contraceptive methods - powerpoint presentation for MBBS students- simplified version.

1. CONTRACEPTION
DR. C. K. CHITRA., MBBS., DGO.,

2.  A method or a system which allows intercourse and
yet prevents conception is called a contraceptive
method.
 Temporary/ permenant.
Depends on:
 Availability, cost.
 Age and parity of the couple.
 Reliability (failure rate).
 Side effects, contraindications to a particular
method.
 Advantages and disadvantages.
 Requirement of follow-up.
 Counselling

3. Types
)
Stages of Family
PlanningCounselling
Stage I: General – Counselling
Stage II: Method Specific
Counselling
• Stage III: Follow-Up Counselling
Purpose of counselling
Counselling is a client
centered approach guide
him/her towards
decision making.
COUNSELLING

4. SAFE
INEXPEN
SIVE
EFFE
CTIVE
REVER
SIBLE
REQUIRE
LITTLEOR
NO
MEDICAL
SUPERVISI
ON
ACCEPTABLE
LONG
LASTING
TOAVOID
FREQUENT
ADMINISTR
ATION
INDEPENDANT
OF COITUS
SIMPLE
TO
ADMINIS
TER
IDEAL
CONTRACEPTIVE

5. Temporary methods
INJECTABLES
Oral hormonal pills
1.OCP
2.centchroman(chaaya)
3.EZY PILLS.
4.POP
380A &375
Barrier methods
DMPA(ANTARA)
IUCD&
PPIUCD
Condom,
diaphragm
cervicalcap,
spermicides
Fertility
awareness
methods,
LAM
withdrawal

6. Long acting:
 Three-monthly oral tablets
 Three-monthly IM injections
 Implants
 IUCD
 Surgical methods
Medium acting:
 Weekly
 Monthly injections
Short acting:
 Condoms, barrier methods
 Postcoital pill
 Daily pills
 Skin patches

7. Medical Eligibility Criteria
The Medical EligibilityCriteria (MEC) forms the scientific foundation for client assessment
regarding family planning methods. It gives a detailed guidance regarding whether a
family planning method can safely be given to a woman with a certain medical condition.
The criteria has been adapted and modified according to the Indian situation, based on the
skills, knowledge and availability of resources in the health delivery system.
Four categories for MEC
Category With
Clinical judgme
nt
With Limit
ed clinical
judgment
1. A condition for which there is no restriction for the use of
the contraceptive method.
Use method in
any circumstances
Yes (Use
the Method)
2. A condition where the advantages of using the method
generally outweigh the theoretical or proven risks
Generally use
the method
Yes (Use
the Method)
3. A condition where the theoretical or proven
risks usually outweigh the advantages of using
the method
Use of method not
usually recommended
No
(Do not use
the method)
4. A condition which represents
an unacceptable health risk if
the contraceptive method is used.
Method not to be used No
(Do not
use the
method)

8. Clinical Assessment and Screening
of Clients
Use Screening checklist placed at
Annexure 2 of Reference Manual for
Injectable Contraceptive MPA
Screening checklist, based on the
contraceptive wheel of
GoI 2015 adapted from WHO MEC
2015
1/6/2017 Family Planning Division, Ministry of Health and Family Welfare

9. Four Types of Birth Control
• Hormonal Methods
• Barrier methods
• Surgical Methods
• Behavioral Methods

11. • Combined Oral Contraceptive (COC)
• Progestin-Only Pill (POP)
• Levonorgestrel Emergency
Contraceptive Pill (ECP)
• Injections, patches, Implants
Hormonal
• Centchroman (Ormeloxifene)
Non-
hormonal

12. Hormonal Methods
• Oral Contraceptives
(Birth Control Pill)
• Injections (Depo-Provera)
• Implants (Norplant I & II)
• Vaginal ring

13. HORMONAL CONTRACEPTION-all hormonal birth
control measures act via same mechanism
Inhibiting
ovulation
Changes in
the
endometrium
Cervical
mucus
changes

14. Oral contraceptive
pills (OCP)
• Oral contraceptive made from synthetic hormones
• 97%-99% effective
• Combined pill or mini- pill
• Contains estrogen and progestin
• 21-day or 28-day form
• Monophasic or multiphasic (fewer side effects)

