METHODS OF Prepared by:

CONTRACEPTION Maricar B. Macalam, MOB

 CONTRACEPTION
aka Birth control, is designed to PREVENT PREGNANCY

the decision maybe made by a woman or jointly by a couple

Motivations:
• desire to avoid pregnancy
• gain control over the number of children conceived
• determine the spacing of future children

category of contraception:
• Short-acting reversible contraception, SARC
• Depo-provera, birth control pills, contraceptive patch, vaginal ring, diaphragm
• Long-acting reversible contraception, LARC
• IUD/IUS, contraceptive implant
Contraception
 contraceptive effectiveness are assessed in two ways:
Perfect use – use of contraceptive as the
manufacturer intended
Typical use – human error

 having UNPROTECTED SEX can put you at risk of:

 unwanted pregnancy
 contacting sexually transmitted infections (STIs)

 types of sex:
o Vagina
o Oral
o Anal
o Genital grinding
o Sex toys
o Masturbation
o Non-penetrative
 effectiveness of method in preventing
pregnancy
FACTORS TO safety of the method

CONSIDER IN client’s age and future childbearing plans

any contraindications in woman’s health
CHOOSING A history
METHOD OF religious or moral factor influencing choice
partner’s support and willingness to
CONTRACEPTION cooperate
personal motivation to use method
FERTILITY AWARENESS METHODS (FAMS)
 aka natural family planning, NFP
 are ways to TRACK OVULATION to
prevent pregnancy
 all these methods require periods of
abstinence and recording of certain events
throughout the cycle
 cooperation of the partners is important
 free, safe, and acceptable to many whose
religious beliefs prohibit other methods
 types:
1) Body Basal Temperature Method
2) Calendar Method
3) Cervical Mucus Method
 BODY BASAL TEMPERATURE METHOD
(BBTM)
 tracking the woman's body temperature DAILY to determine which days of the month she is fertile
 body basal temperature is the temperature of the person fully at rest
 is based on the fact that the temperature drops just before ovulation and rises remains elevated for several days
after
  major benefits to using BBT to identify ovulation are that it is low-cost, easily accessible (the only equipment you
need are a thermometer and chart paper to plot your readings) and non-invasive
 readings may alter with the following:
 breastfeeding
 illness or infection
 drinking alcohol
 oversleeping
 stress
 certain medications
 travel and time zone differences
 many family planning experts recommend combining BBT method with other methods of NFP like CMM
 HOW DOES THE BASAL BODY TEMPERATURE METHOD WORK?
 take basal temperature at the same time every day
• the best time to take the temperature is immediately after waking up; don’t get up; no
drinking (coffee, water), eating, speaking; set an alarm clock; have a minimum of 5 hours of
sleep before measuring
 measure the temperature from the same place every day
• the BBT can be taken in the mouth, vagina, or rectum
 record the temperature each day
• use a graph, list, or fertility-tracking app that allows you to compare each day’s temperature
 identify a temperature increase
• BBT typically rises less than ½ of a degree Fahrenheit after ovulation. It may take a few cycles
to determine when this rise occurs each month.
 consider the fertile period
• you are most likely to get pregnant during the period spanning 2 days before and 3 days after
ovulation
• hoping to become pregnant, have sex during this time
• to avoid pregnancy, do not have unprotected sex
Calendar method, CM
 this method will help the woman identify the fertile and
infertile phases/days of her cycle
 is based on the assumptions that ovulation tends to occur
14 days before the start of the next menstrual period
 sperm are viable for 48 – 72 hrs, and the ovum is
viable for 24 – 48 hrs
 can work for women with regular menstrual cycle
 the 1st day of menstruation is the 1st day of the cycle
 to decrease the risk of pregnancy, couples abstain from
intercourse during fertile days
CALENDAR
METHOD
 day 17 is ovulation
day
 DAYS 12 – 22 are
fertile days/phases
(unsafe) of the
woman’s 28-day
cycle
CERVICAL MUCUS METHOD, CMM
 aka ovulation method or the Billings method
 is based on careful observation of mucus patterns during the
menstrual cycle
 amount and character of CM change because of the influence
of estrogen and progesterone
 at the time of ovulation, the mucus is clearer, more
stretchable and more permeable to sperm
 the PEAK DAY of wetness and clear, stretchable mucus is
assumed to be the time of ovulation
 to use this method correctly, the woman should abstain from
intercourse from the time she first notices that the mucus is
becoming clear, more elastic, and slippery until 4 days after the
last wet mucus day
  Abstinence can be
considered a method of
SITUATION contraception

