Family Planning Methods

Presented by
Dr Rupak Kumar Rana
VCHS
2080
 Contraception
• There are many types of contraception widely used now days for
family planning purposes.
• Each method has its advantages and suits special cases and not
necessarily suits others and the choice of contraception depends
on different needs of the patients like the period of contraception
and also doctor should decide which method suits needs more.
• No method of contraception is completely effective.
• Types:-
1. Natural contraception
2. Mechanical contraception
3. Hormonal contraception
4. Surgical contraception
Characteristics of ideal contraceptive:

• Safe
• 100% effective
• Free of side effects
• Easily obtainable
• Affordable
• Acceptable to the user
• Free of effects on future pregnancies
Types of Birth Control

• Natural
• Barrier
• Hormonal
• IUD
• Permanent sterilization
METHODS BASED ON INFORMATION

• Withdrawal
• Natural Family Planning
• Fertility Awareness Method
• Abstinence
Natural Family Planning & Fertility
Awareness Method

Women take a class on the menstrual cycle to calculate

more fertile times
NFP abstains from sex during the calculated fertile
time
FAM uses barrier methods during fertile time
Perfect effectiveness rate = 91%
Typical effectiveness rate = 75%
No 100% safe day-irregular periods
Types of Birth Control
Types of Birth Control
BARRIER METHOD
• Prevents pregnancy blocks the egg and sperm from
meeting
• Barrier methods have higher failure rates than
hormonal methods due to design and human error
BARRIER METHODS

• Spermicides
• Male Condom
• Female Condom
• Diaphragm
• Cervical Cap
 SPERMICIDES
• Chemicals kill sperm in the vagina
• Different forms:
-Jelly -Foam -
Suppository
• Some work instantly, others require pre-insertion
• Only 76% effective (used alone), should be used in
combination with another method i.e., condoms
 MALE CONDOM
Most common and effective barrier method when used
properly
Latex should only be used in the prevention of pregnancy
and spread of STI’s (including HIV)
MALE CONDOM

• Typical effectiveness rate = 88%

• available
• Combining condoms with spermicides raises effectiveness
levels to 99%
FEMALE CONDOM

• Made as an alternative to male condoms

• Polyurethane
• Physically inserted in the vagina
• Typical rate = 79%
• Woman can use female condom if partner refuses
 The Female Condom

The female condom is a lubricated polyurethane sheath, similar in appearance to a male condom. It is
inserted into the vagina. The closed end covers the cervix. Like the male condom, it is intended for one-time
use and then discarded.
The sponge is inserted by the woman into the vagina and covers the cervix blocking sperm from entering the
cervix. The sponge also contains a spermicide that kills sperm. It is available without a prescription.
 Vaginal Ring (NuvaRing)
• 95-99% Effective A new ring is inserted into the
vagina each month
• Does not require a "fitting" by a health care
provider, does not require spermicide, can make
periods more regular and less painful, no pill to
take daily, ability to become pregnant returns
quickly when use is stopped.

Nuva Ring is a flexible

plastic (ethylene-vinyl
acetate copolymer) ring that
releases a low dose of a
progestin and an estrogen
over 3 weeks.
DIAPHRAGM

Typical Effectiveness Rate = 80%

Latex barrier placed inside vagina during intercourse
Fitted by physician
Spermicidal jelly before insertion
Inserted up to 18 hours before intercourse and can be left in
for a total of 24 hours
DIAPHRAGM
CERVICAL CAP

Latex barrier inserted in vagina before intercourse

“Caps” around cervix with suction
Fill with spermicidal jelly prior to use
Can be left in body for up to a total of 48 hours
Must be left in place six hours after sexual intercourse
Perfect effectiveness rate = 91%
Typical effectiveness rate = 80%
Cervical Cap

The cervical cap is a flexible rubber cup-like device that is

filled with spermicide and self-inserted over the cervix
prior to intercourse. The device is left in place several
hours after intercourse. The cap is a prescribed device
fitted by a health care professional and can be more
expensive than other barrier methods, such as condoms.
Sponge

The sponge is inserted by the woman into the vagina and covers the
cervix blocking sperm from entering the cervix. The sponge also
contains a spermicide that kills sperm. It is available without a
prescription
Hormonal Methods

• Oral Contraceptives
(Birth Control Pill)
• Injections (Depo-Provera)
• Implants (Norplant I & II)
Birth Control Pills
• Pills can be taken to prevent pregnancy
• Pills are safe and effective when taken properly
• Pills are over 99% effective
 Overview

•Oral Contraceptives
•Combined pills
•Phased regimen
•MOA
•Side effects
•Contraindication
•Practical consideration
•References
 Oral Contraceptives

• Hormonal preparations used for reversible suppression of

fertility.
1.Combined Pill
1. Monophasic
2. Biphasic or triphasic
2.Minipill
3.Postcoital (emergency) Contraception
 Combined Pill

• It contains an estrogen and a progestin.  

