CONTRACEPTIVE

By
GROUP 2
Ariana Katrin 12310055
Desy Arianti 12310102
Fadliansyah Sutisna 12310151
Lolla Silviani 12310264
Septa Setiawanto 12310430
Vera Farida

Language Center of Malahayati

@2015
A. Case
A 38-year-old G3P3, divorced executive presents to your clinic for
contraceptive advice. She is currently in a monogamous relationship
and has been in it for several months. She denies any allergy. She
occasionally drinks alcohol and smokes half a pack of cigarettes a day.
She mentions that she used to take birth control pills without any
problems. All of her three children were born via vaginal delivery
without complication. She and her boyfriend are sexually transmitted
disease (STD ) free based on their recent checkups. She repots that
she is tired of using over-the-counter contraceptives because they are
inconvenient. She said that her life is very busy because of work. She
fears any form of surgery and has not excluded having another child.
Her laboratory workup is normal. Her physical examination is normal.
She is looking for the best contraceptive method for she situation.

B. Key Words
A 38-year-old
G3P3
Monogamous relationship
Allergy (-)
Drinks alcohol and smokes
She and her boyfriend are sexually transmitted disease (STD )
free
She used to take birth control pills without any problems
All of her three children were born via vaginal delivery without
complication
Her life is very busy because of work
Haboratory workup and physical examination are normal
C. Definition
Birth control, also known as contraception and fertility control, are
methods or devices used to prevent pregnancy. Planning, provision
and use of birth control is called family planning. Birth control methods
have been used since ancient times, but effective and safe methods
only became available in the 20th century. Some cultures limit or
discourage access to birth control because they consider it to be
morally, religiously, or politically undesirable.

D. Analysis
Objective
1. The general objective is to form a small family in
accordance with the socio-economic strength of a family by
way of setting the child's birth, in order to obtain a happy and
prosperous family that can meet their needs.
2.Other objectives include the setting of birth, maturation age
of marriage, increased resilience and well-being of the family.
3. Improving the health and welfare of mothers, children,
families and nations; Reducing the birth rate to raise the
living standard of the people and the nation; Meet the public
demand for quality family planning services, including efforts
to reduce maternal mortality, infant, and child health and
prevention of reproductive health problems.

Classification
1. Simple contraception
a) Condom
How effective are condoms?
How effective any contraceptive is depends on how
old you are, how often you have sex and whether you
 follow the instructions. If 100 sexually active women dont
use any contraception, 80 to 90 will become pregnant in
a year.
What are the advantages of condoms?
- You only need to use them when you have sex.
- They help to protect both partners from some sexually
transmitted infections, including HIV.
- There are no serious side-effects from using
condoms.
- Male condoms come in a variety of shapes and sizes.
- Male condoms are easily available.
- A female condom can be put in any time before sex.

b) Coitus interuptus
c) Natural contraceptive
d) Diafragma
e) Spermicida

2. Hormonal contraception
a) Pill
What is the pill contraceptive?
The Pill contains low doses of 2 hormones an
oestrogen and a progestogen. These are similar to the
hormones naturally produced in the female body. There
are many combined pills available. They differ in the type
and dose of the 2 hormones they contain.

How does the Pill work?

The Pill works by:
preventing ovulation (egg release from the ovary)
thickening mucus in the cervix so sperm cannot enter the
 uterus (womb) changing the lining of the uterus, making
it unsuitable for pregnancy

How effective is the Pill?

The Pill is 99% effective when taken correctly. This
means that if 100 women take the Pill, 1 woman could
become pregnant in a year. It is less effective than this if
not taken according to instructions. The typical
effectiveness rate in studies of women using the Pill is
92%. This rate reflects the fact that the Pill may not
always be taken consistently

b) Contraceptive injection

What is contraceptive injection?

Contraceptive injections contain a progestogen
hormone which is similar to the natural progesterone that
women produce in their ovaries, there are three types of
injection:
- Depo-provera protects you from pregnancy for 12
weeks
- Noristerat protects you from pregnancy for 8 weeks
- Sayana press protects you for 13 weeks

How effective is contraceptive injection?