15. GOVERNMENT FREE SUPPLY

16. COC
Combined Oral Contraceptive
Pills (COCs)…
• Available in public sector as free and
ASHA supply (Mala-N)
• In each strip, 21 are hormonal tablets
and 7 non hormonal (iron) tablets
• Each hormonal tablet contains
Levonorgestrel (0.15mg) and
Ethinyl estradiol (30 micrograms)
• Should not be given to breastfeeding
women till 6 months postpartum
•Started within 5 days of starting of
menstruation.
• Once a day at the same time ,everyday

17. Pro’s
• ↓ Acne
• ↓ Hair growth
• ↓Breast cysts
• ↓ Ovarian cysts
• ↓ Ovarian carcinoma
• ↓ Dysmenorrhea
• ↓ Endometrial carcinoma
• ↓ PID
• ↓ Risk of ectopic
pregnancy
• ↓ Anemia
• ↓ Osteoporosis

18. Con’s
• ↑ Risk of CV disease
• ↑ Risk of breast cancer
• ↑ Risk of cervical cancer
• ↑ Risk of thromboembolic
episodes
• ↑ Risk of liver adenoma
• Lipid metabolism disorders
• Nausea
• Depression
• Post-pill amenorrhea
• Weight gain
• Breast tenderness

19. Mini-pill- POP
• Contains only progestin
• All 28 pills in a packet are hormone
tablets (EITHER LEVONORGESTREL
OR DESOGESTREL)
Used continuously 28 days
• Effect: thickens the cervical mucus
and makes the lining of the uterus
less receptive to implantation
• Indicated because of medical reasons
and women breatsfeeding
• Started within 5 days of starting of
menstruation
• Once a day at the same time, everyday
• .

20. ORMELOXIFEN- (CHHAYA)
 NON STEROIDAL, NON-HORMONAL AND ONCE-A WEEK PILL
 Weak estrogenic action on bones but strong anti-estrogenic
action on uterus, breasts
 MOA: Creates asynchrony between developing zygote and
endometrial maturation, which prevents implantation of zygote
 Acts like a selective estrogen receptor modulator (SERM) and
anti-estrogenic effects on uterus
 Safe for breast feeding mothers soon after childbirth
 Can be used safely in conditions where hormonal contraceptives
are not advised
 For initiation: 1st pill is to be taken on 1st day of period (1st day
of bleeding) and the 2nd pill 3 days after-for first 3 months.
 Then once a week from 4th month.

22. EMERGENCY CONTRACEPTIVE PILL (ECP)
• To be taken immediately after
unprotected/accidental intercourse or as soon as
possible within next 3 days (72 hours)
• To be used within 72 hours of unprotected sex -contraceptive
accident like condom rupture or missed pills.)I
 Sooner it is taken, more effective
 Not appropriate as a regular contraceptive method due
to less effective than other contraceptives, chances
of menstrual irregularities
• Do not disrupt an existing pregnancy
• In national program, EC pill contains only progestin -
Levonorgestrel (1.5 mg per tab) and available as free
and ASHA supply (ezy-pill)
• Provides an opportunity for women to start using
a regular contraceptive method.
• All methods of contraception can be initiated on the same
day of EC pill.( CuT/ COC/POP/Inj DMPA).

23. ECP

24. Injectable Contraceptives
• Synthetic hormones resembling the natural female
hormones
Types Injectables Schedule
Progestogen-only
Injectables (POI)
Depot
MedroxyProgesterone
Acetate (DMPA)
3 Monthly
Norethisterone enanthate
(NET-EN)
2 Monthly
1 Monthly
Combined Injectables
Contraceptive (CIC)
Estrogen (usually
ethinylestradiol)
and progesterone
Note: Under National Family Planning Program Injectable MPA is introduced
1/6/2017 Family Planning Division, Ministry of Health and Family Welfare

25. DMPA- ONCE IN 3 Months

26. Mechanism of Action
Thinning of
endometrial
lining
Inhibiting
ovulation
Thickening of
cervical mucus
• Suppressing
mid cycle peaks
of LH and FSH
• Depletion of • High
oestrogen progesterone
and depleted
oestrogen
• Thick mucus
prevents sperm
penetration • Unfavorable for
implantation of
fertilized ovum
1/6/2017 Family Planning Division, Ministry of Health and Family Welfare