• Both estrogens and progestins synergise to inhibit ovulation,
• The progestin ensures prompt bleeding at the end of a cycle
and blocks the risk of developing endometrial carcinoma due
to the estrogen.
• A norgestrel–ethinylestradiol combination that is taken
continuously for 84 days followed by 7 days of placebo
tablets; this reduces menstrual bleeding to once every 13
weeks.
 Phased regimens

• To permit reduction in total steroid dose without

compromising efficacy.
• Biphasic or triphasic.
• The estrogen dose is kept constant or varied slightly, while
the amount of progestin is low in the first phase and
progressively higher in the second and third phases.
• Phasic pills are particularly recommended for women over 35
years of age or when other risk factors are present
 Mechanism of Action

• Inhibition of Gonadotropin release from pituitary by

reinforcement of normal feedback inhibition – the progestin
reduces frequency of LH secretory pulses while the estrogen
primarily reduces FSH secretion.

• When the combined pill is taken both FSH and LH are

reduced and the midcycle surge is abolished. As a result,
follicles fail to develop and fail to rupture  ovulation does
not occur.
• Direct actions on the genital tract.
• Thick cervical mucus secretion hostile to sperm penetration
is evoked by progestin action.
• Even if ovulation and fertilization occur the blastocyst may
fail to implant because endometrium is either
hyperproliferative nor hypersecretory or atrophic and out of
phase with fertilization-not suitable for nidation. This action
is the most important in case of minipills and postcoital pill.
• Uterine and tubal contractions may be modified to disfavor
fertilization. This action is uncertain but probably contributes
to the efficacy of minipills and postcoital pill.
 Side effects

• Nonserious side effects:

• Nausea and vomiting: similar to morning sickness of
pregnancy.
• Headache
• Breakthrough bleeding or spotting: specially with
progestin only preparations.
• Amenorrhoea may occur in few, or the cycles may get
disrupted: especially with injectables and minipill.
• Breast discomfort.
 Side effect that appear later

• Weight gain, acne and increased body hair

• Less with norgestimate, desogestrel, and gestodene
• Chloasma: pigmentation of cheeks, nose and forehead,
similar to that occurring in pregnancy.
• Carbohydrate intolerance and precipitation of diabetes in
few subjects taking high dose preparations; but this is
unlikely with the present pills.
• Mood swings, abdominal distention are occasional;
especially reported with progesterone only contraceptives.
 Serious complications

• Leg vein and pulmonary thrombosis: significant risk in women >35

years of age, diabetics, hypertensives and those who smoke.
• Coronary and cerebral thrombosis resulting in myocardial infarction
or stroke
• Rise in BP: less frequent with the low dose pills used these days.
• Benign hepatomas: which may rupture or turn malignant; incidence
of this rare tumour appears to be slightly higher in OC users.
• Gallstones: Estrogens increase biliary cholesterol excretion;
incidence of gallstones is slightly higher in women who are taking
OCs, or after Iong-term use.
 Contraindications
• Absolute contraindications Relative contraindications
• Thromboembolic, coronary and
cerebrovascular disease or a history of it. • Diabetes.
• Moderate-to-severe
hvperlipidaemia
hypertension; • Obesity
• Active liver disease, hepatoma or h/o • Smoking
jaundice during past pregnancy.
• Suspected/overt malignancy of genitals/
• Undiagnosed vaginal
breast. bleeding
• Prophyria • Uterine leiomyoma: may
• Impending major surgery-to avoid
postoperative thromboembolism. enlarge with estrogenic
preparations; progestin only
pills can be used.
• Mentally ill
• Age above35years
• Mild hypertension
• Migraine
• Gallbladder disease
 Interactions

• Enzyme inducers: phenytoin,phenobarbitone, carbamazepine,

rifampine. (metabolism of estrogenic as well as
progestational compounds is increased)

• Suppression of intestinal microflora: tetracycline, ampicillin,

etc. (No deconjugation of estrogens excreted in bile  their
enterohepatic circulation is interrupted blood levels falls).
Choice of Contraceptives
• Treatment should generally begin with preparations containing
the minimum dose of steroids that provides effective
contraceptive coverage.