Depend on how old are you, how often you have sex
and whether you follow the instructions
Contraceptive injections are over 99 percent effective.
The injections is a method of long-acting reversible
contraception (LARC). All LARC is very effective because
while It is being used you do not have to remember to
take or use contraceptions.

How do contraceptive injections work

The main way they work is to stop your ovaries
releasing an egg each month (ovulation). They also:
- Thicken the mucus from your cervix. This makes it
difficult for sperm to move through it and reach an egg
- Make the lining of your uterus (womb) thinner so it is
less likely to accept a fertilised egg.

Can anyone use contraceptive injection?

Most women can have a contraceptive injection.
Some of the condition which may mean you should not
use the injections are:
- Breast cancer within the last 5 years
- Unexplained vaginal bleeding
- Arterial disease or history of serious heart disease or
stroke
- Diabetes with complication
- Disease of the liver
- Risk factor for osteoporosis
- Systemic lupus erymatous

What are the advantages of a contraceptive injection?

- You dont have to think about contraception for as
long as the injection lasts
- You can use it if you are breastfeeding
- They are not affected by other medicines
- It may reduce heavy painful periods and help with
premenstrual symptomps for some women
- It is good method if you cannot use estrogens, like
those in the combined pill, the contraceptive patch
and the contraceptive vaginal ring

What are the disadvantages of a contraceptive injection?

- Your periods may chage in a way that is not
acceptable to you
- Irregular bleeding may continue for some month after
you stop the injections
- Women may put on weight when they use depo-
provera
- The injection works for 12, or 8, or 13, depending on
which type you have it. It cannot be removed from
your bodt, so if you have any side effects, you have to
be prepared for them to conbtinue during this time
and for problem for women who already have risk
factors for osteoporosis
- Women under 18 years old may use depo-provera,
but only after careful evaluation by a doctor or nurse

When can I start using a contraceptive injection?

You can start a contraceptive injection any time in your
menstrual cycle if it is certain that you are not pregnant

Will contraceptive injection affect my periods?

Your periods will probably change
- In most women periods will stop completely
- Some women will have irregular periods or spotting
- Some women will have periods that last longer and
are heavier.
c) Implant

How do they work?

Implants can stop the body from releasing an egg
each month. They also thicken the mucus in the cervix so
that sperm cannot travel up to meet an egg.

The implant works by:

- Preventing ovulation egg release from the ovary
- Thickening of the mucus of the cervix so that sperm
cannot enter the uterus womb
- changing the lining of the uterus, making it unsuitable
for pregnancy

How well does it work?

Implants are more than 99% effective in preventing
pregnancy (this means that only a few women out of a
thousand will get pregnant each year

How is it put in and taken out?

You need to see someone who is trained to insert
and remove implants. A local injection is used to numb
the area. The rods are placed under the skin and
steristrips are used to hold the skin together until the skin
heals. It is removed in the same way. You will have a
small scar from each procedure

Who can use it?

Almost every woman can use it whatever her age. It
is suitable for women who may forget pills, injection
appointments or who may have a medical reason that
stops them using the combined pill

Who should not use it?

- Women who have had breast cancer
- Women who are taking some medications - check
with your doctor if you are taking regular medication

How is it put in and taken out?

You need to see someone who is trained to insert
and remove implants. A local injection is used to numb
the area. The rods are placed under the skin and
steristrips are used to hold the skin together until the skin
heals. It is removed in the same way. You will have a
small scar from each procedure.

What are the advantages?

- Long acting once inserted it will be effective for
several years.
- Easy to use there is nothing to do or remember
once it has been inserted.
- Effective it is extremely effective as a contraceptive.
- Return to fertility rapid return once it is removed
- Does not require daily pill taking
- Or regular injections
- Reversible and rapid return to usual
- Fertility most women ovulate within
- The first month after removal of the
- Implant
- Inexpensive
What are the disadvantages?
- Irregular bleeding, or periods that last longer. This is
quite common especially in the first 6 months and
may last for the whole 5 years. While it can be
annoying, it is not harmful and does not mean the
implant is less effective. There are treatments to
control irregular bleeding so ask Family Planning or
your health professional about it if this is a problem for
you.
- No bleeding periods stop for some women. This is
safe for your body.
- Wound problem you may have bruising.
Occasionally there can be soreness or infection.
- Insertion and removal needs to be done by a trained
health practitioner.
- Difficulty in removing implant occasionally the
implant cannot be easily felt under the skin and you
may need to be referred to someone else to remove
it.
- The research does NOT show that implants cause
any change in weight, mood, headaches or libido

Does it protect you from sexually transmissible infections

(STIs)?
No, you need to use condoms (and lubricant) as well
to protect against Sexually Transmissible infections
(STIs)

What will I notice?