AL  includes:
1) Coitus interruptus
CONTRACE 2) Douching after

PTIVES intercourse
3) Lactational Amenorrhea
Method (LAM)
 ABSTINENCE
it's when you do not have any form of sexual activity

it's a self-enforced restraint from indulging in bodily activities that are widely experienced as giving pleasure

most people find it difficult to comply with abstinence, so only a few of them use this method

benefits of abstinence (no genital contact) include:

> no risk of pregnancy

> no risk of STIs and HIV

> always available

 Coitus interruptus
 aka Pulling Out, Withdrawal Method
 is when the penis is pulled out of the vagina before ejaculation (cum)
 one of the oldest and least reliable methods of contraception
 How to use withdrawal?
a person must know when they are about to ejaculate
when a person is almost ready to ejaculate, they need to pull the penis out of
the vagina and away from the genitals
after ejaculating, wash hands before touching your partner’s genitals
17
 benefits of disadvantages of
withdrawal withdrawal
♥ it requires self-control for both partners.
* it’s better than It can be very hard to stop and withdraw
using no birth the penis before ejaculation
♥ if a person has trouble with premature
control at all ejaculation, it’s not a good idea to use
* it’s available in withdrawal as a method of birth control
any situation ♥ it might decrease pleasure for both
partners
VAGINAL DOUCHE
 from the word “douche” means to wash
or soak
 usually sold in the form of hygiene kit
 is washing the vagina with water or a
mixture of fluids to eliminate odors and
“clean” the vagina
 most often, vinegar is mixed with the
water, but some prepackaged douche
products contain baking soda or iodine
 douching after intercourse is an
ineffective method of contraception and is
not recommended; may facilitate
conception
 LACTATIONAL AMENORRHEA
METHOD (LAM)
“lactational” – related to breastfeeding; “amenorrhea” – no vaginal
bleeding
is a natural, short-term birth control method in which a woman
prevents pregnancy by exclusively breastfeeding after birth
provides natural protection against pregnancy for up to six months
after birth
 more effective if used with other method of contraception
 LAM only works if
♡baby is under 6 months old and
benefits of LAM
♡baby is fully breastfed (baby gets no other ☺ it can work for up to 6 months after birth
liquid or food, not even water) or nearly-fully ☺ it is effective right away
breastfed (baby gets vitamins, water, or other ☺ there are no added hormones that can
fluids or nutrients once in a while and they do
affect breastmilk
not disrupt the frequency of feedings) --- baby
☺ there is no cost and no birth control
should be breastfed at least every 4 hours and
supplies are needed
♡period has not returned. This means you have
☺ breastfeeding has many other health
not had vaginal bleeding for 2 or more days in
a row (not counting bleeding during the first 2 benefits for you and your baby
months after giving birth)
 SPERMICIDES
 contain a chemical nonoxynol-9 that kills or immobilize sperm
 insert spermicide in the vagina before sex
 doesn't require a prescription --- can get spermicide over-the-counter
 increases lubrication during sex
 is most effective when used with a barrier method: condom, diaphragm, contraceptive sponge; cervical cap
 available in many forms:
• cream
• gel
• foam
• film
• suppository
• tablet
 TO USE SPERMICIDE
 Choose a type of spermicide. Foams, gels and creams begin working immediately, while suppositories, films
and tablets need to be inserted 10 - 30 minutes before sex to dissolve. If more than one hour passes between the
application of spermicide and sex, reapply spermicide
 Apply spermicide. Find a comfortable position, such as lying down. Using an applicator or your fingers, insert
spermicide into vagina on or near cervix
 If you use an applicator, fill the applicator with the recommended amount of cream, gel or foam and insert it into
vagina as far as it will go. Push the plunger on the applicator to release the spermicide near the cervix
 To insert spermicide by hand, wash and dry hands and place the suppository, film or tablet on fingers. Slide
fingers along the back wall of vagina as far as you can so that the spermicide covers or rests on or near cervix
 If using spermicide with a diaphragm or cervical cap, follow the instructions that come with the device. If you
have sex more than once, apply fresh spermicide before each sexual encounter
 Be cautious after sex. For maximum effectiveness, make sure the spermicide remains in the vagina for at least
six hours after sex. After six hours, there's no need to clean any remaining spermicide from vagina. Douching
isn't recommended — but if you choose to douche after sex, wait at least six hours
TO USE SPERMICIDE
 BARRIER METHODS OF
CONTRACEPTIVES
prevent the transport of sperm to the ovum,
immobilize sperm, or are lethal against sperm
Male ad female condoms
Diaphragm and cervical cap
Vaginal sponge
Intrauterine devices
FEMALE  made from soft, thin, polyurethane sheath with
a flexible ring at each end
CONDOM  available over the counter (OTC)
 advantages:
 protect both partners from STIs
 only need to use during coitus
 no serious side effects
 disadvantages:
 high cost
 not as widely available as male condoms
 noisiness during intercourse
 cumbersome feel of the device
 FEMALE CONDOM DOS AND
DON’TS
 DO use a female condom from start to
finish, every time you have vaginal sex  DON’T use a male condom
 DO read the condom package insert and with a female condom, as this
check the expiration date can cause tearing
 DO make sure there are no tears or  DON’T reuse a female condom
defects
 DO use lubricant to help prevent the
 DON’T flush female condoms
condom from slipping and tearing as they may clog the toilet
 DO store female condoms in a cool, dry
place
 MALE CONDOM OR RUBBER
• male condom offer a viable means of contraception when used
CONSISTENTLY AND PROPERLY
• is applied to the erect penis, rolled from the tip to the end of the shaft, before
vaginal contact
• a small place must be left at the end to allow for collection of ejaculate, so that
condom will not break at the time of ejaculation
• is small, disposable, inexpensive
• has no side effects, requires no medical examination or supervision, and offers
visual evidence of effectiveness
• all condoms offer protection against STIs
 HOW TO USE MALE CONDOM
 ensure that the condom you are using is new for each act of
sex
 when opening the package, tear it very carefully
 do not to use fingernails, teeth, or anything sharp that might
damage the condom
 once the penis is erect, place the condom on the tip with the
rolled side out
 then unroll or pull the condom all the way to the base of the
penis
 if it doesn’t unroll smoothly, then it may be on backwards,
damaged, or too old --- throw immediately and start over
with a new condom
 once you have ejaculated, just hold the rim of the condom in
place and withdraw the penis from the condoms --- do it,
while it is still erect
 wrap it in tissue and dispose of it by throwing it into the trash
---- make sure to wash hands thoroughly with soap and water
MALE CONDOM
generally three types of condoms:
1) external condoms go over a penis
2) internal condoms go into a vagina
3) Dental dams are placed over the genitals for oral sex
Non-Latex Condoms
• are made of lambskin or other latex alternatives, such as polyurethane or polyisoprene
• use by individuals who are allergic to latex

