfed at least every 4 hrs. during the
day and every 6 hrs. at night
◦ Receives no supplementary feedings
◦ Menses has not returned (mother)
LACTATION AMENORRHEA METHOD
◦After 6 months, or if the infant begins to receive
supplemental feedings or isn’t sucking well, the use of
LAM as an effective birth control method becomes
unquestionable and the woman probably should be
advised to choose another method of contraception.
◦A woman should also consider choosing a different
method of contraceptive once her baby begins
sleeping through the night, even if this occurs before
the child reaches 6 months of age.
COITUS INTERRUPTUS
◦ Coitus Interruptus (Withdrawal) is one of the oldest known
methods of contraception.
◦ The couple proceeds with coitus until the moment of
ejaculation. Then the man withdraws and spermatozoa
are emitted outside the vagina.
◦ Unfortunately, ejaculation may occur before withdrawal
is complete and, despite the caution used, some
spermatozoa may be deposited in the vagina.
COITUS INTERRUPTUS
◦Fertilization may still occur with a few
spermatozoa present in the pre-ejaculation
fluid.
◦This method is only about 75% effective,
and the method should be used with
caution as it can also lead to STIs.
POSTCOITAL DOUCHING
◦Douching following intercourse, no matter what
solution is used, is ineffective as a contraceptive
measure as sperm may be present in cervical
mucus as quickly as 90 seconds after
ejaculation, long before douching can be
accomplished.
FERTILITY AWARENESS METHODS
◦Fertility Awareness Methods rely on detecting when a
woman will be capable of impregnation (fertile) so she
can use periods of abstinence during that time.
◦There are many methods to determine a fertile period
but women should also consider the typical length of a
sperm survival (up to 3-4 days) and the length of time
an ova is ripe for fertilization (about 1 day). Based on
this a fertile period exists from 5 days before ovulation
and 1 day after.
CALENDAR (RHYTHM) METHOD
◦The calendar method requires a couple to abstain
from coitus on the days of a menstrual cycle when the
woman is most likely to conceive.
◦To plan for this, a woman has to keep a diary of about
six menstrual cycles. To calculate “safe” days, she
subtracts 18 from the shortest cycle she documented.
This number predicts her first fertile day. She then
subtracts 11 from her longest cycle. This represents her
last fertile day.
CALENDAR (RHYTHM) METHOD
◦ If she had six menstrual cycles ranging from 25-29 days, her
fertile period would be from the 7th day (25 [shortest cycle] –
18) to the 18th day (29[longest cycle] -11).
◦ To avoid pregnancy she would avoid coitus during those
days.
◦ This method has a low failure rate, however this rate rises
because if irregular menstrual cycles, miscalculation, or
disregard for predicted fertile days.
BASAL BODY TEMPERATURE METHOD
◦ Just before the day of ovulation, a woman’s basal body
temperature (BBT), or the temperature of her body at
rest, falls about 0.5 degrees Fahrenheit.
◦ At the time of ovulation, her BBT rises a full Fahrenheit
degree (0.2C) because of the rise of progesterone with
ovulation. This serves as a basis for the BBT method of
contraception
◦ To use this method, the woman takes her temperature
each morning, immediately after waking before she rises
from bed or undertakes activity, this is her BBT.
BASAL BODY TEMPERATURE METHOD
◦As soon as a woman notices a slight dip in
temperature followed by an increase, she knows she’s
ovulated. She refrains from having coitus for the next 3
days (the possible life of the discharged ovum).
◦Recommended to combine this with the calendar
method because of the life span of the sperm
(survives at least 4-7 days)
 CERVICAL MUCUS METHOD
(Billing’s Method)
◦Another method to predict ovulation is to use the
changes in cervical mucus that occur naturally with
ovulation.
◦Before ovulation each month, the cervical mucus is
thick and does not stretch when pulled between the
thumb and finger. Just BEFORE OVULATION, mucus
secretion increases. On the DAY OF OVULATION, it
becomes copious, thin, watery and transparent. It
feels slippery and stretches at least 1 inch before the
strand breaks, a property known as spinnbarkeit.
 CERVICAL MUCUS METHOD
(Billing’s Method)
◦SPINNBARKEIT is the property of cervical mucus to
stretch a distance before breaking.
◦In addition, breast tenderness and
an anterior tilt of the cervix occur.
◦All the days on which cervical mucus
is copious, and for at least 3-4 days afterward, are
considered to be fertile days.
 CERVICAL MUCUS METHOD (Billing’s
Method)
◦This method has a failure rate of 25% because of
difficulty in interpreting mucus status. Because
sperm have a life span up to 3-4 days, a woman
needs to abstain for 4 days prior to the
appearance of estrogen-influenced mucus;
therefore, this method should be combined with
a calendar method for best results.
 TWO DAY METHOD
◦To use this, a woman assesses for vaginal
secretions daily. If she feels secretions two days in
a row, she avoids coitus that day and the day
following as the presence of secretions suggests
fertility.
◦This method requires conscientious daily
assessment and results in about 12 days per
month in which she should avoid coitus, the
same as calendar method.
