14193_contraception.pptx Contraception PPT

Contraception

1. METHODS OF POPULATION CONTROL

2. Contraceptive or fertility Regulating methods are preventive methods to help women avoid unwanted pregnancies. They include all temporary and permanent measures to prevent pregnancy.

3. IDEAL CONTRACEPTIVE Safe Effective Acceptable Inexpensive Reversible Simple to administer Independent of coitus Long-lasting Little or no medical supervision

4. T he present approach in family planning programmes is to offer all methods from which an individual can choose according to his needs and wishes and to promote family planning as a way of life. Conventional contraceptives denote methods used that require action at the time of coitus. E.g. : Condoms , spermicides , etc .

5. Spacing methods Barrier methods A) PHYSICAL METHODS B) CHEMICAL METHODS C) COMBINED METHODS Intra-uterine devices Hormonal methods Post-conceptional methods Miscellaneous

6. TERMINAL METHODS Male sterilisation Female sterilisation

7. BARRIER METHODS Occlusive methods: The aim of these methods is t o prevent sperm from meeting Ovum. Eg : Male condom, female condom Advantages : Free from side effects associated with pills & IUD. Protection from STD’s , pelvic inflammatory diseases & cancer Cervix.

8. Disadvantages High degree of motivation Less effective than pill or loop They should be used consistently & carefully.

9. INTRA UTERINE DEVICES 2 types of IUDs 1. Nonmedicated 2. Medicated 1.Cu IUDs 2. Hormone Releasing Both types ( Medicated & Nonmedicated ) IUDs made up of polyethylene or other polymers.

10. Non medicated/ Inert/ First generation IUDs : Loops, spirals, coils, rings, bows etc.

11. MEDICATED IUDs Importance of medicated IUDs : Reduce incidence of side effects To increase contraceptive effective ness More expensive SECOND GENERATION IUDs : Metallic copper had a strong antifertility effect Number of cu bearing devices are available 1. Earlier devices a. Copper – 7 b. copper – T- 200 B

12. 2 . Newer devices a. variants of the T devices i. T cu – 220C ii. T cu – 380 A or Ag b. Nova T c. Multi load devices i. ML – Cu -250 ii. ML – Cu- 375 Numbers represents the surface area of the copper on the device (in. sq mm).

13. THIRD GENERATION IUD Most widely used hormonal devices are 1.Progestasert T shape device filled with 38 mg of progesterone It has direct effect on uterine lining, cervical mucus and sperms 2. Levonorgestrel (LNG – 20) T shaped device It has 1. low pregnancy rate 2. less number of ectopic pregnancies 3. Lower menstrual blood loss 4. Fewer days of bleeding

14. MOA Foreign body reaction. Cellular and biochemical changes. Impair the viability of the gamete. Reduce the chances of fertilisation rather than implantation. Copper enhances the Cellular response in the endometrium. Affects the enzymes in the uterus. Alter biochemical composition ofcervical mucus. Hormonal devices increase viscosity of the cervical mucus.

15. Advantages 1. Simplicity 2. Insertion takes few minutes 3. Once inserted IUD stays in place as long as required 4. Reversible 5. In expensive 6. High continuation rates 7. Single act of motivation 8. Free of systemic side effects

16. HORMONAL CONTRACEPTIVES Hormonal contraceptives when properly used are the most effective methods of contraception They provide the best means of ensuring spacing between one childbirth and another GONADAL STEROIDES : a. synthetic steroids: eg ethinyl oestradiol and mestranol. b. synthetic progestogens: they are pregnanes , oestranes and gonanes.

17. CLASSIFICATION a) ORAL PILLS 1.Combined pills 2.Progestogen only pill 3.Post coital pill 4.Once a month pill 5.Male pill b) DEPOT FORMULATIONS 1. Injectables 2. Subcutaneous implants 3. vaginal rings

18. ORAL PILLS Combined pill: It is one of the major spacing methods of contraception.It contains 30-35 mcg of a synthetic oestrogen and 0.5 to 1 mcg of a progesterone. The pill should be taken at a fixed time everyday.

