Methods of contraception and its application , contracindication and importants in popultation.pptx

Contraception is method to prevent sexually transmitted infection and unwanted pregnancy . They are different method available for contraception . Which is highlighted in this presentation

1. Methods of contraception

2. Definition of contraception Intentional prevention of conception or impregnation by interfering with normal process of ovulation, fertilization and implantation through the use of various devices, agents, drugs, sexual practices and surgical procedures.

3. How to be reasonably certain that a woman is not pregnant Ask for the following 3 criteria of LAM The baby is less than 6 months Menstrual period has not returned after last child birth Fully or nearly fully breast fed, fed often day and night, at least 8 – 10 times a day and at least once at night and at least once in 4 hours. Has she abstained from sexual intercourse from her last menstrual period or delivery Has she delivered a baby in the last 4 weeks Is she within 7 days of her last menstrual period Did she has a miscarriage in the last 7 days Has she been using any reliable contraceptives correctly and consistently

4. If her answers are negative for all these questions then pregnancy can’t be ruled out. If her answer is positive to at least one of these questions then pregnancy can be reasonably ruled out.

5. Birth control methods Methods Behavioral Abstinence LAM Rhythm method Fertility awareness Withdrawal technique Barrier and/or spermicidal methods Female methods --- cervical cap, female condoms , diaphragms, contraceptive sponge Male methods --- male condoms

6. Birth control methods ( contd ) Methods Hormonal methods Combined (E + P) --- pills , patch, injectables, vaginal ring Progestogen only --- pills, injectables , subdermal implants Antioestrogens Ormiloxifene (centchroman) Emergency contraception Levonorgestrel pill, Cu- IUCD, ulipristal, mifepristone Intrauterine device Copper containing (ML-375, CuT-380A) Hormone containing (LNG) - mirena Sterilization Female – tubal ligation Male - vasectomy

7. Oral contraceptives Combined oral contraceptives (COC) Progestogen only pills (POP/minipill) Nonhormonal nonsteroidal contraceptives (centchroman)

8. Combined oral contraceptives (COC) Contains both oestrogen (Ethinyl estradiol ) and progesterone (levonorgestrel, desogestrel etc). Mechanism of action Prevents ovulation Inhibition of sperm migration Creation of unfavourable endometrium Reduce tubal motility How to take the pill – in 21 day pack, the pill should be taken daily starting from D1 to D5 of menstrual period followed by 7 days break when withdrawal bleeding starts. The next pack should be started immediately after 7 days break irrespective of menstrual day. Selection of clients – any woman who wants to use COC can start anytime if it is reasonably certain that she is not pregnant and if there is no contraindication. Failure rate – with consistent use 0.3/HWY and with typical use 9/HWY

9. Side effects Minor Major Changes in menstrual pattern Hypertension Nausea & vomitting MI, CVA Headache, dizziness Gall bladder disease Beast changes - tenderness, heaviness DVT Increase vaginal discharge CA cervix Hyperpigmentation Hepatocellular carcinoma (rare) Weight gain Loss of control in diabetics Mood changes Breast cancer (rare) STD

10. Contraindication Absolute Relative Breast feeding mother (less than 6 months) Cholestatic jaundice Smoker aged more than 35 years Hypertension >140/90 Active liver disease Diabetes mellitus Hypertension >160/110 hyperprolactnaemia Suspected pregnancy Gall bladder disease Undiagnosed genital bleeding Migraine without aura Breast cancer Sickle cell disease Past or present thromboembolic phenomena Obesity DM with vasculopathy Enzyme inducing drugs Thrombophilia, SLE Migraine with aura

11. Progestogen only pills (minipill) Contains only progestogen in the form of levonorgestrel (30µg) and desogestrel (75µg). Mechanism of action Ovulation inhibition Thickening of cervical mucous Unfavourable endometrium Reduce tubal motility How to take the minipill – in case of lactating women, it can be started anytime between 6 weeks and 6 months postpartum. One tablet to be taken daily at the same time without any break. In case of menstruating women, it can be started within 5 days of LMP. (comes in 28 tablet pack) Selection of client – a woman can start using POP anytime if pregnancy can be reasonably ruled out and there is no contraindication Failure rate – consistent use 0.3/HWY and typical use 9/HWY.