 SYMPTOTHERMAL METHOD
◦This method of birth control combines the cervical
mucus and BBT methods. Ideal failure rate about 2%.
◦The woman takes her temperature daily, watching for
the rise in temperature that marks ovulation. She also
analyzes her cervical mucus everyday and observes for
other signs of ovulation such as mittelshmerz (midcycle
abdominal pain) or if her cervix feels softer than usual.
◦The couple then abstains from intercourse for 3 days
after the rise in temperature or the fourth day after the
peak of mucus change. Is more effective than either BBT
or the cervical mucus method alone.
 STANDARD DAYS METHOD:
CYCLEBEADS
◦ The method is designed for women with cycles
between 26 and 32 days long which is the
majority of women. CycleBeads products can
be used either to prevent pregnancy or to plan
a pregnancy. Whether you want to prevent
pregnancy naturally or learn how to plan a
pregnancy, these family planning tools make
natural birth control easy and effective.
 STANDARD DAYS METHOD:
CYCLEBEADS
◦The day a woman starts her period she places the
rubber ring on the red bead. Each day she moves the
ring one bead forward, always in the direction of the
arrow. When the ring is on the red bead or a colored
bead, there is very low likelihood of pregnancy, so she
can have intercourse on these days without getting
pregnant. When the ring is on a white bead – Days 8
through 19 (12 white beads) – she is in her fertile period
and 13 additional brown “safe” days follow.
 STANDARD DAYS METHOD:
CYCLEBEADS
◦ If a woman wants to prevent pregnancy, she should
avoid having unprotected intercourse on Days 8
through 19 (days represented by glow-in-the-dark
white beads) as this is her potentially fertile period.
◦If a woman wants to achieve a pregnancy, she and
her partner should have intercourse during these white
bead days as these are days when a woman is most
fertile.
 STANDARD DAYS METHOD:
CYCLEBEADS
◦CycleBeads also come with a fertility calendar
and a woman is encouraged to mark the first
day of her period on it. If a user ever forgets if she
has moved the ring on her CycleBeads, she can
check the date she marked on the calendar to
see which day she is on in her cycle, and which
days are fertile.
STANDARD DAYS METHOD:
CYCLEBEADS
 OVULATION DETECTION
◦ Another method to predict ovulation is by the use of OTC
ovulation detection kits. These kits detect the midcycle surge
of luteinizing hormone (LH) that can be detected in urine 12
to 24 hours before ovulation. Best combined with a cervical
mucus assessment to mark the peak fertile day.
◦ LH is one of the hormones produced by the pituitary gland.
Ordinarily, it’s secreted at very low levels throughout your
menstrual cycle. But once a developing egg follicle reaches
a certain size — usually around the midpoint of your cycle —
LH secretion surges to really high levels. This hormone surge is
what triggers ovulation about 24 to 36 hours later.
OVULATION DETECTION
 SIDE EFFECTS AND
CONTRAINDICATIONS FOR NATURAL
FAMILY PLANNING
Natural Family planning methods has no side
effects. If there is a contraindication to their use it
would be for couples who must prevent
conception, because the failure rate of all forms is
about 25%.
 NATURAL FAMILY PLANNING and
EFFECT ON PREGNANCY

◦Natural family planning methods have

no effect if a woman should get
pregnant while using them as well as
no effect on future pregnancies.
 NATURAL FAMILY PLANNING and
EFFECT on SEXUAL ENJOYMENT
◦Once a couple is certain of a woman’s nonfertile
days using one of the natural planning methods,
more spontaneity in sexual relations is possible.
◦However, the required days of abstinence may
make a natural family planning method
unsatisfactory and unenjoyable for the couple.
◦Coitus interruptus may be unenjoyable because of
the need to withdraw before ejaculation.
 NATURAL FAMILY PLANNING and the
ADOLESCENT
◦ Natural methods of family planning (with the exception of abstinence)
are usually not the contraceptive method of choice for adolescents.
ᴥ Adolescent boys may lack the control or experience to use coitus
interruptus effectively.
ᴥ Girls tend to have occasional anovulatory menstrual cycles for
several years after menarche and so may not experience definite cervical
changes or an elevated body temperature each month.
ᴥ These methods requires a great deal of thought, persistence and
maturity.
ᴥ These methods require adolescents to say “no” to sexual
intercourse on fertile days.
 NATURAL FAMILY PLANNING and the
PERIMENOPAUSAL WOMAN
◦Perimenopausal women are good candidates for
natural family planning methods because they
may not be able to use hormonal methods such
as birth control pills because of risk to them if they
have a history of hypertension, thromboembolic
disease, or cigarette smoking.
NATURAL FAMILY PLANNING and the
POSTPARTAL WOMAN
◦After a successful pregnancy, most women are
interested in delaying their next pregnancy until
their new baby is older.
◦This makes them good candidates for natural
family planning as they can breastfeed with
these methods without worrying about hormonal
contaminations or a decrease in breast milk.