• Breakthrough bleeding may occur if the estrogen-to-progestin

ratio is too low to produce a stable endometrium, and this may
be prevented by switching to a pill with a higher ratio.

• In women for whom estrogens are contraindicated or

undesirable, progestin-only contraceptives may be an option.
 Choice of Contraceptives

• Concomitant administration of medications that may increase metabolism of

estrogens or reduce their enterohepatic recycling. In these situations, a low-dose pill
may not be 99.9% effective due to increased steroid metabolism.

• The androgenic activity of19-nor progestin component may contribute to untoward

effects such as weight gain, acne due to increased sebaceous gland secretions, and
unfavorable lipoprotein profiles. These side effects are greatly reduced in newer,
low-dose contraceptives, but any patients exhibiting such side effects may benefit by
switching to pills that contain a progestin with less androgenic activity.
• Norgestrel : most androgenic activity;
• norethindrone and ethynodiol diacetate : moderate androgenic activity;
• Desogestrel, norgestimate, and drospirenone : least androgenic activity.
 Noncontraceptive Health Benefits

• Lower probability of developing endometrial and ovarian

carcinoma; probably colorectal cancer as well.
• Reduced menstrual blood loss and associated anemia; cycles
if irregular become regular; premenstrual tension and
dysmenorrhea are ameliorated.
• Endometriosis and pelvic inflammatory disease are
improved.
• Reduced incidence of fibrocystic breast disease
 Practical consideration

• Discontinuation of Ocs may result in return of fertility within 1-2

months with increased chance of multiple pregnancy or may not
return at all
• Pregnancy occuring during Ocs use should be terminated
• Normal women: 30ug, Obese women: 50ug and women >40years:
20ug
• If breakthrough bleeding occurs: switch to high estrogen containing
pills
• If androgenic side effects(acne, weight gain and raised LDL): switch to
19-nortestosterone
 Contd…

• Missed dose:

• If 1 pill missed take 2 tablets next day

• If >=2 pills missed use alternative method for current cycle

and start from 5th day of next cycle

• If >=2 pills missed start new pack after identification of

missed pill

•
Emergency Contraception

Emergency contraception pills can reduce the chance

of a pregnancy by 75% if taken within 72 hours of
unprotected sex!
Emergency Contraception (ECP)

Must be taken within 72 hours of the act of

unprotected intercourse or failure of
contraception method
Contains LNG
Must receive ECP from a physician
75 – 84% effective in reducing pregnancy
E.g ECON,IPill
ECP
• Floods the ovaries with high amount of
hormone and prevents ovulation
• Alters the environment of the uterus, making it
disruptive to the egg and sperm
• Two sets of pills taken exactly 12 hours apart
Summary of OCP
How does the pill work?
• Stops ovulation
• Thins uterine lining
• Thickens cervical mucus
Positive Benefits of Birth Control Pills

Prevents pregnancy Decreases incidence

Eases menstrual of ovarian cysts
cramps Prevents ovarian and
Shortens period uterine cancer
Regulates period Decreases acne
Side-effects

• Breast tenderness • Moodiness

• Nausea • Weight change
• Increase in headaches
Taking the Pill

Once a day at the same time everyday

Use condoms for first month
Use condoms when on antibiotics
Use condoms for 1 week if you miss a pill or take one late
The pill offers no protection from STD’s
Important Information about OCP
Combined pills
Side effects

Menstruation:
 Intermestrual bleeding is common in the first 3 months of start of pills
 Scanty menstrual bleeding and sometimes amenorrhagia.

