CONTRACEPTION
BY
1. N U R U L FAT H I YA H B I N T I M O H A M E D A’ S D I
2. MEOR MUHAMMAD LOQMAN BIN ROSLI
3. ABDULLAH IQRAM BIN ZULKIFLI
4. AQILA NAZNEEN BINTI ABDUL RAZAK
Contraception (birth control)
prevents pregnancy by
interfering with the normal
process of ovulation,
fertilization, and implantation
METHOD OF CONTRACEPTION
Natural Family Planning
Barrier method , such as condoms
Long-acting reversible contraception,
such as the implant or intra uterine device
(IUD)
Hormonal contraception, such the pill or
the Depo Provera injection
Emergency contraception
Permanent contraception, such as
vasectomy and tubal ligation.
NATURAL FAMILY PLANNING
Physiological or natural methods for contraception
are easy, cheap, readily available methods with
reasonable efficiency but are not realible when use
alone.
1. Coitus interruptus
Withdrawal and ejaculation outside of vagina during
intercouse is one of the oldest most commonly practised
methods of contraception.
Efficacy of this method is not high as in some cases the
pre ejaculatory fluid may contain sperm capable of
fertilization.
2. CALENDAR METHOD
Intercouse is totally
prevented or protected (by
condom or coitus
interrupted) at the time of
expected ovulation .
This method is suitable
only for intellectual
couples , with regular
cycles
3. CERVICAL MUCUS METHOD
5. LACTATIONAL AMENORRHEA METHOD
o Must be:
Within 6 months postpartum + amenorrhea + fully
breastfeeding
o Advantages:
Effective (no preparation needed, for all breastfeeding
women)
Begins immediately postpartum
o Disadvantages:
Requires conditions
Unreliable for women who cannot breastfeed eg
cracked/sore nipple, breast abscess
No protection against STIs, HIV
BARRIER METHOD
1. Diaphragm or cervical cap—Each of these barrier methods are placed
inside the vagina to cover the cervix to block sperm. The diaphragm is shaped
like a shallow cup. The cervical cap is a thimble-shaped cup. Before sexual
intercourse, you insert them with spermicide to block or kill sperm. Typical use
failure rate for the diaphragm: 17%.
2. Sponge—The contraceptive sponge contains spermicide and is placed in the
vagina where it fits over the cervix. The sponge works for up to 24 hours,
and must be left in the vagina for at least 6 hours after the last act of
intercourse, at which time it is removed and discarded. Typical use failure
rate: 14% for women who have never had a baby 1
3. Female condom—Worn by the woman, the female condom helps keeps
sperm from getting into her body. Typical use failure rate: 21%, 1 and also
may help prevent STDs.
4. Male condom—Worn by the man, a male condom keeps sperm from
getting into a woman’s body. Latex condoms, the most common
type, help prevent pregnancy, and HIV and other STDs, as do the
newer synthetic condoms. Typical use failure rate: 13%.
5. Spermicides—These products work by killing sperm and come in
several forms—foam, gel, cream, film, suppository, or tablet. Can
use a spermicide in addition to a male condom, diaphragm, or
cervical cap. Typical use failure rate: 21%.1
Long Acting Reversible
Contraceptives
(LARC)
TYPES OF LARC?
This methods are very effective to prevent
pregnancy, it is long lasting and reversible
Consist of two:
Intrauterine device (IUD)
Implant (Implanon)
Intrauterine device
It is a T shaped small device that is placed inside the
uterus
There are two types of IUDs
• The hormonal IUD releases progestin (Levonogestrel
IUD)
One hormonal IUD is approved for use up to 5 years.
• The copper IUD does not contain hormones.
It is approved for use for up to 10 years.
LEVONORGESTREL-RELEASING INTRAUTERINE SYSTEM (LNG-IUS)
-MIRENA-
One sterile intrauterine system consisting of a T-
shaped polyethylene frame with a steroid
reservoir containing 52 mg levonorgestrel
packaged within a sterile inserter
Initial release rate of levonorgestrel (LNG) :20
mcg/day;
Reduced by about 50% after 5 years;
Mirena must be removed or replaced after 5
years.
Mode of action
It acts on the endometrium, leading to endometrial atrophy →
preventing implantation
Thickened cervical mucus → inhibits sperm penetration
When to insert?
Any time as long as the provider can be reasonably certain the
woman is not pregnant.
If Mirena is not inserted during the first 7 days of the menstrual
cycle, a back-up method of contraception should be used or the
patient should abstain from vaginal intercourse for 7 days to
prevent pregnancy
Do not insert Mirena until a minimum of 6 weeks after delivery, or
until the uterus is fully involuted.
