Natural contraceptive methods

Gynecology and family planning

1. NATURAL CONTRACEPTIVE METHODS ARYA. K. A

2. CONTRACEPTION Prevention of conception Can be temporary or permanent TEMPORARY CONTRACEPTIVE OPTIONS Hormonal contraception Intrauterine devices Barrier contraception Natural methods

3. NATURAL METHODS Natural family planning methods Coitus interruptus Lactational amenorrhoea method

4. NATURAL FAMILY PLANNING METHODS Also called periodic abstinence Takes into account the natural signs and symptoms of the fertile period and also the viability of the sperm and ovum in the female reproductive tract. Aims at avoiding sexual intercourse around ovulation.

5. Advantages: No side effects. No cost implied. Natural menstruation not affected. Culturally and morally acceptable. Does not need follow up. Disadvantage: Need commitment, motivation, training and the co-operation of both partners. Less effective. Unsuitable for women with irregular cycles. Do not give protection against STDs and HIV.

6. 2 types: Calender based. Symptom based.

7. Calendar-based methods Avoid coitus during the period of maximum fertility. Based on the assumption( Ogino-Knaus theory) that: In a women with regular cycles, ovulation takes place on the 14+/- 2 days before the onset of the next period and that the ovum if not fertilised , seldom survives more than 48-72 hours. If coitus is restricted to10 days prior to menstruation and the first three or four days after, conception is less likely to occur( failure rate is 9-10 per 100 women years).

8. Calendar-based methods Standard days method: Advocates avoiding unprotected intercourse on days 8 through 19 of each cycle. Regular cycles Efficacy reduced even one cycle is out of the 26-32 day range.

9. Rhythm or calendar method: Regular cycles Length of 6 cycles is recorded. Fertile period: Beginning: By subtracting 18 days from the length of the shortest cycle End: By subtracting 11 days from the length of the longest cycle.

10. Women with cycles ranging from 26-32 days: periodic abstinence practiced from the 8 th to the 21 st day. Calculations are to be updated every month always using the 6 most recent cycles.

11. Symptoms-based methods Basal body temperature method(BBT method): Women takes her body temperature at the same time every morning before she gets out of bed or eats anything. Temperature will rise slightly(0.2-0.5C) just after ovulation. Couple are asked to avoid intercourse or use an alternative method of contraception from the first day of the monthly bleeding until 3 days after the temperature rise.

12. Once the fertile period is over, they can have coitus. Failure rate: 11 per 100 women years .

13. Cervical mucus or ovulation or Billing’s method: Cervical mucus changes Women are made aware of the estrogen induced changes in cervical mucus at mid cycle

14. Due to hormonal changes, particularly effect of estrogen on the cervix: Scant and thick preovulatory cervical discharge changes to profuse,transparent , watery, slippery discharge which can be drawn or stretched out into a thread( spinnbarkeit test ) between two fingers- designated as the ‘peak day’ and intercourse is avoided. Failure rate: 3 per 100 women years

15. Symptothermal method: Makes use of atleast two indicators to identify the fertile period. Based on the observation of BBT, spinnbarkeit , midcycle pain, midcycle spotting or bleeding, cervical changes and breast tenderness- Noted in a chart Practice of intercourse same as with the Billing’s method. Failure rate: 2 per 100 woman years

16. Newer methods Special digital thermometers and use of the Rovumeter to note changes in cervical mucus are experimental. PERSONA( Unipath ) consists of dipstick to detect urinary estrone 3-glucuronide which indicates the onset of the fertile period and LH which indicates ovulation.

17. COITUS INTERRUPTUS Withdrawal method Man withdraws his penis from the partner’s vagina and ejaculates outside the vagina, keeping his semen away from her external genitalia. Widely used, but have obvious disadvantages. High failure rate. Needs lot of motivation on the part of male and imposes a lot of strain on the couple.

18. LACTATIONAL AMENORRHOEA METHOD(LAM) Natural effect of breast-feeding on fertility. Lactation: Increased prolactin secretion Inhibits pulsatile secretion of GnRH  inhibits ovulation. Ovary produces very little estrogen and no progesterone. Efficacy depends on the completeness of breast feeding.

19. Rule of 3s for postpartum initiation of contraception : Full breastfeeding: Begin in the 3 rd month, postpartum Partial or no breastfeeding: Begin in the 3 rd week, postpartum

20. Conditions to be satisfied: Mother’s menses has not returned. Full or nearly full breast-feeding Baby less than 6 months old.

21. POST-COITAL DOUCHE Flush out semen immediately after intercourse. High failure rate(ineffective- escae of sperm into the cervical canal before douche. Emotionally disturbing.

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