Genital tract:
 monilial vaginitis
 Carcinoma of endocervix (>5yrs)
Breast:
 Breast cancer is controversial
 Not given to woman with breast cancer
 Lactation is suppressed

Liver:
 Chronic liver disease
 Jaundice
 Adenoma

Gall Bladder
 Function may be affected
Carbohydrate tolerance may be reduced

Nausea and vomiting due to estrogen

Due to progesterone following symptoms occur:

o Headache
o migraine
o depression
o irritability
o weight gain
o lethargy
Contraindications
Cardiac disease
Smoker over 35 years of age
Hypertension
Diabetes
History of thrombosis, myocardial infarct, sickle cell anemia, severe
migraine
Chronic liver diseases
 Thyroid disease
Contraindications

Breast cancer, Lactating woman

Gross obesity
Monilial vaginitis
Patient on enzyme inducing drugs like rifampicin, antiepileptic drugs
4 to 6 weeks prior to planned surgery
Triphasic combined pills

Causes potassium retention

Contraindicated in:
• liver disease
• renal disease
• Previous thromboembolism
Mini Pills/ Progesterone only pills
No major side effects

Contraindicated in:
o Previous ectopic pregnancy
o Ovarian cyst
o Breast and genitial cancer
o Abnormal vaginal bleeding
o Active liver and arterial disease
o Porphyria
o Liver tumour
o Drugs: Valpraote, spironolactone, meprobamate
Interactions with other medications
Analgesics

Interacting Drug Management

Acetaminophen Larger doses required
Aspirin Larger doses may be
required
Meperidine Smaller doses may be
required
Morphine Larger doses may be
required
Anticoagulant

Interacting Drug Management

Antidepressants
Dicumarol, warfarin ----------

Interacting Drug
Anti-inflammatories Management

Imipramine Decrease dosage about a third

Interacting Drug Management

Corticosteroids- Watch for potentiation of effects,
decrease dose accordingly
Tranquilizers

Interacting Drug Management

Diazepam Decrease dose
Alprazolam
Temazepam
Bronchodilators May need to increase dose

Interacting Drug Management

Aminophylline Reduce starting dose by a third
Theophylline
Caffeine
Antihypertensive

Interacting Drug Management

Cyclopenthiazide Increase dose
Antibiotics
Metoprolol May need to lower dose

Interacting Drug Management

Troleandomycin liver damage; avoid its use
Cyclosporine May use smaller dose
Antiretrovirals
Advice to the patient
Patient should be advised to:

 Take from the first day of cycle to reduce the failure rate
 Take at a fixed time of the day- preferably after a meal or before sleep
 Use the barrier methods(Ovulation may not be suppressed in the first cycle )
Missed Dose:

If forget to take a tablet  take 2 tablets the following

day
If forget more than once in a cycle  must use barrier
method during that cycle
(she is no longer adequately protected)
Contraindication

CONTRAINDICATIONS

•Pregnancy
•Unexplained vaginal bleeding
•Recent breast cancer
•Arterial diseases
Keep in mind:

There are many potential side effects of OCP- some

resolve after a few cycle, others persists
OCP has significant interaction with other drugs- do
not take any medicine without prescription
Usually women will have normal menstrual cycles
within 6 months of stopping OCP but return of fertility
may be slightly delayed on account of delayed return of
ovulation
 INTRAUTERINE DEVICES (IUD)
• T-shaped object placed in the
uterus to prevent pregnancy
• Must be on period during insertion
• A Natural childbirth required to use
IUD
• Extremely effective without using
hormones > 97 %

The intrauterine device (IUD) shown uses copper as the active contraceptive,
others use progesterone in a plastic device. IUDs are very effective at preventing
pregnancy (less than 2% chance per year for the progesterone IUD, less than 1%
chance per year for the copper IUD). IUDs come with increased risk of ectopic
pregnancy and perforation of the uterus and do not protect against sexually
transmitted disease. IUDs are prescribed and placed by health care providers.
Contents:
• Introduction
• Types
• Indication
• Mode of action
• contraindication
• Complication
• Missing thread
 IUCD
• Is a intra uterine device, used through out the world
• It has maximum efficacy without increasing the adverse effect
• Classified as two types:
• Open: Aperture is not >5 mm so the loop of intestine /omentum cannot enter &
become strangulated if device perforates. eg. Lippes loop, cu T, cu 7, Multiload &
progesteron
• Close: have the potential to cause strangulation of gut. eg. Grafenberg ring, Birnberg
bow
• Device may be medicated:-
1. Medicated devices
• metal cupper like cu T 200, cu T 380A, multiloaded 250, multiloaded 375

2. Non medicated devices

• Lippes loop

• Hormone containing IUD:

• Either releasing progesteron or levonorgestrel(LNG-IUS)
• Commonly used IUCDs:-
1. Cu T 200
2. Cu T 380 A
3. Mulitload 250
4. Multiload 375
5. LNG-IUS
6. GyneFix

