Welcome

Family Planning Methods

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 FP Methods ( Basket of Choice)
Spacing:
• Condom
• Oral Contraceptive Pills- COC, POP
E-Pill, Centchroman (CHAAYA, Non
Hormonal Oral contraceptive),
• Injectable DMPA (Antara)
• IUCD- IUCD 380A, IUCD 375

Limiting:
• Male Sterilization
• Female Sterilization

Post Partum and Post Abortion Family

Planning Services:
• PPIUCD and PAIUCD
• PPS and PAS

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 Hormonal Contraception & Non- Hormonal

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 Oral Contraceptives
Hormonal Non-hormonal

• Combined Oral Contraceptives • Centchroman

(COC) (Ormeloxifene)

• Progestin Only Pill (POP)

• Levonorgestrel Emergency
Contraceptive Pill (ECP)

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Combined Oral Contraceptive Pills (COCs)

• Safe and Effective

Effectiveness-99.97 to 99.9%,.

Failure rate: Perfect use 0.3 preg/100 women; Typical

use 8 preg/100 women over I year use

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Combined Oral Contraceptive Pills (COCs)

• Can be started any time if it is reasonably certain

that she is not pregnant (Use pregnancy checklist)

• Should not be given to breastfeeding women till 6

months postpartum
• D1 OD for 21 days followed by 7 days gap, New
pack started on D8,3 week on 1 week off.
• In 28 tab pack there is no break in between the
pack

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 When can women start COC-
• During Menstrual cycle
• Between two menstrual cycle
• Breast Feeding-POP
• Switching to another Hormonal Method.
• Switching from Non hormonal method
• Switching from IUD.
• After miscarriage or abortion.

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 Selection of patient

• History & general examination to screen for contraindication-Headache,

Migrane, Examination of breast for nodule,Weight,BP.
• Pelvic Exam to exclude cervical pathlogy.
• Pregnancy is to be excluded.
• Cervical cytology to exclude abnormal cells is done

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 Health benefits-
• Fertility related benefits-
• Prevention of pregnancy
• Non Contraceptive benefits-
• Menstural cycle stabilization
• Reduces Iron deficiency anaemia due to lighter menstrual cycles

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 Side effects-

• Nausea, Vomitting,decreased appetite, usually pass after 2-3 months.

• BTB(Break through bleeding)- common with low dose progesterone pill
• Oligomenorrhoea, Amenorrhoea.
• Breast changes,edema,heaviness,tenderness.
• Chloasma.
• Weight gain, acne ,oily skin.

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 Contraindication to COCS-
• Breast feeding till 6 months
• Smoker
• Multiple risk factor for cardiovascular disease.
• H/O DVT.
• Migrane with Aura
• Current Breast Cancer.
• Diabetis with Neuropathy,Retionpathy,Vasculopathy.
• Acute hepatitis
• Liver disease

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 Key steps for providing COC-

• Give pill,3 month supply, if possible as running out of the pill is major
reason for unintended pregnancy.
• Explain How to use.
• If possible give condoms to use until she starts taking the pills, or if there
• Is possibility of catching STD

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 Missed Pill-
• When women forgets to take one pill ,she should take missed pill at once and
continue rest as scheduled, nothing to worry.
• When she misses 2 pills, in the first week, she should take 2 pills on next two
days, continue rest as scheduled. Extra precaution has to be taken for next 7 days,
either by using condom or avoiding sex.
• If two pills missed in third week or more than 2 active pills are missed at any
time another form of contraception should be used as a backup for next 7 days,
she should start new pack without a break.
• If she misses any of the inactive pills, she should throw away the missed pill, she
should take remaining pill, one a day and start new pack as usual.

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 Centchroman (Ormeloxifene)

 Non steroidal, non-hormonal and once-a week pill, which will be available in
public sector as free and ASHA supply (Chhaya)
 It has weak estrogenic action on bones but strong anti-estrogenic action on
uterus, breasts
 Safe for breast feeding mothers, can be given soon after childbirth
 Very Effective method – effectiveness 1 – 2 pregnancy per 100 women
following one year of perfect use

Family Planning Division, Ministry of Health and Family Welfare,Government of India

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 Centchroman (Ormeloxifene) Contd..
 Prolongation of menstruation cycle is the only side effect. It occurs in 8% cases
usually in first 3 months
 It makes the periods lighter and can help anemic women
 Can be used safely in conditions where hormonal contraceptives are not
advised
 Decreases the risk of ectopic pregnancy
 Return of fertility on stopping the drug is prompt

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 When to Start and How to Use
• One pill (30 mg)is taken twice a week for first three months,
followed by once a week thereafter
• Starting from fourth month, the pill is to be taken once a week on the
first pill day and should be continued on the weekly schedule
regardless of her menstrual cycle
• For initiation: 1st pill is to be If 1st day of First 3 months After 3
pill is months
taken on 1st day of period (1st
day of bleeding) and the 2nd Sunday Sun, Wed Sun
pill 3 days later Monday Mon, Thu Mon
Tuesday Tue, Fri Tue
Wednesday Wed, Sat Wed
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 Missed Pill-
• After forgetting to take the pill, take it as soon as possible.

• If 1 or 2 days have been missed but it is not yet 7 days, the normal
schedule should be continued and the client should use a backup
method (eg, condoms) until the next menstrual period begins.

• If a tablet is missed for more than 7 days, the client should resume taking
it as a new user, i.e twice a week for 3 months and then once a week.
Also, a backup method (e.g, condoms) should be used until the start of
the next menstrual period.

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 Conditions where Centchroman Should be
Avoided:
 Polycystic ovarian disease
 Cervical hyperplasia
 Recent history of jaundice or liver disease
 Severe allergic state
 Chronic illness, like tuberculosis or renal disease

Family Planning Division, Ministry of Health and Family Welfare,Government of India

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Thanks

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