Glow-In-The-Dark Condoms
• can be both fun and functional
• to make them glow, expose the external condom to light for at least 30 seconds before putting it on
• are usually non-toxic and made in three layers:
• first two layers, inner and outer, consist of regular latex
• 3rd layer: sealed between the first two layers, contains a safe dye that glows after being exposed
to light
 MALE CONDOM
Flavored Condoms
• designed to be used during oral sex
• flavor is either added to the lubricant or
coated on the condom
• flavors are mint, grape, orange, banana,
strawberry, bubblegum, chocolate, vanilla,
bacon, and cola
Studded or Textured Condoms
• external condoms can be shaped and textured to
increase pleasure for one or both partners, depending
on where the raised studs and ribs are located on the
condom
DIAPHRAGM
 a small, reusable
rubber or silicone
cup with a
flexible rim that
covers the cervix
 used with
spermicidal
cream or jelly
 always empty
bladder before
inserting the
diaphragm
CARE OF DIAPHRAGM TO USE A
 after each use, wash diaphragm with warm water DIAPHRAGM
and mild unperfumed soap. Do not use detergent
soaps and soaps containing oil products - can
weaken the rubber
 after washing, dry thoroughly with a towel. Then
dust the diaphragm with cornstarch --- scented
talc, body powder, and the like should not be used
because they can weaken the rubber
 place the diaphragm back in the plastic case for
storage. Keep it in a cool, dry place
 never boil a diaphragm
 periodically should be held up to the light and
inspected for tear or holes
  a cup-shaped device made of rubber or
latex-free silicone and have soft domes and
firm brims
 used with spermicidal cream or jelly, that
fits snugly over the cervix and is held in
place by suction
 can be left in place for up to 24 hours

