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CONTRACEPTION
Indications For
Contraception
It aims at spacing pregnancies and choosing the
proper time for conception and childbirth.
Medical Condition
Severe and chronic maternal
Cardiac
Renal
Liver diseases
Methods of Contraception
Physiological Contraception
Barrier Contraception
Intra-Uterine Contraceptive Device (IUD)
Hormonal Contraception
Sterilization (Permanent Contraception)
Methods of Contraception
Physiological Contraception:
Safe period (calendar method)
Coitus interruptus.
Basal body temperature (BBT)
Barrier Contraception:
Mechanical methods:
Condom (male & female latex condoms)
Vaginal diaphragm
Cervical cap.
Chemical methods:
Spermicidals as gel or sponge.
Methods of Contraception
Intra-Uterine Contraceptive Device: (IUD)
Non medicated IUD (Lippes loop)
Medicated IUD (cupper– silver- gold - progesterone)
Hormonal Contraception:
Oral contraceptive pills OCP.
I.M. Injectable contraception.
Subdermal implants.
Contraceptive vaginal ring.
Sterilization: (Permanent Contraception)
Female e.g. Tubal ligation.
Male e.g. vas ligation
Physiological Methods
1. Coitus Interruptus:
It is withdrawal and ejaculation outside the
become irregular.
Can be improved when coupled by the BBT chart or
urinary LH tests.
Physiological Methods
3. Prolonged lactation:
60 % of females do not menstruate while
complications.
Menorrhagia:
Common in the 1st few cycles and may continue
fibrinolytic activity.
Irregular Vaginal Bleeding:
Uterine pathology, Pelvic infection, partial
expulsion.
Complications of IUD
Pelvic Pain:
During or after insertion:
Slight cramping pain is normal.
Severe pain: Disparity in size, Abnormal position,
Perforation, Forcible dilatation.
Backache : Pelvic congestion. Cervicitis. Utero-sacral
ligament.
Acute Abdominal Pain with IUD in place: Abortion, Ectopic
Pregnancy, PID.
Pelvic Infection:
PID, Cervicitis, endometritis, parametritis, salpingitis.
Threads of IUD may carry the organism to inside the
uterus.
Treatment: Antibiotics, then removal of IUD.
Complications of IUD
Vaginal Discharge:
Watery, mucoid → pelvic congestion - cervical erosion.
Mucopurulent → cervicitis → remove IUD + antibiotics.
Vaginitis → treat while IUD in place.
Expulsion:
Usually in the 1st 6 months after insertion.
It may be complete → expelled out the cervix.
It may be incomplete → within the uterus but not
properly placed.
Treatment → Removal and reinsertion of a new IUD.
Complications of IUD
Perforation:
at the time of insertion.
Bleeding and pain may be present
Threads will not felt by the patient.
Pregnancy on IUD:
When the loop is displaced intracervically leaving the fundus
bare and unprotected.
Management includes:
If threads are visible, IUD is removed & pregnancy allowed to
oedema
Cervical mucous become thick and hostile to
sperm penetration
Altered tubal motility and secretions → affect
oocyte transport
Prevent endometrial hyperplasia
Induces cyclic bleeding with excellent cycle control
(Oral Contraceptive Pills (OCP
Progestogen only pills (POPs-MiniPills)
Dose: one tablet daily continuously at the same time,
irrespective of menstruation.
Mode of action: It acts by the contraceptive effect
progestogen (see above)
Higher incidence of menstrual irregularities and ectopic
pregnancy.
Does not affect lactation, therefore may be suitable for
lactating women but progestogen is excreted in milk in
minimal amounts (limits its use).
Advantages of OCPS
Most effective (Failure 0.1-1/HWY)
Excellent cycle control
Cheap and readily available
No long term adverse effects on fertility
No effects on sexual intercourse
Non contraceptive benefits:
Treatment of DUB.
Postponing next menstruation (delaying an expected
cycle).
Treatment of spasmodic dysmenorrhoea.
Associated with less incidence of:
PID
Non neoplastic cysts of the ovary
Endometrial carcinoma
Epithelial ovarian cancer.
Complications of OCPS
1. Menstrual Disturbance:
Spotting: specially midcycle
TTT: continue the cycle & use higher dose of hormones next
cycle
Breakthrough Bleeding similar to menstruation
TTT: stop and on 4th day start new course with higher doses
Hypomenorrhea: gestagens cause glandular atrophy.
Exclude pregnancy.
Stop the pills & shift to another way of contraception.
If not resumed within 3 months (post pill amenorrhea) →
give progesterone to induce withdrawal bleeding then induce
ovulation with clomiphene citrate.
Complications of OCPS
2. Metabolic Effects:
Cardiovascular System:
Headache:
Weight Gain
Acne
May improve
May worsen or appear
Skin Pigmentation: Choloasma similar to pregnancy.
Change in Libido
Vaginal Discharge
Eye Symptoms:
Edema of the cornea
Transient optic nerve ischaemia
Absolute Contraindications for
OCP
Thrombophlebitis or thromoembolic disease.
History of DVT
Coronary heat disease.
Cerebrovascular accidents or strokes.
Benign or malignant Liver disease
Malignancy of the female genital system.
Abnormal genital bleeding
Suspected or known carcinoma of Breast or
History of benign neoplasms of the Breast.
Relative Contraindications for
OCP
Superficial thrombophlebitis
Varicose veins
Migraine headache
Hypertension
Diabetes mellitus.
History of liver disease
Gall bladder stones
Age > 35 years
History of: Pre-eclampsia, Diabetes with pregnancy,
Cholestasis with pregnancy.
Injectable
Contraceptives
Progestin-only Injectables Combined Injectables