Professional Documents
Culture Documents
Dr. Mona A. Almushait
Dr. Mona A. Almushait
Almushait
Methods of Contraception
Methods of Contraception
I. Combined Oral contraceptive pills
Depot medroxyprogesterone acetate injections
Hormonal Transdermal patches and Vaginal rings
Products
II. Barrier Male condoms, Diaphragms
Caps, Female condoms, Spermicides
and
Behavioral Withdrawal, Fertility awareness method,
Natural family planning
Methods
III. Longer Term Progestin implants and Intrauterine devices
Other mechanisms:
→ slowing of tubal transport
→ atrophy of the endometrium
Complications of Estrogen–Containing
Contraceptives:
Thromboembolism
Post pill amenorrhea
Cerebrovascular accidents
Increased in Cholelithiasis (cholestatic
jaundice)
HTN
Benign hepatic tumors (Hepatoma)
Headache in the week off
Contraindications to the Use of
Estrogen–Containing Contraceptives
ABSOLUTE
Arterial thrombosis
Venous thrombus (Thromboembolism)
Pulmonary embolism
Coronary vascular disease, IHD → cardiomyopathy, vascular
heart disease
Past cerebrovascular accident
Pulmonary HTN
Current pregnancy
Breast cancer within the last 5 years
ABSOLUTE Cont’d
Endometrial cancer
Hepatic tumor or abnormal liver function, Dubin–
Johnson or Rotor syndrome, known gallstones
Unexplained abnormal uterine bleeding
Age >35 and cigarette smoking
Uncontrolled hypertension
History of melanoma
Hyperlipidaemia, focal and crescendo migraine
Trophoblastic disease
RELATIVE
Risk factor for arterial disease
Complicated prolonged Diabetes
Estrogen–dependent neoplasm
Depression, Hyperprolactinemia
Severe varicose veins
Hypertriglyceridemia
Increasing age, smoking, obesity, migraine
Progestin–Only Hormonal Methods of
Contraception
(POPs)
PoPs are taken as a continuous preparation, in
28 day packs.
Taken at the same time each day
Mode of action:
Thicken the cervical mucus
Inhibit ovulation
Twining the endometrium
Safe → when oestrogen–containing pills cause side effects, or
contraindicated
Smokers, immediately post–partum, breastfeeding, risk of DVT,
hypertension, migraine, or diabetes, PMS
Pills most frequently used by breastfeeding women
Side effects:
Menstrual changes
Amenorrhea
↑ functional ovarian cyst
↑ risk of ectopic pregnancy
Acne, headache, breast tenderness, nausea, irregular bleeding
Weight change
↑Breast cancer diagnosis
DMPA (Depo–Provera) 150 mg every 3 months, I.M.
Suppresses gonadotropins to inhibit ovulation
Change cervix mucus (thickening)
Twining endometrium
Advantages:
High efficacy
No need to remember to take a pill
Use when oestrogen contraindicates
No increased in ovarian cyst or risk of ectopic pregnancy
Disadvantages:
Delayed of fertility, weight gain, irregular bleeding and
amenorrhea
↑ risk of Osteoporosis due to long term Medroxy
progesterone acetate
Contraindications:
Pregnancy
Liver disease
Transdermal Patch
Appliedonce a week to the abdomen, buttock,
upper outer arm.
Disadvantages:
Requires a prescription
Skin reactions
Slight increase in risk of VTE compared
with COCs
Vaginal Ring
A thin, transparent, flexible ring that contains
oestrogen/progestogen hormones.
It stops ovulation and thickens the cervical mucus.
Advantages:
Easy to use
Can be worn for 3 weeks
Disadvantages:
Does not protect against STD
Spotting
Increased vaginal discharge
II. Barrier and
Behavioral Methods
Male Condom
Advantages:
↓transmission of STD, HIV, Chlamydia and
Gonorrhea
Easily obtained
Disadvantages:
Allergy
Loss of sensation
Slippage/breakage
Diaphragm and Cap
To be filled and coated with spermicide
84% to 94% effective for pregnancy prevention
Must be left in place for at least six hours.
Advantages:
Easy use
Protection from sexually transmitted infections
Disadvantages:
Cystitis
Skin irritation
Female Condom
A lubricated polyurethane
Advantages:
Prevents the transmission of infection
No hormonal side effects
Disadvantages:
Loss of sensation
Can break or leak
Jelly
Jellies come in tubes and are usually used
with a diaphragm or cervical cap.
Time in cycle
→ Ovulation occurs every 12–16 days before a period
→ Pain from ovulation, breast change → less
Lactational amenorrhea
T–shape
Disadvantages:
Amenorrhea
Irregular bleeding for the first 3 months
↑ functional ovarian cyst
Expulsion and perforation
Contraindications:
Pregnancy
Active liver disease
Severe arterial disease
Undiagnosed irregular bleeding
Mechanical heart valves
Untreated STD
Hx of ovarian or endometrial carcinoma
Copper T380A I.U.D.
Mode of action:
Copper is spermicidal
It is inserted in the first 7 days of cycle with antibiotics cover
Inflammatory changes to prevent implantation
Disadvantages:
Pregnancy with I.U.C.D.
Increased rate of Ectopic pregnancy
↑ Menorrhagia
↑ PID
Perforation and expulsion
Actinomycosis → cx smear
Lost coil
IV. Female sterilization
and Vasectomy
Sterilization
Permanent sterilization is the most common method of birth control used.
Mini Laparotomy sterilization
Laparoscopic sterilization
Advantages: Disadvantages:
Permanent birth control Does not protect against
Immediately effective STD
Requires surgery
Requires no daily attention
May not be reversible
Not messy
Possible regret
Cost-effective in the long
run Possibility of Post Tubal
Ligation Syndrome
FILSHIE CLIP TUBAL LIGATION
One common form of laparoscopic (camera) sterilization is the use of
Filshie clips to occlude both fallopian tubes.
HULKA CLIP STERLIZATION
One common form of female sterilization is the use of Hulka clips to
block the fallopian tubes.
Bleeding