CERVICAL CAP
  instructions for insertion and use of the cervical
cap closely resemble the instructions for the use
of the diaphragm
 some of the differences:
 cervical cap can be inserted hours before
sexual intercourse without a need for additional
spermicide later
 no additional spermicide is required for
repeated acts of intercourse when the cap is
CERVICAL CAP used
 requires less spermicide than the diaphragm
when initially inserted
 may be more difficult to fit because of limited
size options
 the cap should be refitted after any (otherwise,
the size should be checked at least once a year)
 gynecologic surgery
 birth
 after major weight losses or gains
  a small, round, pillow-shaped, soft, absorbent synthetic sponge containing
spermicide
VAGINAL  available over the counter

SPONGE  designed to fit over the cervix

 the side that is placed next to the cervix is concave for better fit
 opposite side has a woven polyester loop to be used for removal of the sponge

 sponge is moistened thoroughly with water before insertion to activate the spermicide
 should be left in place for 6 hrs following intercourse and maybe worn for 24 hours,
then removed and discarded
 wearing longer than 24 to 30 hours may put the woman at risk

 advantages:
 professional fitting is not required
 may be used for multiple acts of coitus for up to 24 hrs
 one size fits all
 acts both as a barrier and a spermicide

 disadvantages:
 cost
 problems associated with removing it
 irritation or allergic reactions
 designed to be inserted into the uterus by a
qualified healthcare provider
 is a small T-shaped plastic and copper
INTRAUTERI
device
 string or tail protruding through the cervix
NE DEVICES
into the vagina
 may be inserted during menstrual period
or during the 4 – 6-week postpartum
check
 trigger spermicidal type reaction in the body,
thereby preventing fertilization
 recommended only for women who have at
least one child and in a monogamous
relationship
 advantages:
 high rate of effectiveness INTRAUTERINE DEVICES
 safe to use even when breastfeeding
 continuous contraceptive protection
 no coitus-related activity
 inexpensiveness over time
 it's not affected by other medicines
 once fitted, it works straight away
 disadvantages:
o discomfort to the wearer
o increased bleeding during menses
o intermenstrual bleeding
o dysmenorrhea
o expulsion of the devise
o does not protect against STIs
2 types: INTRAUTERINE DEVICES
1)Copper IUD
works for 5 to
10 years
2)IUS (Hormonal
IUD)
works for 3 to 5
years
 HORMONAL
CONTRACEPTION
formulations include combined
estrogen-progestin medications
and progestational agents
formulations are administered
orally, transdermally, vaginally, by
implantation, by injection, or via
the intrauterine route
COMBINED ORAL CONTRACEPTIVES (COCS)
 often just called "the pill“ or birth control pills
 contains artificial versions of female hormones estrogen and progesterone
 safe, highly effective, rapidly reversible
 some medicines may make the pill less effective
 minor side effects: mood swings, nausea, breast tenderness and headaches
 not suitable for women over 35 years; who smoke cigarettes; or have certain medical
conditions
 very low risk of serious side effects, such as blood clots and cervical cancer
To use a 28‑day pack:
• take 1 pill each day at the same time. The 28‑day packages
HOW TO
come in different ways:
 first 21 pills have hormones and the last 7 pills are
USE THE
hormone‑free
 first 24 pills have hormones and the last 4 pills are
PILL?
hormone‑free
 first 26 pills have hormones and the last 2 pills are
hormone‑free