 BARRIER METHODS OF
CONTRACEPTION
◦Barrier methods are forms of birth control
that place a chemical or latex barrier
between the cervix and advancing sperm
so sperm cannot reach and fertilize an
ovum.
 BARRIER METHODS OF
CONTRACEPTION
◦ Barrier contraceptives:
ᴥcervical caps
ᴥfemale condoms
ᴥ male condoms
ᴥdiaphragms
ᴥvaginal spermicides.
◦ Barriers work by preventing the sperm from reaching the egg.
◦ Sterilization, although not a product, also prevents sperm from
reaching the egg. The procedures for sterilization are called a
vasectomy (for men) and tubal ligation (for women).
 SPERMICIDES
◦ Is an agent that causes the death of spermatozoa before
they can enter the cervix. Such agents are not only actively
spermicidal but also changes the vaginal pH to a strong acid
level, a condition not conductive to sperm survival.
◦ They do not protect against STI’s.
◦ Advantages include:
ᴥ may be purchased without prescription or an
appointment with a healthcare provider
ᴥ when used in conjunction with other contraceptives, it
increases the other method’s effectiveness
ᴥ Various preparations are available, including gels,
creams, sponges, films, foams, and vaginal suppositories.
 SPERMICIDES
◦ Gels or creams are easily inserted into the vagina before
coitus with the provided applicator. The woman should
do this within one hour before coitus. And should wait for
6 hours after coitus prior to washing/douching to ensure
that the agent has completed it spermicidal action.
◦Another form is a film of glycerin impregnated with a
spermicidal agent that is folded and inserted vaginally.
On contact with vaginal secretions or precoital penile
emissions, the film dissolves and a carbon dioxide foam
forms to protect the cervix against invading
spermatozoa.
 SPERMICIDES
◦ Cocoa butter and glycerin-based vaginal suppositories containing a
spermicide. It must be inserted 15 minutes before coitus because it takes
about 15 minutes for a suppository to dissolve.
◦ Foam-impregnated synthetic sponges are moistened to activate the
impregnated spermicide, then inserted vaginally to block sperm access.
SIDE EFFECTS AND CONTRAINDICATIONS:
Vaginally inserted spermicidal products are contraindicated in women
with acute cervicitis because they might further irritate the cervix.
Some women find the vaginal leakage after use of the products
bothersome.
Vaginal suppositories, because of the cocoa butter or glycerin base, are
the most bothersome, in regard.
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 MALE AND FEMALE
CONDOMS
MALE CONDOM
- Is a latex rubber or synthetic sheath that is placed over
the erect penis before coitus to trap sperm.
- Male condoms have an ideal failure rate of 2% and a
true failure rate of about 15% because breakage or
spillage occurs in up to 15% of uses.
- Recommended for partners who do not maintain a
monogamous relationship
MALE CONDOMS
ADVANTAGES:
- One of the few “male-responsibility” birth control
measures available
- No health care visit or prescription needed
- Prevent the spread of STIs such as gonorrhea and
chlamydia
- Their use has become a major part of the fight to
prevent infection from HIV
 MALE CONDOMS
◦To be effective, a condom must be applied before
any penile-vulvar contact as even pre-ejaculation
fluid may contain some sperm. The condom should
be positioned so it is loose enough at the penis tip
to collect the ejaculate without placing undue
pressure on the condom.
◦The penis must be withdrawn before it begins to
become flaccid after ejaculation to prevent sperm
from leaking into the vagina.
FEMALE CONDOMS
◦Condoms for females are sheaths made of latex of
polyurethane, prelubricated with a spermicide so, the
same as male condoms, they offer protection against
conception as well as STIs and HIV.
◦Composed of two rings.
◦Inner ring: is the closed end; covers the cervix
◦Outer ring: is the open end; rests against the vaginal
opening.
◦The sheath may be inserted anytime before sexual
activity begins and removed after ejaculation occurs.
FEMALE CONDOMS
◦ Intended for one time use.
◦ More expensive than male condoms, OTC.
◦ Male and female condoms should not be used
together or there is an increased chance of tearing
one or the other.
◦ Are the only woman-controlled safer sex method
Ideal failure rate (5%) and usual failure rate (15%) of
both male and female condoms are the same.
MALE AND FEMALE CONDOMS
DIAPHRAGM AND CERVICAL CAPS
DIAPHRAGM
- A diaphragm is a circular rubber disk that is placed over
the cervix before intercourse to mechanically halt the
passage of sperm.
- Usually combined with a chemical method of
contraception (spermicide)
- Failure rate as low as 6% (ideal) to 18% (typical use)
- Is prescribed and fitted initially by a healthcare provider
to ensure correct fit.
DIAPHRAGM
DIAPHRAGM
◦Should remain in place for at least 6 hours after
coitus, because spermatozoa remain viable in the
vagina for that length of time. They may be left in
place for as long as 24 hours.
◦Leaving them in place longer than this can cause
cervical inflammation (erosion) or urethral irritation
from the pressure against the vaginal walls.
◦Lasts up to 2 years if its kept well.