Mirena
 Copper T 200

• Carries 215 sq mm surface area of fine copper wire

wounded round the vertical stem of device

• T shaped; made of a polyethylene frame

• Two thread are used for detection and removal

• Barium sulfate is incorporated in the device

making it radio-opaque

• Contain 124 mg copper; lost at rate of 50 ug/24 hr

• Can be used for only 4 years

Copper T 380A

• Carries 380 mm2 surface area of

copper wire wound (around the

stem314 mm2 and around each
copper sleeve of horizontal arms
33mm2)

• Frame contain barium sulphate and is

radiopaque

• Replaced in every 10 years

 Multiload cupper 375

• Has 375 mm2 surface area of

copper wire around its vertical
stem

• It can be replaced in every 5 years

Levonorgestrel intrauterine system(LNG-
IUS)

• T shaped device, with polydimethylsiloxane

membrane around the stem which acts as a steroid
reservoir

• 52 mg of levonorgestrel used and released at the

rate of 20 ug/day

• Replaced in every 7 years

Mode of Action

• Mechanism is not identified till now clearly

• Probable mechanism can be:

1. Biochemical and histological changes in the endometrium
2. Increased tubal motility which prevent fertilization of the ovum
3. Endometrial inflammatory response  decrease sperm
transport and impedes the ability of the sperm to fertilize the
ovum
4. Ionized Copper  prevent blastocyst implantation through
enzymatic interference
Contraindication for insertion of IUCD
1. Presence of pelvic infection current or within 3 months
2. Undiagnosed genital tract bleeding
3. Suspected pregnancy
4. Distortion of the shape of uterine cavity as in fibroid or congenital
uterine-malformation
5. Severe dysmenorrhea
6. Past history of ectopic pregnancy
7. Within 6 weeks following Cesarean section
8. STI-current or within 3 month
9. Trophoblastic disease
10. Significant immunosuppression
Time for insertion
a) Interval
• Beyond 6 weeks following childbirth or abortion
• Preferable to insert 2-3 days after period is over but can be inserted
anytime during the cycle
• Open cervical canal
• Distended uterine cavity
• Less cramp
• Anytime during lactational amenorrhoea
b) Postabortal
• Immediately following termination of pregnancy by D&E or following
spontaneous abortion
c) Postpartum
• Withhold insertion for 6 weeks
d) Postplacental delivery
• Expulsion rate is high
Methods of insertion

• Preliminaries
• Actual procedure
Preliminaries
• History taking(to eliminate contraindication of
insertion)
• Patient informed about the device, and take the
consent
• Insertion is done in the outpatient department,
taking aseptic precaution without sedation or
anesthesia
• Ibuprofen may be given 30 minutes before
insertion to reduce cramping
• Placement of the device inside the inserter
• No touch insertion method is preferred
 Actual procedure
1. Bladder is emptied and patient placed in
lithotomy position
2. Uterine size and position are ascertained
by pelvic examination.
3. Vagina and cervix are cleaned by antiseptic
lotion.
4. Anterior lip of the cervix is grasped by Allis
forceps
5. A sound is passed through the cervical
canal to note the position of the uterus
and the length of uterine cavity
6. Appropriate length of the inserter is
adjusted depending on the length of the
uterine cavity
Contd…

• The inserter with the device placed inside is

then introduced through cervical canal right
up to the fundus.
• The device is not pushed out of the tube
but held in place by the plunger while the
inserter is withdrawn(withdrawn
technique)
• Excess of nylon thread beyond 2-3 cm from
the external os is cut
• Allis forceps and the posterior vaginal
speculum are taken off
 No touch insertion technique
• Loading the IUD in the inserter without
opening the sterile package.

• The loaded inserter is now taken out of

package without touching distal end

• Not to touch the vaginal wall and the

speculum while introducing the loaded
IUD inserter through the cervical canal
Instruction to patient
• Possible symptoms of pain and slight vaginal bleeding
should be explained

• The patient are advised to feel the thread periodically

by the finger

• Patient are advised to follow up in 1 month for the

first time then annually
 Cu devices and hormone releasing IUDs
Advantages Disadvantages

