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 8th to the 21st
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 3rd month, postpartum
 Partial or no breastfeeding: Begin in the 3rd 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.

22. THANK YOU