• when the pack is done, start a new pack the next day. Always
start your new pack of pills on time, even if your period hasn’t
ended. Your period should stop in a few days.
• if you don’t have a period, start your new pill pack and see your
health care provider
To use a 21 - day pack:
• take 1 pill each day at the same time for 21 days HOW TO USE THE
• when the pack is done, wait 7 days before PILL?
starting a new pack
• you’ll get your period when you aren’t taking
pills (hormone‑free days). You’re still
protected from pregnancy during this time
• the hormone‑free days must not be longer than 7
days. At the end of the hormone‑free days, start
a new pack. Always start your new pack of
pills on time , even if your period hasn’t ended.
Your period should stop in a few days
• if you don’t have a period, start your new pill
pack and see your health care provider
 MINIPILL
aka the progestin-only pills (POPs) ------ doesn't contain estrogen

thickens cervical mucus and thins the endometrium

• prevent sperm from reaching the egg

take a pill every day (same time each day), with no break between packs of pills

Advantages
• it doesn't interrupt sex
• can use it even when breastfeeding
• no estrogen
• suitable for women over 35 years; who smoke cigarettes

Disadvantages
• periods may be lighter, more frequent, or may stop altogether, and may have spotting between periods
• it doesn't protect you against STIs
• some medicines may make the pill less effective
CONTRACEPT available by prescription only
IVE PATCH
a transdermal patch (looks like a thin, light brown
bandage) which is applied to the skin:
• lower abdomen
• upper outer arm
• upper torso (front and back, excluding the breasts)
• buttocks

application is on the same day once a week for 3

weeks, followed by a week without the patch

• withdrawal bleeding occurs during the “no patch” week

 Only use one patch at a time and:
When you use the
• leave the patch on during activities patch, don’t:
(e.g., exercise, shower, swim) o use any bath oil, body wash,
• if a patch isn’t sticking, try to put it on
lotion, or powder on the area
again in a different place. If it won’t
use any bath oil, body wash, lotion, or powder on the area where you
put stick,
the patchtake it off
on your and put a new patch on
breasts
where
will putyou will
your new put
patch your new patch
put the patch on skin that is red, cut, or scratched
right away o put the patch on your breasts
o put the patch on skin that is red,
use bandages or tape to hold the patch in place as this affects how the hormones are absorbed
• check that your patch is secure every
day cut, or scratched
• store your patches at room temperature o use bandages or tape to hold the
(never put them in your fridge or patch in place as this affects how
freezer) the hormones are absorbed
 benefits of the birth side effects of the patch(more
control patch
likely in the first 3 months)
menstrual period may be more regular,
 headaches
lighter, and/or shorter with less
cramping  tender breasts
may lower your risk of getting ovarian  moodiness
and endometrial cancer  irritated skin
may help with acne and dysmenorrhea  slight weight gain or loss
it’s safe to use for many years. There’s  spotting or bleeding between
no need to take a break from using it periods
can get pregnant as soon as you stop  upset stomach (nausea)
using the patch  bloating
 VAGINAL RING
1. available only with a prescription
2. a flexible plastic ring (usually latex-free)
that is inserted into the vagina
3. will wear the ring for 3 weeks, remove then
allow menstruation, replaced with another
one after 1 week
VAGINAL
RING
LUNELLE
a contraceptive injection

combination of estrogen and progesterone

administered every monthly intramuscularly

prevents ovulation and thickens cervical mucus

works like the combined oral contraceptives, COCs

 Subdermal Contraceptive
Implants
 a 4-cm (1.5 in), match-sized single-rod implant that
can be inserted subdermally, upper nondominant arm
 takes a few minutes
 when the implant is in place, a dressing and an
adhesive bandage is placed over the area
 need a prescription for the implant
 may be inserted at any time during the menstrual cycle
 removing the implant, which is usually done when the
implant is no longer effective, requires a skin incision
 after implant removal, ovarian activity normalizes
immediately
 insertion and removal should be quick and easy
 Subdermal Contraceptive
Implants
• it slowly releases progestin to stop ovulation
and thickens the mucous in the cervix
• most common adverse effects: irregular
vaginal bleeding, amenorrhea, headache
  benefits of the
implant
• works on its own to prevent pregnancy
• you don’t have to do anything
• if use for 3 years, it costs less than other
birth control like the pill, patch, or ring
• you can get a new implant after 3 years if
you want to keep using it
• may make period cramps less painful
• can use the implant while breastfeeding
• your healthcare provider can take out the
implant at any time and for any reason you
want
DEPO- PROVERA
 is an injectable birth control method
 commonly referred to as depo shot or birth control shot
 is injected into the muscle (often arm or buttocks) and needs to be provided on a schedule of
approximately every 12 weeks or three months
 advantages:
o very useful for women who find it difficult to remember to take a pill at the same time every day
o useful for women who cannot use contraception that contains estrogen
o not affected by other medicines
o provides long-term protection as long as you get the shot on time (every three months)
o doesn’t interfere with sexual activity