◦Cannot be used during menstrual period
◦ The Pros :
◦ It is reusable and relatively inexpensive
◦ It is small and easy to carry
◦ It rarely hinders the sexual experience
◦ The Cons :
◦ It requires consistent use for each sexual encounter
◦ Spermicidal agents may be messy
◦ A prescription is required
◦ It may contribute towards urinary tract infections
◦ It must be cleaned and stored
◦ It may need to be resized following a pregnancy,
abortion, pelvic surgery, or weight loss or gain of 20 lbs. or
more
CONTRAINDICATIONS
◦ History of Toxic Shock Syndrome
◦ Concurrent pelvic infection
◦ Not recommended if risk of Sexually
Transmitted Disease
◦ Abnormal Pap Smear or cervical
biopsy in last 12 weeks
◦ Vaginal Spermicide Allergy
- Consider alternative Spermicide
brand
- Consider less concentrated
Spermicide (2%)
◦ Latex Allergy
◦ Woman unable to insert or
remove diaphragm
◦ Anatomic constraints
- Markedly anteverted Cervix
- Poor diaphragm fit
- Shallow vaginal shelf making
stabilization difficult
- Poor vaginal tone
- Presence
of Rectocele or Cystocele
CERVICAL CAPS
◦is a small, thimble-shaped cup made of silicone that fits
over the cervix (the part of the uterus that opens into
the upper part of the vagina). It is considered one of
the barrier methods of birth control because it provides
a physical barrier between a male's sperm and a
female's egg.
◦must be used with spermicide
◦Cervical caps are smaller than diaphragms and the
shape is a little different: diaphragms are shaped like a
dish, and cervical caps look like a sailor’s hat.
CERVICAL CAPS
◦You can leave the cervical cap in longer than a
diaphragm (up to 2 days), but diaphragms are slightly
more effective at preventing pregnancy.
◦The "typical use" failure rate for the cervical cap can
range from 14-29% because cervical caps tend to
dislodge more readily than diaphragms during coitus.
◦The most common side effect from using a cervical cap
is vaginal irritation. Some women also experience an
increase in the number of bladder infections they have.
CONTRAINDICATIONS
◦They are contraindicated with women who has:
- An abnormally short or long cervix
- A current abnormal pap smear
- a history of TSS ( a staphylococcal infection
introduced through the vagina)
- An allergy to latex or spermicide
- A history of cervicitis or cervical inflammation
- A history of cervical cancer
- Undiagnosed vaginal bleeding.
CERVICAL CAPS
Advantages of all barrier methods:
Barrier methods of birth control:
◦ Do not affect a woman's or man's future fertility.
◦ Are only used at the time of sexual intercourse.
◦ Are safe for a woman to use while she is breastfeeding.
◦ Do not affect other health conditions, such as high blood
pressure or diabetes.
◦ Are less expensive than hormonal methods of birth control,
and some are available without a prescription.
◦ Condoms and diaphragms may reduce the risk of cervical
cancer, which is caused by a sexually transmitted human
papillomavirus.
Disadvantages of all barrier methods
◦Failure rates for barrier methods are higher than for
most other methods of birth control. If you are
considering using a barrier method for birth control,
think through what the emotional and financial costs
of an unintended pregnancy would be if the method
fails.
◦To prevent pregnancy with a barrier method, you and
your partner must be comfortable with using it and be
prepared to use it every time you have sex.
 HORMONAL CONTRACEPTION
◦Hormonal methods of birth control prevent eggs from
being released from the ovaries, thicken cervical mucus
to prevent sperm from entering the uterus, and thin the
lining of the uterus to prevent implantation.
◦Taken orally, transdermally, intravaginally, or
intramuscularly cause such fluctuations in a normal
menstrual cycle that ovulation or sperm transport does
not occur.
 HORMONAL CONTRACEPTION
◦There are two main types of hormonal contraceptive
formulations: combined methods which contain both
an estrogen and a progestin, and progestogen-only
methods which contain only progesterone or one of its
synthetic analogues (progestins).
◦Combined methods work by suppressing ovulation and
thickening cervical mucus; while progestogen-only
methods reduce the frequency of ovulation, most of
them rely more heavily on changes in cervical mucus.
 COMBINATION ORAL CONTRACEPTIVES
◦ Combined oral contraceptive pill (COCP), often referred to as
the birth control pill or colloquially as "the pill", “OC’s” is a birth
control method that includes a combination of an estrogen
(estradiol) and a progestogen (progestin). When taken by
mouth every day, these pills reversibly inhibit female fertility.
◦ The estrogen acts to suppress follicle-stimulating hormone
(FSH) and luteinizing hormone (LH) to suppress ovulation.
◦ The progesterone action causes a decrease in the
permeability of cervical mucus and so limits the sperm motility
and access to ova. Also interferes with tubal transport and
endometrial proliferation such as extent the possibility of
implantation is significantly decreased.
 Popular COCs prescribed in the US
are:
◦Monophasic pills : contain fixed doses of both
estrogen and progestin throughout a 21 day cycle
◦Biphasic pills: are preparations that deliver a
constant amount of estrogen throughout the cycle
but varying amounts of progestin.
