CONTRACEPTION

DR SNEHAL SHINDE
Assistant Professor
OBGY Department
 All temporary or permanent methods designed to
prevent pregnancy due to coital act
 Pearl index is used to calculate the contraception
effectiveness or pregnancy failure rate
Ideal Contraceptive
 Highly effective.
 No side effects.
 Independent of intercourse.
 Rapidly reversible.
 Cheap.
 Widespread availability.
 Acceptable to all cultures and religions.
 Administration and healthcare personnel not required.
 Easily distributed
 Natural Method
1) Rhythm method/ Calendar method/ Safe Period

2) Basal body temperature method

3) Cervical mucus method

4) Symptothermic method

5) Coitus Interruptus/ Withdrawal method

6) Sexual abstinence

7) Lactational amenorrhoea method

Rhythm Method
Programmed Sex i.e abstinence required for almost
½ month.
Suitable only for educated people.

Days near ovulation( Day 14) are unsafe period and

sexual abstinence should be maintained

Calendar Method
Basal Body Temperature Method
Rise of body temperature occurs by 0.3-0.5cc due to
raised progesterone at time of ovulation and again
falls
So sexual intercourse should be restricted to post-

ovulation phase only

Cervical Mucus Method
Also known as Billings method / Ovulation
method
 Method : Wipe tissue paper inside of vagina.
 mucus characteristics at ovulation :
Watery, clear,profuse,slippery =Unsafe
Dry, thick and tacks = safe period
Sexual Abstinence
 It is the only method which is 100% effective

Coitus Interruptus
Man withdraws Penis from vagina just before
ejaculation.
High rate of failures

Pearl Index =18 per 100 woman years

Barrier Methods
Male Condom

-circular cylinder with a closed tip and an open proximal

end having an integrated rim
-mechanical barrier to sperms
-15-20 cm long,3-5.5cm diameter, 0.03-0.08 mm thick
-latex and nonlatex materials-longer shelf life, fit more
comfortably and are less constricting, better pleasurable
sensation
 Contraceptive advantages
-reliable,relatively inexpensive
-light, compact, disposable
-effective immediately
-no side effects
-no supervision
-no follow up required
-does not affect breastfeeding
-can be used as backup to other methods
 Non contraceptive advantages
-protection against STD,HIV
-collection of semen for infertility investigations
-cover for transvginal probe of USG
-mold for vaginoplasty
-tamponade treatment for Atonic PPH
 Disadvantages
-user dependent
-disposal of used condom may be problem
-may rupture leading to failure
 Failure rate- 12-18/HWY
Female Condom
-loose fitting prelubricated vaginal pouch made of
soft, medical grade polyurethane or latex tube
-17cm long and has flexible rings at either end.
-inner 65mm diameter ring is closed and fits behind
the pubic bone and the outer 70mm diameter ring
covers the labia. It can be inserted upto 8hrs before
having sex.
-It gives protection against STD and PID
-Failure rate:5-21/HWY
- Contains spermicide : Nonoxynol 9
Hormonal Contraception

 First generation : Estrogen -50mcg or more

 Second generation : Estrogen 20-35mcg and progesterone as LNG
or Lynestrenol
 Third generation : Estrogen: 20-30mcg and progesterone as
Desogestrol or gestodene
 Fourth generation : Progesterone as Drospirenone, dienogest or
nomegestrol
 Monophasic : same estrogen and progesterone
content throughout the cycle
 Standard dose : Estrogen- 50 mcg and
progesterone- 250 mcg
 Low dose : Estrogen- 30 mcg and progesterone -
150 mcg
 Very low dose : Estrogen- 20 mcg and
progesterone- 100 mcg
 Mutiphasic
 Biphasic : Estrogen 35 mcg and progesterone
varies in two phases low dose i.e 35mcg in first ten
days and then high dose i.e 100 mcg in next 11
days of the cycle
 Triphasic : Estrogen and progesterone dose varies
throughout the cycle
Days EE P Color
6 30 50 Brown
5 40 75 White
10 30 125 Ocher
 Mechanism of Action
- Inhibits ovulation by suppression of LH and FSH

- Changes in endometrium- stromal edema, decidual

reaction, regression of glands

- Cervical mucus becomes thick, viscus and scanty

- Tubal motility and capicitation of sperm is affected

 Instruction: 3 weeks on 1week off

 Contraindication
Benefits
 Contraceptive  Noncontraceptive
 Convenient to use  Regulation of menstrual
cycle
 Reversible  Reduction of
 Independent of dysmenorrhoea,
intercourse menorrhagia, PMS
 Failure rate-0.1  Protection against iron
def.anemia,PID,endomet
riosis,Osteoporosis,endo
metrial ca , ovarian ca,
colorectal ca
 Adverse effects
 Minor

-nausea, vomiting, headache, leg cramps

-mastalgia
-weight gain
-acne and chloasma
-menstrual abnormalities: breakthrough bleeding,
hypomenorrhea, menorrhagia, amenorrhea
-libido , leucorrhea
 Major
- Depression

- Hypertension

- Venous thromboembolism

- Cholestatic jaundice
POP/Mini Pill
Implant
Emergency Contraception
IUCD
 Types : Medicated, Non-medicated,Hormone
containing IUCD
IUCD LIFE SPAN

CuT 380A 10years

Multiload 375 5Yrs

Progestastert 1year

MIRENA 7-10years

CuT 200B 4years

 Mechanism of Action
-inflammatory reaction along with biochemical changes in
endometrium
-increased tubal motility
-Copper intiates the release of cytokines which are cytotoxic
and prevent blastocyst implantation
-Mirena causes suppression of endometrium. Cervical mucus
becomes scanty. Anovulation and insufficient luteal phase
activity is seen
Method of Insertion
 Time of Insertion
- Interval

- Postpartum

- Postabortal

- Postplacental
Benefits
 Contraceptive  Non Contraceptive
 Cost free  Reduction in menstrual
 Good compliance bloodloss,menorrhagia,
dysmenorrhoea, PMS
 Prolonged  Used in treatment of
contraceptive effect
endometrial
 No systemic side hyperplasia,
effects adenomyosis,endometri
 Prompt reversal osis,uterine leiomyoma
 Contraindication  Complications
-Pregnancy Immediate Remote
-Undiagnosed genital tract bleeding -pain -AUB
-Congenital uterine malformation -syncopal -PID
attack -Spontaneous
-Uterine or cervical neoplasia -partial or expulsion
-Endometritis complete -Uterine
perforation perforation
-STD
-Trophoblastic disease
-Wilson disease
-Copper allergy
-Hepatic tumor
-Arterial disease
Causes : 1) Thread has torn

2) Cu-T expelled out

3) Cu t perforated uterus and entered abdominal cavity

4) Cu T deep in uterine cavity

Rx: Laparotomy

IOC : X-Ray/USG

Gold standard IOC : Hysteroscopy

Cu T visible in X - ray due to presence of BaSO4 coating

Vasectomy
Tubectomy
Thank You