1. Inexpensive 1. Require motivation

2. Simplicity in technique of insertion 2. Limitation in its use

3. Prolonged contraceptive protection 3. Adverse local reaction manifested by menstrual

abnormalities, PID, pelvic pain and heavy periods

4. Systemic side effects are nil 4. Risk of ectopic pregnancy

5. Suitable for hypertensive breastfeeding women and

epileptics

6. Reversibility of fertility is prompt after removal

Complications

Immediate • Pain Remote

• Cramp like pain • Abnormal menstrual bleeding
• Syncopal attack • Pelvic infection (PID)
• Partial or complete perforation • Spontaneous expulsion
• Perforation of uterus
• Pregnancy (2 in 100 women)
Indications for removal
1. Persistent excessive regular or irregular uterine bleeding
2. Flaring of salpingitis
3. Perforation of uterus
4. Partial IUD expulsion
5. Pregnancy occurring with the device insitu
6. Woman desirous of a baby
7. Missing thread
8. One year after menopause
9. When effective life span of device is over

IUD removal is simple and can be done at any time by pulling the
strings gently and slowly with a forceps.
• Thread may not be visible through cervical os due to:-
• Thread coil inside
• Thread torn through
• Device expelled outside unnoticed by the patient
• Device perforated the uterine wall and is lying in the peritoneal cavity
• Device pulled up the growing uterus in pregnancy
• Methods of identification of missing thread:-
(pregnancy should be excluded first)
1. Ultrasonography
• Can be detected either in uterine cavity of peritoneal cavity
2. Hysterescopy
• Can be used for direct visualization of the uterine cavity and can be removed
spontaneously
3. Sounding
4. Straight X-ray
Removal of device

Device outside uterus but inside

Device inside uterine cavity abdominal cavity
1. Specially designed blunt hook 1. Laparoscopy
2. Artery forceps 2. Laparotomy (rarely done)
3. Uterine curette
4. Hysterscopically under direct
vision
• Advantages of third generation IUD(Cu T
380 A, multiload 375 and levonorgestrol(IUS)):-
• Highly efficacy with lowest pregnancy rate
• Longer duration of action(5-12 years)
• Low expulsion rate and fewer indication for medical removal
• Risk of ectopic pregnancy is significantly reduced (in Cu T 380, LNG-IUS)
• Risk of PID is reduced
• Anemia is improved
• Disadvantages of third generation IUD:

• Expensive
• Amenorrhea is a cause of its discontinuation(5%)
• Malpositioning with long duration of use, may cause pregnancy or expulsion
•Non-contraceptive benefits of LNG-IUD:-
1. Significantly reduction in menstrual blood loss, menorrhagia, dysmenorrhea
and pre-menstrual tension syndrome
2. Treatment of:
• Endometrial hyperplasia
• Adenomyosis
• Endometriosis
• Uterine leiomyoma
• Endometrial cancer
3. Can be used as an alternative to hysterectomy for menorrhagia, DUB
Minipill, Depo-provera, Norplant
Indication

INDICATION

•Nursing mother 6 weeks after delivery

•Women in whom estrogen is C/I
•When Combined Oral Contraceptives
are unsuitable for the patient due to
side effects of estrogen
Mechanism of Action

• It makes cervical mucus thick and viscous  prevention of sperm

penetration
• Atrophy of endometrial hinders blastocyst implantation
• Inhibition of ovulation
• Increased tubal motility
• Premature luteolysis Minipill
 Increase in tubal motility

Atrophy of endometrium
Common Advantages

• Can be used during lactation Estrogen is not good for lactation

because it dries the milk and reduces production
• Can be prescribed to patient having hypertension, fibroid, diabetes,
epilepsy, smoking, and history of
thrombo-embolism
• Reduces risk of Pelvic Inflammatory
Disease
Common Advantages

• Side effects attributed to estrogen in combined pill are totally

eliminated
• Decrease total menstrual blood loss
• Decreases dysmenorrhoea
• Reduces risk of endometrial cancer
• Reduces risk of ovarian cancer
• Reduces risk of ectopic pregnancy
 Advantages
Norplant
Minipill Injectables
-Fertility restored after
-Known as Reduces:
stopping use
“Lactation Pill” -Highly effective for long-
-Easy to take and -Salpingitis
term use
there is no “On -Iron Deficiency
-Suitable for women who
and Off” regime Anemia
have completed their
-Fertility restored -Sickle Cell
family but do not desire
after stopping the Problems
permanent sterilization
pill -Endometriosis
-Decreases incidence of
anemia
-Effective within 24 hours
Common Disadvantages

• Irregular bleeding
• Weight gain
• Headache most in Norplant
• Nausea
• Dizziness
• Breast tenderness
• Loss of libido
Common Disadvantages