◦Triphasic and Tetraphasic pills: vary in both estrogen
and progestin content throughout the cycle.
USAGE
◦ Combined oral contraceptive pills should be taken at the
same time each day. If one or more tablets are forgotten
for more than 12 hours, contraceptive protection will be
reduced. Most brands of combined pills are packaged in
one of two different packet sizes, with days marked off for
a 28-day cycle. For the 21-pill packet, a pill is consumed
daily for three weeks, followed by a week of no pills. For the
28-pill packet, 21 pills are taken, followed by a week of
placebo or sugar pills. A woman on the pill will have a
withdrawal bleed sometime during the placebo week, and
is still protected from pregnancy during this week.
USAGE
◦ Placebo pills : The placebo pills allow the user to take a pill
every day; remaining in the daily habit even during the
week without hormones. Placebo pills may contain an iron
supplement, as iron requirements increase during
menstruation.
◦ Must be prescribed a health care provider after a pelvic
examination, screening for eligibility , and usually a pap
smear.
◦ When used correctly, they are 99% effective. Typical failure
rate is about 5%
USAGE
 Oral Contraceptives have benefits in addition to
preventing pregnancy, such as decreasing incidents of:
◦ Dysmenorrhea, because of lack of ovulation
◦ Premenstrual Dysphoric Syndrome and acne, because of the increased
progesterone levels
◦ Iron deficiency anemia, because of the reduced amount of menstrual
flow
◦ Acute pelvic inflammatory response (PID) and resulting tubal scarring
◦ Endometrial and ovarian cancer, ovarian cysts, and ectopic
pregnancies
◦ Fibrocystic breast disease
◦ Possibly osteoporosis, endometriosis, uterine myomata, and possibly
rheumatoid arthritis
◦ Colon cancer
 Women can set a start date for a
cycle of pills in one of 4 ways:
◦First Day of Period Start: Start your pills on the first day of
your period. Continue to take one pill every day at the
same time. With this method, you do not need to use a
backup method as the pills are effective in preventing
pregnancy right away.
 Women can set a start date for a
cycle of pills in one of 4 ways:
◦Quick Start: Take your first pill today at a good
time for you. Continue to take one pill every day
at the same time. With this method, you need to
use backup pregnancy protection (such as
condoms or abstinence) for at least 7 days.
 Women can set a start date for a
cycle of pills in one of 4 ways:

◦Sunday Start: Take your first pill on the first Sunday

following the start of your period. If your period starts on
a Sunday, start your pill that day. Continue to take one
pill every day at the same time. With this method, you
need to use backup pregnancy protection (such as
condoms or abstinence) for at least 7 days.
 Women can set a start date for a
cycle of pills in one of 4 ways:
◦After Childbirth, a woman should start the
contraceptive on a day (or Sunday) closest to 2
weeks after birth; after an elective termination of
pregnancy, she could begin on a chosen day or
the first Sunday after the procedure.
 Taking the Birth Control Pill
◦Take ONE PILL EVERY DAY AT THE SAME TIME for as long
as you don’t want to become pregnant.
◦Take the pills from left to right.
◦When you get to the placebo pills at the end of the
package, continue to take them the same way.
◦When you take the last pill in the package, start a new
package the very next day.
◦As long as you do this, you are protected from
pregnancy for the entire month
 FREQUENTLY ASKED QUESTIONS
What if I miss taking a pill for one day, or take it late?
◦Consider using a backup method such as condoms or
you could abstain (not have sex) for the first 7 days
after you missed the pill.
◦Take one pill as soon as you remember and your
regular pill at the usual time (you may be taking 2 pills
on the same day: one at the time you remember and
the other at your regular time).
 FREQUENTLY ASKED QUESTIONS
What if I miss a period while using birth control pills?
◦ It is not unusual to occasionally skip a period completely
while using the pill. Remember, pills can make your flow
lighter so even a very small amount of blood is considered
a period.
◦ If you do miss a period (and you have no signs of
pregnancy), continue with your next pack of pills on
schedule.
◦ If you miss another period the next month, continue with
your pills but go to a clinic or your doctor and have a
pregnancy test done. Pills are not known to harm an early
pregnancy.
 There are some serious danger signs that all
women using the pill should be aware of.
These are:
◦ A abdominal pain, especially on the right side of your stomach,
below your rib cage
◦ C chest or arm pain, shortness of breath, coughing up blood
◦ H headaches, severe and not relieved by aspirin or Tylenol
◦ E eye problems, blurred vision, flashing lights, double vision,
blindness
◦ S swelling, redness, numbness, tingling or pain in the legs
◦ Seek medical attention immediately if you have any of the
above symptoms.
 EXTENDED-USE PILLS
◦ Extended hormonal contraception delays menstruation; continuous
use eliminates menstruation. Lybrel contains a full year of active pills
with no inactive pills.
◦ Extended-regimen contraception has been used for years to relieve
menstrual-related complaints and to treat women with
menorrhagia, dysmenorrhea, endometriosis, chronic pelvic pain,
and anemia. Menstrual suppression through continuous COC use is
associated with reduction in menstrual migraines, endometriosis,
and acne and an improved sense of well-being.