12. Side effects Changes in menstrual pattern – prolong postpartum amenorrhea, irregular bleeding, breakthrough bleeding etc. Headache, dizziness Nausea & vomiting Mood changes Breast tenderness Acne Enlarged ovarian follicles or cyst. Severe abdominal pain (suspected ectopic pregnancy)

13. Contraindications Suspected pregnancy Undiagnosed vaginal bleeding Breast cancer Thromboembolic phenomena – DVT, CVA Cardiovascular disease – MI Liver disease Migraine with aura

14. Centchroman Contains Ormiloxifene (SERM) 30mg per tablet Mechanism of action – it makes the endometrium out of phase so that implantation does not take place. How to take – it should be started on D1 of menstrual period and the second tablet after 3 days (weekly 2 tablets) for the first 3 months. Then from 4 th month 1 tablet once a week. Comes in 8 tablets pack. Selection of client – a woman can start using centchroman anytime if pregnancy can be reasonably ruled out and there is no contraindication. It is safe in breast feeding women. Failure rate – 1 to 2 pregnancy/HWY

15. Side effects Delayed or prolonged menstruation Headache Nausea & vomiting Weight gain Hypersensitivity Enlarged ovary

16. Contraindications PCOD Recent history of jaundice Liver impairment Renal disease Pregnancy Ca cervix Hypersensitivity

17. Emergency contraception Definition – it is defined as any drug or device used after unprotected intercourse to prevent unplanned pregnancy. Methods available are Hormonal – COC, POP Mechanical – IUCD Others – Mifepristone, ulipristal, centchroman Mechanism of action – it interferes with ovulation, fertilization or implantation depending upon the time of menstrual cycle. However, it does not interfere if conception has already taken place. Failure rate – POP --- 1 pregnancy/HWY and IUCD --- 1 pregnancy/thousand woman per year

18. EC-Dose information Method Dose Timing after intercourse CuT Single IUCD 0 to 120 hours LNG 1.5mg tablet 0 to 72 hours (best before 12 hours) Yuzpe method High dose COC 0 to 72 hours Mifepristone 10 – 50 mg 0 to 120 hours Ullipristal 30mg 0 to 120 hours

19. Indication of EC Any unprotected sexual exposure Contraceptive accidents Following rape There is no contraindications for emergency contraceptives.

20. Follow up If menstruation is delayed for 3 weeks. Pregnancy to be ruled out Persistent irregular bleeding Lower abdominal pain.

21. Side effects Nausea & vomiting Headache, dizziness Breast tenderness Changes in bleeding pattern Abdominal pain

22. IUCD CuT 380 A, ML-375 and LNG IUD ( mirena ) Mechanism of action Causes chemical change in the sperm that damages them so that sperms cannot fertilse the ova Foreign body reaction in the endometrium which renders it unfavourable for implantation. In case of LNG containing IUCD, the hormone causes endometrial atrophy and thickening of cervical mucous. Selection of client – a woman can start using IUCD anytime if pregnancy can be reasonably ruled out and there is no contraindication. It is safe in breast feeding women. Failure rate – consistent use --- 0.6/HWY and typical use --- 0.8/HWY

23. Time of insertion Menstruating women – within 12 days of LMP After childbirth within 48hours of child birth between 6 weeks to 6 months postpartum After abortion – immediately within 12 days provided there is no infection Technique of insertion – non touch withdrawal method

24. Side effects Immediate Early Late Difficulty in insertion Expulsion PID Vasovagal attack Perforation Pregnancy Uterine cramps Spotting Ectopic pregnancy Perforation Menorrhagia Perforation Dysmenorrhea Menorrhagia Vaginal infection Dysmenorrhea PID

25. Contraindications Absolute Relative Suspected pregnancy Between 48 hours to 6 weeks post partum Puerperal or post abortal sepsis Severe thrombocytopenia Undiagnosed vaginal bleeding Ovarian cancer Genital TB, Ca Cervix, endometrial Ca, GTD HIV infection not on treatment Distortion of uterine cavity (congenital or acquired) Increased risk of STD Current PID Wilson disease Copper allergy

26. PPIUCD PPIUCD insertion refers only to those IUCDs placed during the immediate or early post partum period (within 10 min or upto 48hours of delivery). Does not interfere with breast milk quality Timing of insertion Postplacental – within 10 min of expulsion of placenta Immediate postpartum – between 10 min to 48 hours postpartum Intracaesarean – during CS after removal of placenta before closure of uterus Follow up at 6 weeks along with post partum check up

27. Barrier contraceptives ( male condom) Made of thin latex rubber sheath that covers and fit erect penis. Mechanism of action – forms mechanical barrier between semen and vagina preventing their contact. How to use – it must be used with every sexual act and should be placed before contact of penis with the vagina. Withdrawal must occur with the condom in situ. Spermicidal agents improves efficacy. Failure rate – consistent use --- 2 pregnancy/HWY and typical use --- 18 pregnancy/HWY Contraindication – latex allergy

28. Non contraceptive benefits of male condom Prevents STD Protects from cervical cancer Protects against tubal factor of infertility In condom catheter For covering of TVS probe In vaginoplasty operation over the vaginal mould Postpartum haemorrhage

29. Female sterilisation Involves blocking of both the fallopian tube by surgical method (laparoscopy or minilap ) to prevent fertilisation Suitable for those women who do not desire further children. Counselling and consent must be taken before sterilisation. Technique of tubectomy – modified Pomeroy’s method and application of Fallope’s ring Failure rate – 0.5 pregnancy/HWY in the first year but after 10 years it becomes 2 pregnancy/HWY

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