Contraceptive Methods

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 and failure rates for most reversible methods are strongly influenced by compliance. Types:1. 2. 3. 4.

Natural contraception Mechanical contraception Hormonal contraception Surgical contraception

Characteristics of ideal contraceptive:

Safe

100% effective
Free of side effects Easily obtainable Affordable Acceptable to the user and sexual

partner Free of effects on future pregnancies

Conditions of family planning

Pregnancy
Lactation Before puberty

After menopause
Abstinence

Natural Family planning methods

These methods involve finding out when a woman is

at her most fertile, so that she can be extra careful or avoid sex altogether during these times. This can be done by using techniques such as the woman keeping a daily record of her body temperature using a special fertility thermometer. A combination of techniques is recommended to increase the effectiveness of these methods. These are a natural alternative to hormonal and barrier methods but the techniques used require a significant level of motivation and a clear understanding of how to monitor fertility. Natural methods of contraception also do not take into account fluctuations in the menstrual cycle.

Natural Family planning methods

They include:

Calendar (Rhythm) method Basal body temperature Cervical mucous method Symptothermal method Ovulation awareness method Lactational amenorrhea method Withdrawal ( Coitus interruption )

Rhythm method
This method can be used for patients with regular cycles

only. This is done depending on the exact knowledge of ovulation day and avoiding intercourse during the days before and after ovulation; for example in a regular period that occurs every 28 days the exact day of ovulation should be the day 14 so intercourse should be avoided 4-5 days before and after this days. There are many methods to detect ovulation days; 1- Increase in body temperature by about o.5 C. 2- Change in type cervical mucous 3- Ovulation kits nowadays are available for ovulation day detection by measuring LH surge

Withdrawal
When having sex, the man has to take his penis

out of the vagina before ejaculation. This is intended to stop sperm from entering the woman. This method frequently fails as drops of sperm can already escape from the penis into the vagina before the man ejaculates. Effectiveness: Failure rate can be as high as 15% (15 pregnancies per 100 women). More reliable methods are advised.

Mechanical family planning methods

Male condoms
Female condoms Diaphragms

Spermicidal
Intrauterine devices (IUD) Sponge

Male condom
It's a thin latex or plastic sheath placed over a man's

erect penis during sex to trap sperm at the point of ejaculation. It must be put on the penis as soon as it becomes erect and before any contact takes place with the vagina. Men should withdraw as soon as they have ejaculated and take care not to spill any semen. Condoms must be used with care as they can slip off or split. They should never be used with oil-based products such as petroleum jelly or suntan oil as these will damage the rubber. Advantages: easily available; offers protection against sexually transmitted infections including HIV/AIDS. Effectiveness: 94%-98% depending on correct use. Only use condoms that have been manufactured.

Female condom (Femidom)

It's a thin polyurethane sheath placed inside the

vagina (also covering the cervix and the area outside) to stop sperm from entering. It can be put in at any time before sex and is actually stronger than the male condom. It need to be sure that the penis enters the condom and is not inserted between the condom and the vaginal wall. Advantages: offers protection against sexually transmitted infections, including HIV/AIDS. Effectiveness: 95% if used correctly.

Diaphragms/cervical cap
A diaphragm or cap is a dome of rubber which

is fitted by the woman over her cervix before sex. It acts as a barrier to stop sperm getting through to the uterus. It should be used with a spermicidal cream, jelly or pessaries that contain a chemical that kills sperm. The diaphragm must stay in place for six hours after sex. Advantages: only needs to be used when the couple has sex Spermicides may cause irritation or an allergic reaction. Effectiveness: 92%-96% if used correctly.

Spermicides
These are creams, gels, sponges or

pessaries that contain a chemical that kills sperm. They can increase the effectiveness of certain barrier methods of contraception such as a diaphragm. However, they don't provide reliable contraception when used alone.

The IUD
An IUD - also known as a Coil - is a small

plastic and copper device, usually shaped like a 'T', which is fitted into the woman's uterus by a doctor using a simple procedure. It works by preventing an egg from settling in the womb. An IUD can stay in place for five years - sometimes for 10. It can also be used as an emergency method of contraception within five days of unprotected intercourse. Advantages: no need to think about it once it is in place and it last for a long time. Considerations: There is a higher risk of infection for women with more than one partner. It may cause heavier, more painful periods. Effectiveness: 98%-99%.

VAGINAL SPONGE
Vaginal contraceptive sponges are soft

synthetic sponges saturated with a spermicide. Prior to intercourse, the sponge is moistened, inserted into the vagina, and placed over the cervix . After intercourse, the sponge is left in place for 6 to 8 hours. It is quite similar to the diaphragm as a barrier mechanism. About 18 to 28 pregnancies occur over one year for every 100 women using this method. The sponge may be more effective in women who have not previously delivered a baby. This method was removed from the U.S. market, but plans are underway to re-introduce it in the near future.

Hormonal family planning methods

Skin patch
Vaginal ring Pills ( Combined & Minipill )

Injection
Implant

Contraceptive skin patch

The Contraceptive Patch looks like a square

band-aid. It is applied to the abdomen, buttocks, upper arm, or upper torso. The Patch is changed each week for a schedule of 3 weeks on and 1 week off. It works by slowly releasing a combination of estrogen and progestin hormones through the skin. These hormones prevent ovulation (release of an egg from the ovary) and thicken the cervical mucus, creating a barrier to prevent sperm from entering the uterus. Effectiveness: When used correctly, its about 99% effective as birth control except for women weighing 198 pounds or more when it is only about 92% effective.