◦ Extended or continuous regimens are useful for women who want
convenience for their menstruation, including women who travel,
are on deployment in the military, or seek more control regarding
the timing of menstruation.
 Progestin-only pills(mini pill)
◦ The minipill, also known as the progestin-only birth control pill, is an
oral contraceptive that contains the hormone progestin. Unlike
combination birth control pills, the minipill doesn't contain
estrogen.
◦ The minipill thickens cervical mucus and thins the lining of the
uterus (endometrium) — preventing sperm from reaching the egg.
The minipill also sometimes suppresses ovulation. For maximum
effectiveness, you must take the minipill at the same time every
day.
◦ Without estrogen content, ovulation may occur, but because the
progestins have not allowed the endometrium to develop fully or
sperm to freely access the cervix, fertilization and implantation will
not take place.
 Main Side Effects of COCs
◦ Nausea
◦ Weight gain
◦ Headache
◦ Breast tenderness
◦ Breakthrough bleeding (spotting outside normal
menstrual period)
◦ Monilial vaginal infections
◦ Mild hypertension
◦ Depression
 Call your healthcare provider if you have
any of the following:
◦Abdominal or pelvic pain or tenderness
◦Unusually heavy or frequent vaginal bleeding
◦Severe or worsening headaches
◦Jaundice (your skin or eyes become unusually yellow)
◦Chest pain
◦Shortness of breath
◦Severe leg pain
◦Eye problems, such as blurred vision
CONTRAINDICATIONS by WHO
 TRANSDERMAL CONTRACEPTION
◦Refers to patches that slowly but continuously release a
combination of estrogen and progesterone. Patches are
applied each week for 3 weeks. No patch is applied on
the first week – menstrual flow occurs. Then a new cycle
begins after the patch free week.
◦The patch can be applied to the abdomen, buttocks,
upper torso except breasts, and upper arms. Should not
be placed anywhere else. Can be worn while showering.
◦If a patch comes loose, it should be replaced
immediately.
 Most common side effects
◦ Breast symptoms
◦ Application site reactions (skin irritation, redness,
itching, or swelling where the patch was worn)
◦ Nausea
◦ Upper respiratory tract infection
◦ Dysmenorrhea
◦ Headache, anxiety, mood changes
◦ Irregular vaginal bleeding or spotting
 HOW DOES IT WORK?
◦ The birth control patch prevents pregnancy by stopping sperm
from meeting an egg (which is called fertilization). Like most
birth control pills, the patch contains the hormones estrogen
and progestin, which are similar to hormones our bodies make
naturally. You wear the patch on certain parts of your body,
and the hormones are absorbed through your skin.
◦ The patch stops your ovaries from releasing eggs (called
ovulation). No ovulation means there’s no egg hanging
around for sperm to fertilize, so pregnancy can’t happen.
◦ The patch’s hormones also thicken the mucus on your cervix.
Thicker cervical mucus makes it hard for sperm to swim to an
egg — kind of like a sticky security guard.
 VAGINAL ESTROGEN/PROGESTIN
RINGS
◦ A NuvaRing is a flexible silicone vaginal ring that, when placed
around the cervix, continually releases a combination of estrogen
and progesterone.
◦ The ring is inserted vaginally by the woman and left in place for 3
weeks, then removed after 1 week with menstrual bleeding
occurring during the ring free week.
◦ NuvaRing’s hormones stop ovulation. The ring’s hormones also
thicken the mucus that lives on the cervix. Thicker cervical mucus
makes it hard for the sperm to swim to an egg.
◦ When used perfectly, the NuvaRing is 99% effective. But when it
comes to real life, the ring is about 91% effective because it can be
hard to be perfect. So in reality, 9 out of 100 ring users get pregnant
each year.
 What makes NuvaRing less effective?
◦ The antibiotics Rifampin, Rifampicin, and Rifamate
(other antibiotics aren’t a problem)
◦The antifungal Griseofulvin (other antifungals aren’t a
problem)
◦Certain HIV medicines
◦Certain anti-seizure medicines (these are sometimes
also used to treat psychiatric disorders like bipolar
disorder)
◦The herb St. John’s Wort
ADVANTAGES:
◦ Is effective when used properly
◦ Convenient
◦ makes your period a breeze.
◦ has health benefits; can help reduce or prevent
◦ acne
◦ bone thinning
◦ cysts in the breasts and ovaries
◦ ectopic pregnancy
◦ endometrial and ovarian cancers
◦ serious infections in the ovaries, fallopian tubes, and uterus
◦ iron deficiency (anemia)
◦ PMS (premenstrual syndrome)
DISADVANTAGES:
◦You have to change NuvaRing on time
◦Shorter lighter periods
◦Weight neutral
◦Increase in vaginal discharge
◦Headache
◦Vaginitis
 SUBDERMAL HORMONE IMPLANTS
◦ The birth control implant (AKA Nexplanon or Implanon) is a
tiny, thin rod about the size of a matchstick. The implant
releases hormones into your body that prevent you from
getting pregnant. A nurse or doctor inserts the implant into
your arm and that’s it — you’re protected from pregnancy for
up to 4 years. It’s get-it-and-forget-it birth control.
