Contraception

• Define contraception
• Explain the mechanisms of the following
contraceptive techniques:
i. 1. Barrier methods
ii. 2. Hormonal methods
iii. 3. Intrauterine device (IUD)
iv. 4. Emergency contraceptive pills (ECPs)
v. 5. Male and female sterilization
 Definition of Contraception
• Contraception refers to methods used to
prevent pregnancy by interfering with the
normal process of ovulation, fertilization, or
implantation.
• Ovulation: The release of a mature egg (ovum) from
the ovary into the fallopian tube, typically occurring
around the middle of the menstrual cycle.
• Fertilization: The fusion of a sperm cell with an egg
cell in the fallopian tube, forming a zygote.
• Implantation: The process by which the fertilized
egg (blastocyst) attaches to the lining of the uterus,
beginning the early stages of pregnancy.
 Rhythm Method of Fertility Control

Definition:
A natural method of contraception based on avoiding sexual
intercourse during the fertile window of the menstrual cycle.
• Understanding the Menstrual Cycle
• A cyclical physiological process in females, typically lasting about 28
days, involving hormonal changes that regulate ovulation,
preparation of the uterine lining for pregnancy, and shedding of the
lining if fertilization does not occur.
• Phases of the Menstrual Cycle:
1 Menstrual Phase (Days 1-5): Shedding of the uterine lining.
2 Follicular Phase (Days 6-13): Egg matures, estrogen rises.
3Ovulation (Day 14): Egg is released.
4 Luteal Phase (Days 15-28): Uterus prepares for pregnancy.
 Ovulation & Fertility Window:

• Ovulation occurs on Day 14 (in a 28-day cycle).

• The ovum (egg) survives for 24-48 hours.
• Sperm can survive for 24-48 hours inside the
female reproductive tract.
• Fertile window: 5 days before ovulation + 2 days
after = “Dangerous Period”
 Safe & Unsafe Periods

Safe Periods (No Pregnancy Likely)

• 4-5 days after menstruation ends
• 5-6 days before the next period starts

Unsafe Period (Fertile Window)

• A few days before ovulation (Day 10-13) & a
few days after (Day 14-16)
 How It Works

To Avoid Pregnancy:
• Avoid sexual intercourse during the fertile window.
• Track menstrual cycle carefully.
• Use additional methods (like tracking basal body temperature).
• BBT is your body's lowest temperature when fully at rest, measured right after
waking up.
✔ Before ovulation – Your temperature is slightly lower.
✔ After ovulation – Your temperature rises slightly (by about 0.3–0.5°C or 0.5–1°F).
• By tracking BBT daily, you can know when ovulation happens. Avoiding
intercourse during the fertile days helps prevent pregnancy.

For Pregnancy Planning:

• Have intercourse during the fertile window to increase chances of conception
 Advantages & Disadvantages

• Advantages:
• No medications or devices required.
• Cost-free and hormone-free.
• No side effects.
• Disadvantages:
• Requires regular cycle tracking.
• Less effective if periods are irregular.
• Higher failure rate compared to other contraceptive methods.
 Why does the rhythm method have a higher failure rate
compared to other contraceptive methods?