27. Benefits
Contraceptive Non Contraceptive
Long term contraceptive benefits. May decrease menstrual cramps and reduce
pre-menstrual syndrome/tension
Easy to use Improves anaemia
Acts for 3 months (grace period of 4 weeks). Reduces the symptoms of endometriosis
Completely reversible: 7-10 months from date Decreases benign breast disease and ov
of last injection cyst
Private and confidential method Helps prevent uterine tumours (fibroids)
Does not interfere with sexual
intercourse/pleasure
Reduces the incidence of symptomatic pelvic
inflammatory disease (PID).
Pelvic examination not required prior to use. Protect against endometrial & ovarian cancer
Reduces sickle-cell crises
Suitable for breast feeding women (after 6
weeks postpartum)
Immediate postpartum (Non Breast Feeding)
and post abortion contraception
Protects against ectopic pregnancy
Minimal drug interactions
Any age or parity if they are at risk of
pregnancy
1/6/2017 Family Planning Division, Ministry of Health and Family Welfare

28. Eligibility Criteria
• MPA is safe in women who:
Are of any age, including adolescents and women over 45
years old.
Have or have not had children.
Are unmarried.
Have just had an abortion or miscarriage.
Are smoker, regardless of age.
Are breastfeeding (starting 6 weeks after child birth).
Are at risk of STI/ HIV infection.
Are infected with HIV, whether or not on antiretroviral therapy
1/6/2017 Family Planning Division, Ministry of Health and Family Welfare

29. MPA is not recommended for the
woman
• Breastfeeding woman less than six weeks
postpartum,
• Blood pressure 160/100 mm Hg or more,
• Unexplained vaginal bleeding etc (Category
IV as per WHO MEC).
1/6/2017 Family Planning Division, Ministry of Health and Family Welfare

30. SIDE EFFECTS
• Extremely irregular menstrual bleeding and
spotting for 3-6 months!
• NO PERIOD  after 3-6 months
• Weight change
• Breast tenderness
• Mood change
*not every woman has side-effects!

31. Intrauterine Devices (IUD)
• T-shaped object placed in the
uterus to prevent pregnancy
• Must be on period during
insertion
• A Natural childbirth required to
use IUD
• Extremely effective without using
hormones > 97 % and with
hormones- 99 %
• IUCD can be
• Plain
• Copper
• Silver
• Hormones.

34. What are the most cu ( IUD ) used today ?
Today two types of cu IUD are used mostly
Multiload (left) and cupper T (right) :

35. Inverted U shaped device
3.5 cm long and 1.8 cm wide with 5 stubs on each
side on the ‘U’
Only vertical stem is wound with copper wire 375
sq.mm / nylon threads
5 years from the day of insertion,
Both IUCD 380 A and IUCD 375 have the same
mechanism of action. • Copper ions decrease sperm
motility and function by altering the uterine and
tubal fluid environment, thus preventing sperm
from reaching the fallopian tubes and fertilizing the
egg (Rivera et al. 1999) •The device stimulates
foreign body reaction in the endometrium that
releases macrophages and prevents implantation
T shaped device
Dimensions 3.6 cm long and 3.2 cm
wide
CopperWireVertical stem and
horizontal arms are wound with
copper wire
Surface Area of Copper 380 sq. mm
Material of the Strings Polyethylene
strings Monofilament
Duration 10 years from the day of
insertion
INTRAUTERINECONTRACEPTIVE DEVICE
Cu-T380A
Cu-T375

36. Types of IUCD Insertion
After informed consent from the client, the IUCD can be inserted by trained providers in:
1.EXTENDED POSTPARTUM/INTERVAL IUCD: women who return for postpartum
care at 6 weeks or later, can receive the IUCD.The technique of insertion and the
related precautions are the same as for regular IUCD insertion.
2.POSTPLACENTAL IUCD the IUCD is held in a suitably long forceps without a lock (eg.
PPIUCD Insertion forceps).The instrument is inserted up to the fundus of the uterus, and the
IUCD is released.
3. INTRA CESAREAN IUCD:IUCD is introduced through the uterine incision during a caesaren
section and placed at the uterine fundus.This is done manually or using a regular ring forceps
(sponge holding forceps), since it is not necessary to use a long instrument to reach the fundus.
4.POSTPARTUMWITHIN 48 hours: the IUCD is inserted within 48 hours following the birth of
the baby.The trained provider can insert the IUCD in a procedure or examination room in the
postpartum ward using PPIUCD insertion forceps.
5.(POSTABORTION IUCD). - After SurgicalAbortion: Immediately or within 12 days of an
abortion procedure, after ensuring that the abortion is
complete (there are no retained products of conception) and infection and injury to the genital
tract are ruled out or resolved
• After Medical Method of Abortion: Around day 15 of MMA (follow up/
3rd scheduled visit for medical method of abortion), provided the abortion process is complete
and evidence of infection is ruled out