◦ The birth control implant is a tiny, thin rod about the size of a
matchstick. It’s also called Nexplanon and there’s a slightly
older version called Implanon. A doctor inserts the implant
under the skin of your upper arm. It releases the hormone
progestin to stop you from getting pregnant.
SUBDERMAL HORMONE IMPLANTS
◦ The hormones in the birth control implant prevent
pregnancy in two ways:
◦ Progestin thickens the mucus on your cervix, which
stops sperm from swimming through to your egg. When
sperm can’t meet up with an egg, pregnancy can’t
happen.
◦ Progestin can also stop eggs from leaving
your ovaries (called ovulation), so there’s no egg to
fertilize. When eggs aren’t released, you can’t get
pregnant.
 INTRAMUSCULAR INJECTIONS
◦ This medication is used to prevent pregnancy.
Medroxyprogesterone is like a natural hormone made by
the body. It works mainly by preventing the growth and
release of an egg (ovulation) during your menstrual cycle. It
also makes vaginal fluid thicker to help prevent sperm from
reaching an egg (fertilization) and changes the lining of the
uterus (womb) to prevent attachment of a fertilized egg.
◦ Medroxyprogesterone is also used to treat endometriosis. It
works by lowering the amount of certain hormones in the
body and decreasing the growth of abnormal tissues that
cause endometriosis. This helps reduce pain and other
symptoms.
DMPA (Depot Medroxyprogesterone
Acetate)
◦This medication is given by injection into a
muscle (upper arm or buttock) as directed by
your doctor, usually once every 3 months. To
make sure you are not pregnant, the first
injection is usually given during the first 5 days of
your menstrual period.
 INTRAUTERINE DEVICES
◦ An intrauterine device (IUD or coil)is a small, often T-shaped birth
control device that is inserted into a woman's uterus to prevent
pregnancy. IUDs are one form of long-acting reversible birth
control.
◦ Among birth control methods, IUDs, along with contraceptive
implants, result in the greatest satisfaction among users. Evidence
supports effectiveness and safety in adolescents and those who
have and have not previously had children. Once removed,
even after long-term use, fertility returns to normal rapidly. Failure
rates are about 0.8% with copper devices and 0.2% with
hormonal (levonorgestrel) devices in the first year of use.
 Types of IUDs
◦ Hormonal IUD. The hormonal IUD releases levonorgestrel,
which is a form of the hormone progestin. The hormonal IUD
appears to be slightly more effective at preventing
pregnancy than the copper IUD. Hormonal IUDs prevent
pregnancy for 3 to 5 years, depending on which IUD is used.
(Mirena IUD)
◦ Copper IUD. The most commonly used IUD is the copper
IUD. Copper wire is wound around the stem of the T-shaped
IUD. The copper IUD can stay in place for up to 10 years and
is a highly effective form of contraception. (CopperT380)
How it works
Both types of IUD prevent fertilization of the egg by damaging or
killing sperm. The IUD also affects the uterine lining (where a
fertilized egg would implant and grow).
◦ Hormonal IUD. This mucus in the cervix thick and sticky, so
sperm can't get through to the uterus. It also keeps the lining of
the uterus (endometrium) from growing very thick.1 This makes
the lining a poor place for a fertilized egg to implant and grow.
The hormones in this IUD also reduce menstrual bleeding and
cramping.
◦ Copper IUD. Copper is toxic to sperm. It makes the uterus and
fallopian tubes produce fluid that kills sperm. This fluid contains
white blood cells, copper ions, enzymes, and prostaglandins.
 Why It Is Done
You may be a good candidate for an IUD if you:
◦ Do not have a pelvic infection at the time of IUD insertion.
◦ Have only one sex partner who does not have other sex partners
and who is infection-free. This means you are not at high risk for
sexually transmitted infections (STIs) or pelvic inflammatory disease
(PID), or you and your partner are willing to also use condoms.
◦ Want an effective, long-acting method of birth control that
requires little effort and is easily reversible.
◦ Cannot or do not want to use birth control pills or other hormonal
birth control methods.
◦ Are breastfeeding.
 Advantages of IUDs
◦ cost-effectiveness over time, ease of use, lower risk of ectopic
pregnancy, and no interruption of foreplay or intercourse.
◦ Reduces heavy menstrual bleeding by an average of 90% after the first
few months of use.
◦ Reduces menstrual bleeding and cramps and, in many women,
eventually causes menstrual periods to stop altogether. In this case, not
menstruating is not harmful.
◦ May prevent endometrial hyperplasia or endometrial cancer.
◦ May effectively relieve endometriosis and is less likely to cause side
effects than high-dose progestin.
◦ Reduces the risk of ectopic pregnancy.
◦ Does not cause weight gain.
