Contraceptive methods I

Contraceptive methods part 1 for UG MBBS students including information on types of contraceptives, cafeteria choice, Barrier methods,IUD,Mirena.

1. Contraceptive methods- I Dr Mamta Gehlawat MBBS MD PGDHHM PGDG Asst Prof Comm Med GMC SDPT

2. Contraceptive methods= preventive methods to help women avoid unwanted pregnancies

3. An ideal contraceptive? Safe Effective Acceptable Inexpensive Reversible Simple to use Independent of coitus Long lasting Need minimum supervision

4. Cafeteria choice More healthy, less cost, no side effects, but forget about it !! More creamy, more cost, more side effects, but I like it !!

5. Cafeteria choice Health Worker Eligible couple Options

6. Any contraceptive Ideal/perfect use Practical/in practice/typical use Failure rate expressed in no. of pregnancy per 100 women-years Pearl index : the number of failures of a contraceptive method per 100 woman years of exposure

7. Conventional contraceptives? Methods requiring action at the time of coitus/sexual intercourse Eg. Condom, spermicide etc

8. Types of contraceptive methods

9. Barrier methods= to prevent live sperm from meeting the ovum

10. barrier methods- Why ? Why not? No S/E like pill/IUD Need high motivation STD prevention Less effective than pill/IUD PID risk reduction Need consistent/careful use Cervical cancer risk reduction

11. Physical methods Condom Diaphragm Vaginal sponge Male Female

12. Condom

13. Condom Made of latex/rubber To be fitted on erect penis before intercourse Expel air first to keep space for semen To withdraw carefully to avoid spill in vagina Each sexual act needs new condom Combination with spermicide gives added protection Pearl index= 2 – 14 mostly due to incorrect use

14. Advantages/ Disadvantages of condoms

15. Female condom Prelubricated with silicon Effective against STD High cost Poor acceptability Pearl Index= 5-21

16. Diaphragm

17. Diaphragm/Dutch cap Shallow cup of rubber/plastic Flexible rim of metal/spring Different sizes available For women with good vaginal tone Kept in place for 6 hrs after coitus Used along with spermicide Pearl index= 6-12 S/E – nil Need training/privacy/fitting Variations of diaphragm= cervical cap/vault cap/ vimule cap

18. Vaginal Sponge ( TODAY ) Polyurethane sponge with spermicide nonoxynol-9 Less effective than diaphragm Pearl index= 9-40

19. Chemical Methods= Spermicides Foams- tablets/ aerosols Creams, jellies, pastes- squeezed from tubes Suppositories- inserted manually Soluble films- C film inserted manually

20. Chemical Methods

21. Spermicides Surface active agents = kill sperms by cutting sperm cell oxygen supply Drawbacks- High failure rate, action before intercourse, correct application into vagina, irritation, messy No safe spermicide available Recommended only for combination with other barriers

22. Take a Break.. Lets continue after…. https://youtu.be/Zx8zbTMTncs

23. IUD= Intra-uterine device

24. First generation IUD = non medicated/inert IUD

25. Comment on Images A and B A B

26. Second generation IUD = Copper IUD Newer Cu-T devices= 5 years life

27. Advantages of copper devices Low expulsion rate Lower S/E- pain and bleeding Easy and better tolerated in nulliparous too More effective Can be a post-coital contraceptive too

28. Third generation IUD = Hormone releasing IUD

29. Progestasert Mirena/ LNG 20 Has 38mg Progesterone Has 52 mg Levonorgestrel Releases 65mcg per day Releases 20mcg per day

30. https://www.mirena-us.com/about-mirena/

31. Ideal IUD candidate Has borne atleast one child No h/o pelvic disease Has normal menstrual periods Is willing to check for IUD threads/tail Has no problem with need of follow up/treatments Is in a monogamous relationship

32. IUDs are not recommended for nulliparous or polygamous women Due to risk of PID possible infertility

33. When to insert IUD? During menstruation/ first 10 days of cycle Immediate postpartum insertion = within first week of postpartum Post-puerperal insertion = 6-8 weeks after delivery Immediately after first trimester MTP Why follow up is needed? For continued support to woman To confirm presence of IUD To diagnose/treat any side-effects/complications Follow up after 1 st and 3 rd periods after insertion Bi-annual follow ups

34. Side effects/ complications…

35. …Side effects/ complications