Contraceptive methods obstetric gynaecology

contraceptive method

1. CSL-CONTRACEPTIVE METHODS Dr NAJIMUDEEN Year 5 R 3 October 2019/2020 24.06.2020

2. BARRIER METHODS Male and female condoms The condom is the only form of contraception that protects against most STIs as well as preventing pregnancy. This method of contraception can be used on demand, is hormone free and can easily be carried with you. male and female varieties.

3. MALE AND FEMALE CONDOM

4. BARRIER METHODS Male condoms are rolled onto an erect penis and act as a physical barrier, preventing sexual fluids from passing between people during sex. The female condom is placed into the vagina right before sex. Based on typical use, the female condom is not quite as effective as the male latex condom and it may take a little practice to get used to.

5. BARRIER METHODS Pros include: It is the best protection against STI can be used on demand hormone free. Cons include: It can tear or come off during sex if not used properly Partner dependent some people are allergic to latex condoms. More effective when spermicide is added

6. ORAL CONTRACEPTIVE PILL Combined oral contraceptive pills (COC) –Combination of oestrogen and progesterone Oestrogen: Ethinyl oestradiol 30 microgram Progesterone: Varies Desogestrel, Medroxy progesterone acetate Levonorgestrel, Lynestrenol, Norethisterone or Norgestrel) Progesterone only pill

7. COMBINED ORAL CONTRACEPTIVE PILL 21 tablets containing hormones (Oestrogen and progesterone) 7 tablets- Vitamin tablets During Vitamin tablets, menstruation occurs

8. MECHANISM OF ACTION OF OCP Prevention of ovulation (i)Progestogen negative feedback works at the hypothalamus to decreases the pulse frequency of gonadotropin releasing hormone (ii)Decrease the level of FSH and LH (iii)LH surge in the midcycle is stopped Progesterone: Cervical mucous become thick- Ascend of sperm difficult Progesterone: Endometrium become unsuitable for implantation

9. CONTRAINDICATION FOR COC Breast cancer Deep vein thrombosis Over 35 years and heavy smokers Obesity (BMI ≥40 kg/m 2 ) Hypertension (SBP ≥160 mmHg or DBP ≥100 mmHg)May have an increased risk of stroke or MI Valvular and congenital heart disease (complicated by pulmonary hypertension, atrial fibrillation, history of subacute bacterial endocarditis)COC use may further increase the risk of arterial thrombosis

10. CONTRAINDICATION FOR COC Within 6 weeks of postpartum if breast feeding Migraine headache with focal neurological symptoms and aura at any age DM with retinopathy, nephropathy, neuropathy or DM >20 years in duration

11. PROGESTIN-ONLY PILLS (POPS) Progestin-only Pills (POPs) Also known as “mini-pills”; contain low doses of progestins (eg Desogestrel, Ethynodiol diacetate, Levonorgestrel, Lynestrenol, Norethisterone or Norgestrel) May be considered in women in whom estrogen is contraindicated

12. PROGESTIN-ONLY PILLS (POPS) The chief mechanism of action is an increase in the viscosity of cervical mucus which prevents sperm entry It causes thinning and atrophy of the endometrium Injectable progestins work primarily by inhibiting secretion of gonadotropins and therefore, suppress ovulation

13. CONTRACEPTIVE INJECTION Depo Provera (Depot Medroxy progesterone acetate) 150 mg Intramuscular injection Lasts for 3 months Acts by altering the endometrium Amenorrhoea Delay in return of fertility Weight gain

14. CONTRACEPTIVE INJECTION May be considered in women in whom estrogen is contraindicated women who are breastfeeding (started 6 weeks after childbirth; immediately if not breastfeeding) women who smoke; women who experience migraine headaches; with endometriosis, sickle cell disease; and those taking anticonvulsants

15. DMPA NON-CONTRACEPTIVE BENEFITS Amenorrhea and subsequent decrease in dysmenorrhea and risk for iron-deficiency anemia Reduced risk of endometrial cancer, ovarian cysts, ovarian cancer, PID, sickle cell crises, and ectopic pregnancy Decrease in symptoms associated with endometriosis, PMS and chronic pelvic pain Excellent method for women taking anticonvulsant drugs Lactation is not affected Sickle cell crises are reduced in patients with sickle cell anemia

16. DISADVANTAGES OF DEPO PROVERA Irregular menstruation during 1st several months Hypoestrogenism may occur, which can cause dyspareunia, hot flashes and decreased libido May be associated with weight gain, acne and complexion changes Must return to the clinic every 11-13 weeks for injection Impossible to immediately discontinue