37. IUD Contraindications
• Pregnancy or past ectopic history
• Undiagnosed irregular bleeding
• Current or suspected pelvic or vaginal infection
• HIV or immunosuppressive therapy
• Distorted scarred uterine cavities
• Small uterus 5.5cm

38. Possible side-effects
After insertion:
• Some cramps
for several
days
• Some spotting
for a few weeks
 Other common side-
effects:
• Longer and
 heavier periods
• Bleeding or spotting
between periods
• More cramps or
pain during
periods
May get less after a few
months
How would you feel
about these side-
effects?
If you choose this method, you may have some side-effects.
They are not usually signs of illness.

39. • The LNG IUS is made of flexible
plastic
• The LNG IUS contains a progestin hormone
called levonorgestrel which has been used in
birth control pills since the 1970s.
• Not available in government setup.
PROGESTASERT( 38mg/ 65 µg ) yearly
LEVONOVA ( 60mg/ 20 µg ) 5 years
MIRENA ( 53 mg / 20 µg ) 5years
Levonorgestrel Intrauterine system

40. Mirena: Theoretical Mechanism
of Action
• Cervical mucus
thickened
• Sperm motility and
function inhibited
• Endometrial effects
• Ovulation inhibited
(in some cycles)
Jonsson B et al. Contraception1991;43:447-458.
Nilsson CG et al. Fertil Steril 1984;41:52-55.
Videla-Rivero L et al. Contraception 1987;36:217-226.

41. LNG IUS ENDOMETRIAL
EFFECTS
Days of the menstrual cycle Days of the menstrual cycle

42. Contraceptive patch
• Transdermal delivery system
• Effect: same as OCP
• Application: stuck on skin every week
• Side effects: same as OCP, greater risk (con)
• Pro: better compliance

43. The Patch

44. IMPLANTS
• Physically inserted in simple 15 minute outpatient
procedure
• Plastic capsules the size of paper matchsticks inserted
under the skin in the arm
• 99.5% effectiveness rate

45. Norplant-1 Implant

46. Contraceptive implants
• Slow release of a progestin
over a period of five years(
each rod- 36mg/ 85µg)
• Effect: prevents the release of
the egg from the ovary
(ovulation); promotes thick
cervical mucus
• Application: inserted in the
upper arm under local
anesthesia
• Side effects: irregular
bleeding
• Pro: fertility rapidly returns

47. Implanon
• Contains 68 mg etonogestrel
• Single rod implanted subdermally on day 1-5 of
cycle
• Last for 3 years.
• Works by thickening cervical mucus and also
inhibits ovulation
• Extremely effective in pregnancy prevention >
99%
• Irregular bleeding common side effect

48. NuvaRing–The Ring92% -99%

49. Vaginal Ring (NuvaRing)
• 95-99% Effective A new ring is inserted into the vagina each
month
• Does not require a "fitting" by a health care provider/ self
insertion/ removed after 3 weeks/ 20 micro progesterone
• does not require spermicide, can make periods more regular and
less painful,
• no pill to take daily, ability to become pregnant returns quickly
when use is stopped.

50. How Often Do You Take It?
Method Frequency
Pills Every day

51. How Often Do You Take It?
Method Frequency
Pills Every day
Patch Once a week

52. How Often Do You Take It?
Method Frequency
Pills Every day
Patch Once a week
Ring Once a month

53. How Often Do You Take It?
Method Frequency
Pills Every day
Patch Once a week
Ring Once a month
Injection Every 3 months*
Implant (Implanon®) Every 3 years*

54. How Often Do You Take It?
Method Frequency
Pills Every day
Patch Once a week
Ring Once a month
Injection Every 3 months*
Implant Every 3 years*
IUD Every 5 years*/ 10 years