Risks
Risks of using an intrauterine device (IUD) include:
◦ Menstrual problems. The copper IUD may increase menstrual bleeding or
cramps. Women may also experience spotting between periods. The
hormonal IUD may reduce menstrual cramps and bleeding.
◦ Perforation. In 1 out of 1,000 women, the IUD will get stuck in or puncture
(perforate) the uterus.1 Although perforation is rare, it almost always
occurs during insertion. The IUD should be removed if the uterus has been
perforated.
◦ Expulsion. About 2 to 10 out of 100 IUDs are pushed out (expelled) from
the uterus into the vagina during the first year. This usually happens in the
first few months of use. Expulsion is more likely when the IUD is inserted
right after childbirth or in a woman who has not carried a pregnancy.
When an IUD has been expelled, you are no longer protected against
pregnancy.
Disadvantages of IUDs
◦ High cost of insertion
◦ No protection against STIs, and the need to be removed by a
doctor.
◦ Hormonal IUD may cause noncancerous (benign) growths
called ovarian cysts, which usually go away on their own.
◦ The hormonal IUD can cause hormonal side effects similar to
those caused by oral contraceptives, such as breast
tenderness, mood swings, headaches, and acne. This is rare.
When side effects do happen, they usually go away after the
first few months.
 SURGICAL METHODS OF
REPRODUCTIVE LIFE PLANNING
Sterilization is a permanent method of contraception,
and is the most commonly used form of family
planning among couples both in the United States
and worldwide. For men and women who no longer
want to have children, sterilization offers a
permanent, safe, cost-effective and efficacious way
to prevent unintended pregnancy. Male sterilization is
less common than female sterilization, but both are
nearly 100% effective at preventing pregnancy.
 FEMALE STERILIZATION
◦ Female sterilization is an outpatient procedure that can be done
surgically or with a nonsurgical implant. Both of these methods seal
or block the fallopian tubes, preventing eggs from travelling down
the tubes to the uterus and blocking sperm from fertilizing the egg.
Recent data from the Centers for Disease Control and Prevention
(CDC) show that among women ages 15 to 44 who use a
contraceptive method, one in four used tubal ligation as their
method of contraception, which is approximately the same rate
as the pill.
◦ Sterilization rates are highest among 35 to 44 year olds, formerly
married women, and women with three or more births. Sterilization
rates are also higher among black and Hispanic women, as well as
women with lower education level
FEMALE STERILIZATION
 FEMALE STERILIZATION
SURGICAL TUBAL LIGATION
◦ There are two main methods of surgical tubal ligation: mini-
laparotomy and laparoscopic sterilization. A mini-
laparotomy (also called a minilap) is most commonly used
immediately postpartum, right after childbirth under
general or regional anesthesia. A small incision is placed in
the abdomen and part of the fallopian tube is removed or
blocked. The procedure can be performed by a broad
range of healthcare providers.
 SURGICAL TUBAL LIGATION
◦Laparoscopic sterilization, on the other hand, can
only be performed by specially trained surgeons or
gynecologists, and it is not recommended for
postpartum use.2 While the patient is under general
anesthesia, a small incision is made in the abdomen
and a small, thin camera is inserted to view the
fallopian tubes which are then sealed. Recovery time
is quicker for a laparoscopic sterilization than for a
mini-laparotomy.
 STERILIZATION IMPLANT
◦Currently, there is one nonsurgical method of female
sterilization. Approved by the FDA in 2002, Essure is a
device that is comprised of two flexible coils which
are inserted into each of the fallopian tubes through
the cervix. Over time, scar tissue builds up around
these coils, blocking the tubes. This process takes
about three months to become effective. However,
once it does, the failure rate is extremely low with
fewer than three pregnancies for every 1000 women.
According to the manufacturer, Bayer, more than
750,000 women have received Essure since 2002.
 ESSURE
◦Because no anesthesia or incisions are necessary, this
procedure is considered safer than surgical methods.
However, there have been widespread complaints
reporting adverse effects due to Essure including
chronic pain and bleeding. Some of the effects may
be due to nickel allergies, a metal found in the device.
In response, the FDA has required a new warning label
on the packaging that describes the potential for
severe side effects, and has asked Bayer to conduct
more tests on the device
MALE STERILIZATION
◦Male sterilization, also called a vasectomy, is an
outpatient procedure. In the traditional procedure, a
doctor will make two small incisions on either side of
the scrotum in order to clip, cut and tie, or cauterize
the vas deferens, which connect the testicles to other
glands. There is also a newer “no-scalpel” technique
in which only a small puncture in the scrotum is
needed to reach the vas deferens, reducing
complications and recovery time. Despite lower
frequency of use, vasectomies are safer, cheaper,
and more effective than female sterilization
 MALE STERILIZATION
◦Only one out of every 1000 women will become
pregnant using this contraceptive method; however,
vasectomies are not effective immediately. It usually
takes three months for sperm that is left in the tubes
to be reabsorbed or ejaculated. Until then, an
alternate form of contraception must be adopted.
Male sterilization also does not protect against STIs.
Non-surgical alternatives, such as spring clips, have
been available in the past, but the vast majority of
men use surgical methods of vasectomy.