Vaginal Ring
A soft, flexible vaginal ring, which is about 2

inches in diameter, delivers low doses of estrogen and progestin into the body. This helps prevent pregnancy by suppressing ovulation and thickening the cervical mucus, which helps block sperm from entering the uterus. The ring is inserted into the vagina and left for 3 weeks. It is then removed for 1 week, during which a woman menstruates, and a new ring is inserted after the 1-week "break." The vaginal ring is at least 98 percent effective with perfect use, which refers to always correct and consistent use.

Combined pill
This is the most common type. It contains two hormones estrogen and Progesterone which prevent an egg from being

released from a woman's ovary each month. The combined pill can reduce pre-menstrual syndrome (PMS) and period pain. There is evidence that it also offers some protection against cancer of the uterus and ovaries. Advantages: the pill does not interfere with the spontaneity of sex. A full medical history is essential as this pill is not suitable for women who have certain conditions such as high blood pressure, circulatory disease or diabetes. Women over 35 who smoke or are very overweight may be advised to choose another method of contraception. There are several different types of pill so if one does not suit then another might. The combined pill is not reliable if taken over 12 hours late or if have vomiting and diarrhea, when extra protection is required. Some drugs like antibiotics can also affect its reliability. Effectiveness: 99% if taken correctly.

Progesterone-only pill (mini pill)

Unlike the combined pill, this only contains the hormone

Progesterone. It works by thickening the cervical mucus, which

acts as a barrier to stop sperm entering the womb. It also makes the lining of the womb thinner, to prevent it accepting a fertilised egg. This type of pill is good for women who are breast-feeding, older women, smokers and others who cannot use the combined pill. It can also help with premenstrual syndrome (PMS) and painful periods. Advantages: the pill does not interfere with the spontaneity of sex. It must be taken at the same time each day or at most within three hours of that time. It will not work if taken over three hours late, or if have vomiting and diarrhea, in these cases extra protection is needed. It can cause irregular bleeding and periods may stop altogether while are taking it. Effectiveness: 98% if taken correctly.

Contraceptive injection
It's an injection of hormones that provides a longer-acting

alternative to the pill. It works by slowly releasing the hormone progesterone into the body to stop ovulation. Each injection lasts for 8-12 weeks. Injections may reduce heavy or painful periods and may give some protection against cancer of the uterus. Advantages: unlike the pill dont need to remember to take a tablet every day. Periods can become irregular or stop altogether. It can take over a year for fertility to return to normal after stopping contraceptive injections, so if patient is planning to start a family in the near future, it may not be suitable. Effectiveness: 99%.

Contraceptive implant
It's a small stick containing the hormone

progesterone which is inserted under the skin in the arm. The hormone is slowly released into the body, preventing eggs from being released from the ovaries, sperm from reaching an egg or an egg settling in the womb. Advantages: implants are a good method for women who want a long-term contraceptive, as each implant lasts for three years. Periods can become irregular or stop altogether. Effectiveness: 99%.

Side effects of Hormonal family planning methods

Nausea
Weight gain Headache

Breast tenderness
Breakthrough bleeding Vaginal infections

Mild hypertension
Depression

Absolute Contraindications of Hormonal family planning methods

Breast feeding
Family history of CVA or CAD History of thromboembolic disease

History of liver disease

Undiagnosed vaginal bleeding

Possible Contraindications of Hormonal family planning methods

Age > 40 years
Breast or reproductive tract malignancy DM

Elevated cholesterol and triglyceride

High blood pressure Mental depression

Migraine and other types of vascular

headache

Cont. Possible Contraindications of Hormonal family planning methods

Obesity
Pregnancy Seizure disorders

Sickle cell and or other

hemoglobinopathies Smoking Use of medication or drug with drug interaction effect

Surgical family planning methods

(Sterilization)
Vasectomy (Male)
Tubal ligation (Female)

Minilaprotomy Laparoscopy

Essure

Male sterilization
Vasectomy:-division or occlusion of the vas deference

prevents the passage of sperms. Methods:1- Clips 2- Diathermy 3- Percutaneous injection of sclerosing agents or occlusive substances. The success of the procedure is verified by the absence of sperms from two consecutive samples of ejaculate collected at least 4 weeks apart. Contraception must be continued until confirmation of two negative semen results has been achieved and this is achieved after 16-18 weeks of performing the vasectomy.

Female sterilization
Female sterilization is done surgically by blocking

both fallopian tubes by three ways: Laparotomy minilaparatomy laparoscopy Laparotomy: Bilateral salpingectomy or hysterectomy may be preferable when there is a coexistent pathology while the other two ways are more preferable, safe and effective A number of chemical agents have been tested for their ability to occlude the fallopian tube when installed into the tube either directly or transcervically via the uterus. Inflammation and fibrosis result and occlude the tubes. However, safety of quinacrine sterilization has not yet been determined so surgical method is safer

Female sterilization
Methods of tubal occlusions:

Ligation by absorbable or non-absorbable sutures the ends left free or buried in the broad ligament or uterine cornue. Electrocautery:-Bipolar diathermy allows only the tissue held between the jaws of the forceps to be cauterized. Falope ring:- ring of silicone or rubber is placed over a loop of the tube with a specially designed applicator. This destroys 2-3 cm of tube. Clips: - a variety of clips are available tlulka-clemens clip (stainless steel and polycarbonal and filshie clip) (titanium lined with silicon rubber). Smaller length of the tube is destroyed via this method. Laser; CO2 laser divides tube very cleanly but may allow a high incidence of recanalization.