17. INTRAUTERINE CONTRACEPTIVE DEVICE (IUCD) Copper T LNG-IUS

18. COPPER IUCD Mechanism of action creates a local inflammatory reaction that appears to prevent sperm from reaching the fallopian tubes. Copper weakens the spermatozoa Tubal motility increased

19. Cu IUCD Cu T 380 A IUCD Multiload Cu 375 IUCD

20. Copper IUCD Effective for 8-10 years Can be used as emergency contraception – Should be inserted within 5 days of sexual exposure

21. Copper IUCD Side effects Menorrhagia Dysmenorrhoea Expulsion Spotting Postcoital bleeding Perforation Infection

22. Copper IUCD- Contraindication Active pelvic infection Undiagnosed vaginal bleeding Carcinoma of uterus, cervix Pregnancy

23. LNG IUS (Progesterone containing IUCD)

24. LNG IUS (Progesterone containing IUCD) Progesterone releasing IUCD (MIRENA IUCD) Releases 20 microgram LNG progesterone daily Mechanism of action Creates a local inflammatory reaction that appears to prevent sperm from reaching the fallopian tubes. Progesterone cervical mucous becomes thick. Ascent of spermatozoa diminished

25. Contraceptive Implant The contraceptive implant (Nexplanon) is a small flexible plastic rod that's placed under the skin in the upper arm It releases the hormone progestogen into the bloodstream to prevent pregnancy and lasts for 3 years

26. Long-acting reversible contraception (LARC) Long-acting reversible contraception (LARC) is a contraceptive that lasts for a long time. There are two types of LARC in Aotearoa New Zealand: the  intra uterine device (IUD)  that lasts for three, five or ten years the  implant  that lasts for five years. They are sometimes called “fit and forget” contraception because once it is put in, you don’t need to remember it every day or every month. LARCs are the most effective types of contraception. They are more than 99% effective at preventing pregnancy.

27. Contraceptive Ring This method consists of a flexible plastic ring constantly releasing hormones that is placed in the vagina by the woman. It stays in place for three weeks, and then you remove it, take a week off then pop another one in. The ring releases the hormones oestrogen and progestogen. These are the same hormones used in the combined oral contraceptive pill, but at a lower dose. Pros include: You can insert and remove a vaginal ring yourself; this contraceptive method has few side effects, allows control of your periods and allows your fertility to return quickly when the ring is removed. Cons include: It is not suitable for women who can't take oestrogen-containing contraception; you need to remember to replace it at the right time; does not protect against STIs

28. DIAPHRAGM Diaphragm A diaphragm is a small, soft silicon dome is placed inside the vagina to stop sperm from entering the uterus. It forms a physical barrier between the man's sperm and the woman's egg, like a condom. The diaphragm needs to stay in place for at least six hours after sex. After six - but no longer than 24 hours after sex - it needs to be taken out and cleaned. Some of the pros: You can use the same diaphragm more than once, and it can last up to two years if you look after it. Some of the cons: Using a diaphragm can take practice and requires keeping track of the hours inserted. The diaphragm works  fairly well if used correctly , but not as well as the pill, a contraceptive implant or an IUD.

29. SURGICAL STERILIZATION Male- Vasectomy Female: Bilateral tubal ligation

30. EMERGENCY CONTRACEPTION Copper intrauterine device (IUCD) and Emergency contraceptive pills such as levonorgestrel, ulipristal acetate, combined oral contraceptive pills (Yuzpe method),

31. EMERGENCY CONTRACEPTION Mechanism of action of drugs delaying or inhibiting ovulation. alterations in hormone levels, changes in the endometrial environment, and inhibition of fertilization

32. EMERGENCY CONTRACEPTION  Levonorgestrel (LNG) taken as a single dose of 1.5 mg, or alternatively, LNG taken in 2 doses of 0.75 mg each, 12 hours apart.

33. ULIPRISTAL ACETATE (UPA) Ulipristal acetate (UPA) taken as a single dose of 30 mg Should be taken within 120 hours of sexual exposure

34. YUZPE METHOD COCs, taken as a split dose, one dose of 100 μg of ethinyl estradiol plus 0.50 mg of LNG, followed by a second dose of 100 μg of ethinyl estradiol plus 0.50 mg of LNG 12 hours later. (Yuzpe method)