55. BARRIER METHODS
• Spermicides
• Male Condom
• Female Condom
• Diaphragm
• Cervical Cap

56. SPERMICIDES
• Chemicals kill sperm in the vagina
• Different forms:
-Jelly -Film
-Foam -Suppository
• Some work instantly, others require pre-insertion
• Only 76% effective (used alone), should be used in combinationwith
another method i.e., condoms

57. Foam
• 80-85% effective
• Works immediately
• Effective for an hour
• Over the counter
• No douching for 6 hours after
intercourse
• 20% have burning (reaction)

58. Film
• 80-85% effective
• Works 10 min after
insertion
• Effective for an hour
• Over the counter
• No douching for 6 hours
after intercourse
• 20% have burning
(reaction

59. MALE CONDOM
• Perfect effectiveness rate = 97%
• Typical effectiveness rate = 88%
• Latex and polyurethane condoms are
available
• Combining condoms with spermicides
raises effectiveness levels to 99%

60. Female Condom
• 95% effective
• Protects against some STDs
• Noisy
• Use extra lubrication

61. Proper Use and Placement
of a Female Condom
Copyright © 2010 Pearson Education, Inc.

62. DIAPRAGHM
• Perfect Effectiveness Rate = 94%
• Typical Effectiveness Rate = 80%
• Made out of LATEX
• Spermicidal jelly before insertion
• Placed in the vagina covering the os.
• Inserted up to 18 hours before intercourse and can
be left in for a total of 24 hours

63. DIAPHRAGM
The diaphragm is a flexible rubber cup that is filled with
spermicide and self-inserted over the cervix prior to
intercourse. The device is left in place several hours
after intercourse. The diaphragm is a prescribed device
fitted by a health care professional and is more
expensive than other barrier methods, such as condoms

64. Proper Use and Placement
of a Diaphragm
Copyright © 2010 Pearson Education, Inc.

65. CERVICAL CAP
• Latex barrier inserted in vagina before intercourse
• “Caps” around cervix with suction
• Fill with spermicidal jelly prior to use
• Can be left in body for up to a total of 48 hours
• Must be left in place six hours after sexual
intercourse
• Perfect effectiveness rate = 91%
• Typical effectiveness rate = 80%

66. Cervical Cap
The cervical cap is a flexible rubber cup-like device that is filled with
spermicide and self-inserted over the cervix prior to intercourse. The
device is left in place several hours after intercourse. The cap is a
prescribed device fitted by a health care professional and can be more
expensive than other barrier methods, such as condoms.

67. Sponge
The sponge is inserted by the woman into the vagina and covers the
cervix blocking sperm from entering the cervix. The sponge also
contains a spermicide that kills sperm. It is available without a
prescription

68. METHODS BASED ON
FERTILITY
INFORMATION
• Abstinence
• Withdrawal
• Calender Method/ Rhythm
avoiding the ovulation
period.

69. Behavioral Methods
• Withdrawal: removing the penis from the vagina
just before ejaculation
• Abstinence or outercourse (kissing, hugging,
touching)
• Fertility awareness
– Cervical mucus method
– Body temperature method
– Calendar method

70. Female and Male
Sterilization
Copyright © 2010 Pearson Education, Inc.
Procedure performed on a
man or a woman
permanently sterilizes
Female = Tubal Ligation
Male = Vasectomy

71. TUBAL LIGATION
• Surgical procedure performed on a woman
• Fallopian tubes are cut, tied, cauterized, prevents eggs from reachingsperm
• Failure rates vary by procedure, from 0.8%-3.7%
• May experience heavier periods
Surgical sterilization which
permanently prevents the
transport of the egg to the uterus
by means of sealing the fallopian
tubes is called tubal ligation,
commonly called "having one's
tubes tied." This operation can be
performed laparoscopically or in
conjunction with a Cesarean
section, after the baby is delivered.
Tubal ligation is considered
permanent, but surgical reversal
can be performed in somecases

72. Laparoscopy-’band-aid’sterilization

73. vasectomy
• Ligation of Vas Deferens tube
• Faster and easier recovery than a tubal ligation
• Failure rate = 0.1%, more effective than
female sterilization

74. During a vasectomy (“cutting the vas”) a urologist cuts
and ligates (ties off) the ductus deferens. Sperm are still
produced but cannot exit the body. Sperm eventually
deteriorate and are phagocytized. A man is sterile, but
because testosterone is still produced he retains his sex
drive and secondary sex characteristics.