Your periods are likely to change. A few women have
no periods, a few women have their normal periods, but
 most women have a change in bleeding pattern. This
may be infrequent bleeding, frequent bleeding, light
bleeding or heavy bleeding. This is safe for your body,
and there are pills to treat this if it happens. Research
has shown that about one woman in every seven has the
implant removed because of bleeding problems.

What are the possible health benefits of Implant ?

- some women will have no bleeding or minimal
bleeding only
- may reduce painful periods, premenstrual symptoms
PMS and acne in some women

What are the possible side effects of Implant ?

Side effects include:
- headaches
- mood changes
- breast tenderness
- acne
- decreased sexual interest

What are the possible risks associated with Implant ?

The risks associated with include:
- bruising and soreness at the site for to up to 1 to 2
weeks
- a small scar - a small number of women are
predisposed to the development of thickened scars

d) IUD
What Is an IUD?
 The letters IUD stand for "intrauterine device." IUDs
are small, "T-shaped" devices made of flexible plastic. A
health care provider inserts an IUD into a woman's uterus
to prevent pregnancy.
There are two types of IUD available in the United States
copper (ParaGard) and hormonal (Mirena or Skyla).
The ParaGard IUD contains copper. It is effective for 12
years.
The hormonal IUD releases a small amount of progestin.
There are two brands. Mirena is effective for five years.
Skyla is slightly smaller and effective for three years.

How Does an IUD Work?

Both the copper and hormonal IUDs work mainly by
affecting the way sperm move so they can't join with an
egg. If sperm cannot join with an egg, pregnancy cannot
happen.
For some women, hormonal IUDs may prevent the egg
from leaving the ovary. Pregnancy cannot happen if there
is no egg to join with sperm. Progestin also prevents
pregnancy by thickening a woman's cervical mucus. The
mucus blocks sperm and keeps it from joining with an
egg.

How Effective Is the IUD?

Effectiveness is an important and common concern
when choosing a birth control method. IUDs are one of
the most effective forms of birth control available. Less
than 1 out of 100 women will get pregnant each year if
they use an IUD.
Keep in mind that the IUD doesn't protect against
sexually transmitted infections. Use a condom along with
the IUD to reduce the risk of infection.

How Safe Is the IUD?

Most women can use an IUD safely. But all
medications have some risks, so safety is a common
concern when choosing a birth control method. Certain
conditions increase the risk of side effects. Talk with your
health care provider about your health and whether an
IUD is likely to be safe for you. There are many other
methods of birth control that may be safe for you if you
cannot use an IUD.

You should not use an IUD if you :

- have had a pelvic infection following either childbirth
or an abortion in the past three months
- have or may have a sexually transmitted infection or
other pelvic infection
- think you might be pregnant
- have cervical cancer that hasn't been treated
- have cancer of the uterus
- have unexplained bleeding in your vagina
- have pelvic tuberculosis
- have a uterine perforation during IUD insertion

You should not use the ParaGard IUD if you :

- have, or may have, an allergy to copper or have
Wilson's Disease an inherited disease that blocks
the bodys ability to get rid of copper.
You should not use a hormonal IUD if you :
- have severe liver disease
- have, or may have, breast cancer

What are the Benefits of an IUD?

IUDs are some of the least expensive, longest lasting
forms of birth control available to women today. There are
many other benefits.
- IUDs may improve your sex life. There is nothing to
put in place before intercourse to prevent pregnancy.
Some women say that they feel free to be more
spontaneous because they do not have to worry
about becoming pregnant.
- The ParaGard IUD does not change a woman's
hormone levels.
- Hormonal IUDs may reduce period cramps and make
your period lighter. On average, menstrual flow is
reduced by 90 percent. For some women, periods
stop altogether.
- IUDs can be used during breastfeeding.
- The ability to become pregnant returns quickly once
the IUD is removed.