• Depression
• Fatigue
• Nervousness
• Acne
• Hirsutism
• Loss of scalp hair
• Low protection from STDs
Disadvantages
Norplant
Minipill Injectables
-High cost
-Simple cysts -Delayed -Requires minor surgical
of ovary (but return of procedure for insertion
do not fertility and removal
require -Inadvertent deep
surgery) insertion or inadequate
insertion of capsule
-Local infections
Minipill
Introduction

• Is also known as “Progesterone-Only Pill”

• Forms:
o Levonorgestrel 75 microgram
o Norethisterone 350 microgram
o Desogestrel 75 microgram
o Lynestrenol 500 microgram
o Norgestrel 30 microgram
How To Take

• The first pill has to be taken on the first day of the cycle and
continuously
• Should be taken regularly at the same time of the day
• If delay in intake > 3 hours, then women should have missed pill
immediately and the next one as scheduled
How to Take

• Extra precaution should be taken for next 2 days [by using condom or
avoiding sex]
• Make sure you counsel patient about mechanism of action,
advantage, disadvantages
Efficacy

• Failure rate is about 0.5-2% per 100 women years of use

• Failure is more in young women compared to women over 40 years
• Efficacy diminished in user of anti-seizure drugs
Injectable Progestins
How does the shot work?
• The same way as the Pill!
• Stops ovulation
• Stops menstrual cycles!!
• Thickens cervical mucus
Types

1. Depomedroxyprogesterone Acetate (DMPA)

2. Norethisterone Enanthate (NET-EN)
 How to Use
• Both are given Intramusuclarly (deltoid and gluteus muscle) within 5
days of the cycle
• Make sure you counsel patient about mechanism of action, advantage,
disadvantages

DMPA NET-EN

•Dose : 150mg given every 3 •Dose: 200mg given 2

months months interval
•Dose : 300mg given every 6
months
Norplant
Norplant

• Norplant I  Used to contain 6 capsules but now it is replaced by 1

capsule. These 6 capsules were inserted in fan-like fashion.

• Norplant II (Jadelle)  2 capsules as described in later slides.

Introduction

• It is an implant
• Used subdermally
• 2 rods of 4cm long with diameter 2.4mm used
• Each rod contains 75mg of levonogesterel
• Releases 50 microgram of levonogesterel/day
• Effective for 5 years
Introduction

• Efficacy similar to Combined Oral Contraceptive Pills

• Failure rate = 0.1/100 women years
• Easier to insert and remove
• It is ideally inserted within Day 5 of a menstrual cycle, immediately
after abortion and 3 weeks after post-partum
 How to Insert
• Inserted subdermally
• Inner aspect of non-dominant arm,
6-8cm above elbow fold
• Between biceps and triceps muscles
• Area is cleaned and small cut is made
• Implants are placed under the skin
• Bandage is put to protect the spot for
a few days
How to Insert

• Procedure takes 5-10 minutes

• You can feel it in your arms but it won’t bother, hurt or disturb
How to Remove

• Done by making 2mm incision at the tip of implant

• The rod is pushed until it pops out
• Done under local anaesthesia
The Patch
STERILIZATION

• Procedure performed on a man or a woman permanently sterilizes

• Female = Tubal Ligation
• Male = Vasectomy
TUBAL LIGATION
• Surgical procedure performed on a woman
• Fallopian tubes are cut, tied, cauterized, prevents eggs from
reaching sperm
• Failure rates vary by procedure, from 0.8%-3.7%
• May experience heavier periods

Surgical sterilization which

permanently prevents the
transport of the egg to the uterus
by means of sealing the fallopian
tubes is called tubal ligation,
commonly called "having one's
tubes tied." This operation can be
performed laparoscopically or in
conjunction with a Cesarean
section, after the baby is delivered.
Tubal ligation is considered
permanent, but surgical reversal

can be performed in some cases

LAPAROSCOPY-’BAND-AID’
STERILIZATION
VASECTOMY

• Male sterilization procedure

• Ligation of Vas Deferens tube
• Faster and easier recovery than a tubal ligation
• Failure rate = 0.1%, more effective than female sterilization
During a vasectomy (“cutting the vas”) a urologist cuts and ligates (ties off) the
ductus deferens. Sperm are still produced but cannot exit the body. Sperm
eventually deteriorate and are phagocytized. A man is sterile, but because
testosterone is still produced he retains his sex drive and secondary sex
characteristics.
THANK YOU