• The rhythm method has a higher failure rate because

ovulation can be unpredictable due to cycle
variations, stress, or health factors.
• Human errors in tracking cycles and calculating
safe days can lead to unintended pregnancies
 Barrier Methods
• Mechanical barriers are used to prevent the entry
of sperm into uterine cavity. These barriers are
called condoms.
• - Examples:
• • Male condoms
• • Female condoms
• • Diaphragm
• • Cervical cap
• • Spermicides
• Barrier methods prevent sperm from reaching
the egg by creating a physical or chemical
barrier.
• - Male condoms – A thin sheath worn over the
penis that prevents semen from entering the
vagina.
• - Female condoms – A pouch inserted into the
vagina before intercourse to block sperm.
• - Diaphragm – A dome-shaped device placed over the
cervix, often used with spermicide.
• - Cervical cap – A smaller version of a diaphragm that
fits tightly over the cervix.
• - Spermicides –
 Chemical substances, which destroy the sperms, are
applied in female genital tract before coitus.
 Destruction of sperms is called spermicidal action.
 The spermicidal substances are available in the form of
foam tablet, jelly, cream and paste.
 Hormonal Methods
These methods regulate hormones to prevent ovulation, alter cervical mucus,
or modify the uterine lining.
 Combined oral contraceptive pills (OCPs) – Contain estrogen and
progestin to inhibit ovulation and thicken cervical mucus.
 Progestin-only pills (Mini-pill) – Suitable for breastfeeding women,
thickens cervical mucus and suppresses ovulation.
 Contraceptive patch – A skin patch that releases hormones into the
bloodstream.
 Injectable contraceptives (e.g., Depo-Provera) – A progestin injection
given every 3 months.
 Hormonal implants (e.g., Nexplanon) – A small rod placed under the skin
that releases progestin for long-term contraception.
 Vaginal ring (e.g., NuvaRing) – A flexible ring inserted into the vagina that
releases hormones over three weeks
• Oral contraceptives are the drugs taken by mouth (pills) to prevent
pregnancy.
• These pills prevent pregnancy by inhibiting maturation of follicles
and ovulation.
• This leads to alteration of normal menstrual cycle. The menstrual
cycle becomes the anovulatory cycle.
• This method of fertility control is called pill method and pills are
called contraceptive pills or birth control pills. These pills contain
synthetic estrogen and progesterone. Contraceptive pills are of three
types:
• 1. Classical or combined pills
• 2. Sequential pills
• 3. Minipills or micropills.
 Classical or combined pills
• contain a moderate dose of synthetic estrogen like
ethinyl estradiol or mestranol and a mild dose of
synthetic progesterone like norethindrone or
norgestrol.
• Pills are taken daily from 5th to 25th day of
menstrual cycle. The withdrawal of the pills after
25th day causes menstrual bleeding.
• The intake of pills is resumed again after 5th day of
the next cycle.
 Sequential pills
• Sequential pills contain a high dose of estrogen along
with moderate dose of progesterone. These pills also
prevent ovulation.
• Sequential pills are taken in two courses:
 Daily for 15 days from 5th to 20th day of the
menstrual cycle and then
 During the last 5 days, i.e. 23rd to 28th day.
 Mini pills
• Mini pills contain a low dose of only progesterone and are
taken throughout the menstrual cycle.
• It prevents pregnancy without affecting ovulation.
• The progesterone increases the thickness of cervical mucosa,
so that the transport of sperms is inhibited. It also prevents
implantation of ovum.
• About 40% of women who use contraceptive pills may have minor transient
side effects. However, long term use of oral contraceptives causes some
serious side effects.
• Some of the side effects are rare, but may be dangerous. Following are the
disadvantages and adverse effects of oral contraceptives:
i. Major practical difficulty is the regular intake of the pills
ii. May not be suitable for women having disorders such as diabetes,
cardiovascular diseases or liver diseases
iii. Clotting tendency of blood due to suppressed production of
anticoagulants in liver
iv. Hypertension and heart attack
v. Increases the risk of stroke
vi. Tenderness of breast and risk of breast cancer (but may decrease the risk
of ovarian and uterine cancer).
 LONG-TERM CONTRACEPTIVES
• To avoid taking pills daily, the long-term contraceptives are
used. These contraceptives are in the form of implants
containing mainly progesterone.
• The implants, which are inserted beneath the skin release the
drug slowly and prevent fertility for 4 to 5 years. Though it
seems to be effective, it may produce amenorrhea.
INTRAUTERINE CONTRACEPTIVE DEVICE (IUCD) – PREVENTION
OF FERTILIZATION AND IMPLANTATION OF OVUM

Fertilization and the implantation of ovum are prevented by

inserting some object made from metal or plastic into uterine
cavity. Such object is called intrauterine contraceptive device
(IUCD).
• An **IUD** is a small, T-shaped device inserted into the
uterus to prevent pregnancy.
• - **Hormonal IUD (e.g., Mirena, Kyleena)** – Releases
progestin, thickens cervical mucus, and suppresses ovulation.
• - **Copper IUD (e.g., Paragard)** – Releases copper ions,
which are toxic to sperm and prevent fertilization.
 DISADVANTAGES OF IUCD
• IUCD has some disadvantages. It has the tendency to:
1. Cause heavy bleeding in some women
2. Promote infection
3. Come out of uterus accidentally.
 Emergency Contraceptive Pills (ECPs)
• ECPs are used after unprotected sex to prevent pregnancy by
delaying ovulation.

• - Levonorgestrel (Plan B, Postinor-2) – A high dose of

progestin taken within 72 hours of intercourse.
• - Ulipristal acetate (EllaOne)– A selective progesterone
receptor modulator, effective up to 5 days after unprotected
sex.
• - Copper IUD as emergency contraception – Can be inserted
within 5 days to prevent fertilization.
 Male and Female Sterilization
• These are permanent methods of contraception:
• - Male sterilization (Vasectomy) – A surgical procedure
where the vas deferens (tubes carrying sperm) are cut
or sealed, preventing sperm from entering semen.
• - Female sterilization (Tubal ligation or Tubectomy)**
– The fallopian tubes are cut, tied, or blocked to
prevent eggs from reaching the uterus.
• - Hysteroscopic sterilization ( no longer widely used) –
A device is placed inside the fallopian tubes, causing
scar tissue to block them.
 Conclusion
• - Contraception provides various options to
prevent pregnancy.
• - The choice of method depends on individual
needs, health status, and lifestyle.
• - Consultation with a healthcare provider is
recommended to select the most appropriate
method.
Thank you