19. The pill is given orally for 21 days starting on the 5 th day of menstrual cycle followed by a break of 7 days during which menstruation occurs. This is called withdrawal bleeding. The department of family welfare , in the Ministry of Health and Family Welfare Govt. of India has made available low dose of oral pills – MALA-N and MALA-D.

20. 2. Progesterone only pill It is called as minipill or micropill .it contains only progesterone which is given in small doses through out the cycle. These pills have an increased pregnancy rate so not being used , but can be used for women with cardiovascular problem and for those with the risk factors for neoplasia.

21. 3. Post coital contraception: It is used within 48 hrs of unprotected intercourse. Two methods are available. a) IUD: e.g. copper device b) Hormonal: combine oc pill is used. It contains double dose of the standard combined pill. 2 pills immediately followed by 2 pills 12 hours later. For emergency contraception a women must take four instead of 2 in each dose.

22. 4. Once a month long acting pill Quniestrol , a long acting estrogen is given in combination with a short acting progesterone. Disadvantage: high pregnancy rate and irregular bleeding.

23. 5. Male pill: The approach is a) preventing spermatogenesis. b) interfering with sperm storage. c) preventing sperm transport. d) affecting the seminal fluid constitution. An ideal male contraceptive will decrease the sperm count while leaving testosterone at normal values.

24. Mode of action of oral pill: Combined only pill prevents the release of ova from the ovary by blocking the pituitary secretion of gonadotropin. Progesterone only pills render the cervical mucus thick and scanty and inhibit the sperm penetration.

25. Effectiveness : If taken according to the prescribed regimen oral contraceptives of the combined type are 100% effective. It is also influenced by drugs – rifampicin, phenobarbital, ampicillin.

26. BENEFICIAL EFFECTS Contraceptive benefits- prevention of unwanted pregnancy (failure rate- 0.1per 100 women year). Non contraceptive benefits- a. relief of: menorrhagia (50% ), dysmenorrhoea (40% ), premenstrual tension syndrome, mittleschmerz syndrome. b. improvement of: iron def. anemia,hirsutism , acne, endometriosis, autoimmune disorders of thyroid, rheumatoid arthritis.

27. c. Marked reduction in: pelvic inflammatory disease, benign breast cancer, ectopic pregnancy, fibroid uterus, functional ovarian cysts, carcinoma of ovary (40%) carcinoma of endometrium (50% ) protection against osteoporosis.

28. b) DEPOT FORMULATIONS Injectable contraceptives, sub dermal implants and vaginal rings come in this category . Injectable contraceptives : There are two types: PROGESTAGEN ONLY INJECTABLES : (a) DMPA: Depot medroxy - progesterone acetate. Dose is i.m injection of 150mg every 3months.

29. It is safe effective and an acceptable contraceptive. Acceptable in the postpartum period as a means of spacing. Side effects: weight increase, irregular menstrual bleeding.

30. (b) NET-EN Norethisterone enantate is given as i.m injection dose of 200mg. every 60 days. Contraceptive action is by inhibiting ovulation and progesterogenic effects on cervical mucus. ADMINISTRATION: Both DMPA ,NET-EN should be given during first five days of menstrual period.

31. B. COMBINED INJECTABLE : They contain a progestogen and an oestrogen . Given at monthly intervals. Act by suppressing ovulation ,cervical mucus is affected mainly by progestogen and inhibits sperm penetration. CONTRAINDICATIONS: confirmed or suspected pregnancy; past or present evidence of thromboembolic disorders; cerebrovascular or coronary artery disease; focal migraine; malignancy of breast and diabetes with vascular complications.

32. 2. SUBDERMAL IMPLANTS: Norplant : it consists of 6 silastic capsules containing 35mg of levonorgesterel . The capsules are implanted beneath the skin of forearm or upper arm. Effective contraception is provided for 5 years.

33. 3. VAGINAL RINGS Vaginal rings containing levonorgesterel are highly effective. The hormone is slowly absorbed through the vaginal mucosa , bypassing the digestive tract and liver and allowing a potentially lower dose. The ring is worn in the vagina for 3 weeks and removed for the 4 th week.

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