What Are the Disadvantages of an IUD?

It's important to think about the possible side effects of
using an IUD.
You may have :
- mild to moderate pain when the IUD is put in
- cramping or backache for a few days
- spotting between periods in the first 36 months
 - irregular periods in the first 36 months with Mirena
or Skyla
- heavier periods and worse menstrual cramps with
ParaGard
Serious problems with the IUD are rare.
There are three main things to watch out for when
using an IUD:
- The IUD can sometimes slip out of the uterus.
Sometimes it comes all the way out. Sometimes it
only comes out a little. This is more likely to happen to
women who are younger and who have never had a
baby. If the IUD slips out of place, pregnancy can
happen. If it comes out only part of the way, it has to
be removed.
- In rare situations, a woman could develop an infection
when using the IUD. This happens if bacteria get into
the uterus when the IUD is inserted. Most infections
develop within three weeks of having the IUD
inserted. If the infection is not treated, it can affect a
woman's ability to become pregnant in the future.
- In very rare situations, when the IUD is inserted, it can
push through the wall of the uterus. This might sound
painful, but it usually isn't. Usually, when this happens,
the health care provider will notice it and it can be
fixed right away. But if not, the IUD can move around
and harm other parts of the body. When this happens,
surgery may be needed to remove the IUD.

3. Surgery
a) Tubectomy
 What is tubectomy?
Tubectomy can be binding and cutting, can also
Tubektomi for women is also known as tubal occlusion or
sterilization.
Tubektomi has advantages as follows. how relatively
easy, cheap and safe, just need a motivation, once the
action and does not require further scrutiny is ongoing.
The failure rate is low and highly effective in preventing
pregnancy and the fewest side effects.
Types Tubektomi :
- Minilaporatomi is tubal sterilization is performed
through a small suprapubic incision with a length of
usually 3-5 cm. Minilaparotomi is a method of female
sterilization is the most frequently performed
worldwide since keamananya, simplicity, and ease of
adaptation to the surgical environment.
- Laparoscopy is an endoscopic examination of the
inside of the peritoneal cavity by means of a
laparoscope is inserted through the anterior wall of
the abdomen.

Indication :
With a permanent nature, sterilization is only suitable
for couples who do not want more children.
Contraindication:
Contra indications steady contraception in women is a
matter of relationships, disagreements on the operation
of one of the spouses, and illness or disability that may
increase the risk of the operation.

b) Vasectomy
What Is vasectomy?
- Permanent contraception for men who will not want
more children.
- Through a puncture or small incision in the scrotum,
the provider locates each of the 2 tubes that carries
sperm to the penis (vas deferens) and cuts or blocks it
by cutting and tying it closed or by applying heat or
electricity (cautery).
- Also called male sterilization and male surgical
contraception.
- Works by closing off each vas deferens, keeping
sperm out of semen. Semen is ejaculated, but it
cannot cause pregnancy.
How Effective?
One of the most effective methods but carries a small
risk of failure:
- Where men cannot have their semen examined 3
months after the procedure to see if it still contains
sperm, pregnancy rates are about 2 to 3 per 100
women over the first year after their partners have
had a vasectomy. This means that 97 to 98 of every
100 women whose partners have had vasectomies
will not become pregnant.
- Where men can have their semen examined after
vasectomy, less than 1 pregnancy per 100 women
over the first year after their partners have had
vasectomies (2 per 1,000). This means that 998 of
every 1,000 women whose partners have had
vasectomies will not become pregnant.
 What contraceptive options are avaible to this women?
The options to this women are:
- Implant
- Condom
- Injections

We suggest to this women to choose implant contraception because

the implant has a prolonged period of time suitable for career women
and has no contraindications to a sexually transmitted diseases
(STDs).

F. Which contraceptive are contraindicated for her?

- Cervix caps
- IUD
- Combination injection

G. Conclusion
We suggest implant to this women, because she fears any form of
surgery and has not excluded having another child and condom to
protect against sexually transmissible infections (STIs).