 disadvantages:
 side effects: weight gain, headaches, mood swings, breast tenderness and irregular bleeding
 periods may become more irregular, heavier, shorter, lighter or stop altogether
 EMERGENCY
CONTRACEPTION
 aka “morning-after pill”
 the earlier the treatment is started, the
greater the effectiveness
Forms of EC

Emergency Contraceptive Pills Copper Intrauterine Device (IUD)

(ECPs)
•2 types: levonorgestrel and
ulipristal acetate
•can be used up to 5 days after
unprotected sex
•a small, soft, T-shaped device with
a copper wire wrapped around it
•can be put into the uterus up to 7
days after unprotected sex
 EMERGENCY
CONTRACEPTION
 use EC to help prevent pregnancy if:
• no birth control was used
• been sexually assaulted
• withdrawal (pulling out) was used
• a condom broke, leaked, slipped, or
fell off
• method of birth control wasn’t used
the right way (slipped diaphragm)
 refers to surgical
procedures that
permanently
OPERATIV prevent
E pregnancy

STERILIZA both procedures

are theoretically
TION reversible
1) Vasectomy
2) Tubal ligation
VASECTOMY  is a surgical procedure to cut or seal the tubes to permanently
prevent pregnancy (male sterilization)
 during sexual intercourse, ejaculation will still occur but the
semen will contain only seminal fluid and no sperm
 carried out under local anesthetic, and takes about 15 - 20
minutes
 a small 1/2 cm cut is made in the scrotal skin, through
which the vas deferens are cut and tied at both ends
 few stitches are used to close the wound and are removed
after a week
 is a quick and relatively painless surgical procedure
 a relatively simple operation
 does not require hospital stay
 normal work and physical activities can be resumed after 1
or 2 days, but heavy lifting and strenuous exercise should
be avoided
 VASECTOMY
 is not immediately effective after the operation
 may take up to 20 ejaculations to clear all the sperm
cells
 another reliable contraceptive method should be
used until no more sperms are detected
 2 samples of seminal fluid should be tested at 3
to 6 monthly intervals for sperm count
 doesn’t affect sex drive or ability to enjoy sex
 can be sometimes reversed through microsurgery
techniques
 restored fertility is 30% to 76% depending on the
length of time between vasectomy and reversal
MALE CONTRACEPTION

Vasectomy and condom are currently the only

forms of male contraception available

Research on hormonal contraception (male pill

that prevent sperm production) are under way
 a type of permanent birth control where the fallopian tubes
are cut, tied or blocked to permanently to prevent
pregnancy
TUBAL
 a minor operation
 surgeon will block the fallopian tubes (tubal occlusion) by LIGATION
either:
 applying clips – plastic or titanium clamps are closed
over the fallopian tubes
 applying rings – a small loop of the fallopian tube is
pulled through a silicone ring, then clamped shut
 tying, cutting and removing a small piece of the
fallopian tube
 does not interrupt sex drive
 does not affect hormone levels and still have periods
 may be done at anytime but the postpartum period is an
ideal time to perform because the tubes are enlarged and
easily located
 reversal of tubal ligation depends on the type of procedure
 pregnancy rate is 44% - 81%
  world’s 1st approved birth control app
 is a non-hormonal birth control option
— an attractive choice for women who
have had unwanted side effects from
NATURAL other birth control methods
 use the app to know when the woman is
CYCLES fertile, which can help with planning a
pregnancy or as a birth control method
APP  a Swedish company that uses a
thermometer- and algorithm-based
system to track signs of fertility and tell
women when they should abstain from
or have protected sex