Advantage
Long-acting, can last for 5 years
Low failure rates, ~1%
Speedy return of fertility
Can treat heavy menstrual bleed or dysmenorrhea
Complications
Expulsion (5%, especially in first 3 months)
Perforation (usually during insertion, d/t poor
technique, can cause ‘lost threads’)
↑ risk of PID
IUD-failure pregnancy is rare, but if it occurs, ↑ risk
of ectopic pregnancy.
COPPER-BEARING IUCD
Mode of action
• Foreign body triggers inflammation in the endometrium
prevents implantation
• Copper content is toxic to spermatozoa and inhibit its motility
Timing of IUCD insertion
If not pregnant: Any time during the cycle
Post-partum: insert 4-6wks after delivery
Following termination of pregnancy: insert within 48h after
termination
Complication
Irregular PV bleeding in the first 3-6 months of use
Risk of infection (PID)
IUCD expulsion (first 6 months, during menstruation)
Perforation (pass through uterine wall into peritoneal cavity)
Dysmenorrhea
Contraindication
Pregnancy
PID, genital tract infection
Copper allergy
Uterine anomalies or fibroids distorting cavity
PROGESTOGEN-ONLY SUBDERMAL IMPLANTS – IMPLANON
Content
• Etonogestrel ( 3-keto desogestrel ) – active metabolite of desogestrel
Administration
• Subdermally – on the inner side of the upper arm (in the groove between
biceps and triceps) about 8-10 cm proximal to medial epicondyle
• Under LA
• Last for 3 years
Dose
• 68 mg – initial release rate of 60 mcg/day which falls to 30 mcg/ day at the
end of 3 years
Failure rate
0.2 – 0.5 per 100 women per year Progestogen-only Subdermal Implants –
Implanon
HORMONAL
CONTRACEPTION
COMBINED ORAL CONTRACEPTIVE PILL
Contain two type of hormone both synthetic
estrogen and progestrerone Ethinyl estradiol
and Mestranol
Low dose COCP 20-35mcg estrogen
1 pill is taken every day for 21 days followed
by 7days pill free where women will
experience withdrawal bleeding
PRINCIPLE
WHO SHOULD NOT USE COCP
- History of PE or disease that increase risk
of causing thrombosis
- Uncontrolled hypertension
- History of stroke or heart attack
- Severe liver disease
- Migraine headache with neurological
component
- Diabetes with retinopathy or nephropathy
- Estrogen dependent cancer of breast or
endometrium
SIDE EFFECT
Weight gain, fluid retention and leg cramps
Headache, nausea and vomiting
Chloasma and greesy skin
Mood change and depression
Loss of libido
Mastalgia and breast enlargement
Vaginal dischage and irregular bleeding
Growth of fibroid
PROGESTERONE ONLY PILL (POP)
INDICATION :
For whom a COC contraindicated
- Breastfeeding women
- Hypertension
- Age above 40
- Smoking
- diabetic
PROGESTIN ONLY INJECTABLE CONTRACEPTIVES
DEPO MEDROXYPROGESTERONE ACETATE (DMPA 150MG)
Given at 3 monthly IM injection
Suitable for breastfeed mother
Mode of action ; inhibition of ovulation
Disadvantage :
-Weight gain
-Menstrual irregularity
-Abdominal cramps
EMERGENCY
CONTRACEPTION
EMERGENCY CONTRACEPTION
- Take another dose if vomiting occurs within 2 hours.
- Do no combine both methods! Effects might counteract
and not work at all!
PERMANENT
CONTRACEPTION
BILATERAL TUBAL LIGATION
Permanent
Effectiveness > 99%
Failure rates around 2 per 1000 women
Can perform within 7 days postpartum or anytime after baby is 6 weeks old
Between 7 days and 6 weeks there is an increased risk of complications as the
uterus has not fully involuted.
Provide effective interim method of contraception (e.g. a hormonal method)
prior to scheduled date
Can be performed at the time of elective caesarean section
HYSTEROSCOPIC INSERTION OF TINY COILS (ESSURE)
INTO THE FALLOPIAN TUBES
POMEROY PROCEDURE
FILSHIE CHIP
THANK YOU
REFERENCE:
https://www.cdc.gov/reproductivehealth/contraception/index.htm
https://
www.fsrh.org/standards-and-guidance/documents/ukmec-2016-summary-sheets
Essential of gynaecology, Department of obstetric and gynaecology cairo university,
2016,
Clinical protocol in obstetric and gynaecology for malaysian hospital , 2015
