6. Family Planning Method: Types
• Rhythm (Calendar) method
• Basal Body Temperature (BBT) Method
• Ovulation or Cervical Mucus Method
• Symptothermal method
• Coitus Interrupts
• Lactation Amenorrhea Method (LAM)
A. Natural
Method
• Barrier Method
• Hormonal Method
• Intrauterine Devices
• Post-coital Method
B. Temporary
Method
• Male Sterilization
• Female Sterilization
C. Permanent
Method
2/20/2023 Reena Bhagat 6
7. A. Natural( Traditional) Method
No introduction of chemical of foreign material into the
body.
Practice may be due to religious belief, ―natural‖ way is
best for them.
Effectiveness varies greatly, depends on couple‘s ability
to refrain from having intercourse on fertile days.
Effective in women whose menstrual cycle is regular..
(28-32 days).
2/20/2023 Reena Bhagat 7
8. 1. Rhythm (Calendar) method
• Also called fertility awareness method.
• ―Fertility awareness‖ means that a woman knows how to
tell when the fertile time of her menstrual cycle starts and
ends.
• Sometimes called periodic abstinence or natural family
planning.
• Calendar-based methods involve keeping track of days of
the menstrual cycle to identify the start and end of the
fertile time. – Examples: Standard Days Method, which
avoids unprotected vaginal sex on days 8 through 19 of
the menstrual cycle, and calendar rhythm method.
2/20/2023 Reena Bhagat 8
10. How to calculate??
Example: If she has 6 menstrual cycles ranging from 25 to
29 days, fertile period would be from 7th day (25- 18) to the
18thday (29-11). i.e. 7th day- 18th day
• So, to calculate fertility phase:
• Subtract 18 from shortest cycle and 11 from the longest one
• * 25- 18= 7 (infertile phase)
• * 29-11= 18 (post -ovulatory infertile phase)
•
To avoid pregnancy, avoid coitus/use contraceptive
during those days.
2/20/2023 Reena Bhagat 10
11. 2. Basal Body Temperature (BBT)
- Identifying fertile and infertile period of a woman‘s
cycle by daily taking and recording of the rise in body
temperature during and after ovulation.
- At time of ovulation, as a result of increase in her BBT
0.3- 0.60C i.e. ( 0.5-1 0F) rises a full degree (influence
of progesterone).
DISADVATAGES
- NOT reliable method of birth control, especially for
women with irregular cycles.
2/20/2023 Reena Bhagat 11
13. 3. Ovulation or Cervical Mucus Method
- Cervical mucus, is a fluid produced by small glands
near the cervix. This fluid changes throughout her
cycle, from scant and sticky, to cloudy and thick.
• Cervical Mucus/Ovulation
- During the peak of fertility, The consistency of
ovulation mucus is like that of an egg white and it can
be stretched between the fingers.
- After the ovulation, the mucus tends to dry up again.
These are also safe days.
2/20/2023 Reena Bhagat 13
15. Symtothermal Method
• Combines the cervical mucus and BBT methods.
Watches temp. daily and analyzes cervical mucus
daily.
• Watch for midcycle abdominal pain. Couple must
abstain from intercourse until 3 days after rise in
temp. or 4th day after peak of mucus change.
• More effective than BBT or CM method alone.
- Ideal Failure rate: 2%
2/20/2023 Reena Bhagat 15
17. 5. Coitus Interrupts Method
One of oldest known
methods of voluntary
contraception.
Couple proceeds with
coitus until the moment
of ejaculation which
offers little protection, i.e
withdrawal of penis just
before ejaculation.
Effectivity: 75%
2/20/2023 Reena Bhagat 17
18. 6. LactationAmenorrhea Method(LAM)
LAM: Natural birth control
technique based on the fact that
lactation (breast milk production)
causes amenorrhea (lack of
menstruation).
• How it works:
Breastfeeding interferes with the
release of the hormones needed
to trigger ovulation.
2/20/2023 Reena Bhagat 18
19. Contd..
• The lactational amenorrhea method (LAM) requires 3
conditions. All 3 must be met:
1. The mother‘s monthly bleeding has not returned.
2. The baby is fully or nearly fully breastfed and is fed
often, day and night.
3. The baby is less than 6 months old.
Works primarily by preventing the release of eggs from
the ovaries (ovulation). Frequent breastfeeding
temporarily prevents the release of the natural hormones
that cause ovulation.
2/20/2023 Reena Bhagat 19
21. How Effective?
• Effectiveness depends on the user: Risk of pregnancy is
greatest when a woman cannot fully or nearly fully
breastfeed her infant.
• As commonly used, about 2 pregnancies per 100 women
using LAM in the first 6 months after childbirth.
• When used correctly, less than 1 pregnancy per 100
women using LAM in the first 6 months after childbirth.
• Return of fertility after LAM is stopped: Depends on
how much the woman continues to breastfeed
• Protection against sexually transmitted infections: None
2/20/2023 Reena Bhagat 21
23. 1. Barrier Methods
A. Mechanical
Condoms (male and female)
Diaphragm
Cervical cap
B. Chemical
Spermicidal
Sponge
2/20/2023 Reena Bhagat 23
24. A. Mechanical Methods
Work by forming a barrier that keeps sperm out of
the vagina, preventing pregnancy.
Condoms( both male and female) are the only
contraceptive method that can protect against both
pregnancy and sexually transmitted infections.
2/20/2023 Reena Bhagat 24
26. 1.Condoms( Male)
Sheaths, or coverings, that fit over a man‘s erect penis.
Also called rubbers, ―raincoats,‖ ―umbrellas,‖ skins,
prophylactics; known by many different brand names.
Most are made of thin latex rubber. Male condoms also
are made from other materials, including polyurethane,
polyisoprene, lambskin, and nitrile.
Work by forming a barrier that keeps sperm out of the
vagina, preventing pregnancy.
Also keep infections in semen, on the penis, or in the
vagina from infecting the other partner.
2/20/2023 Reena Bhagat 26
27. Male condoms help
protect against
sexually transmitted
infections, including
HIV.
Condoms are the
only contraceptive
method that can
protect against both
pregnancy and
sexually transmitted
infections.
2/20/2023 Reena Bhagat 27
28. How Effective??
Effectiveness depends on the user: Risk of pregnancy or
sexually transmitted infection (STI) is greatest when
condoms are not used with every act of sex.
As commonly used, about 13 pregnancies per 100
women whose partners use male condoms over the first
year.
When used correctly with every act of sex, about 2
pregnancies per 100 women whose partners use male
condoms over the first year.
Return of fertility after use of condoms is stopped: No
delay
2/20/2023 Reena Bhagat 28
29. Contd..
Protection against HIV and other STIs:
Male condoms significantly reduce the risk of
becoming infected with HIV when used correctly with
every act of vaginal or anal sex.
When used consistently and correctly, condom use
prevents 80% to 95% of HIV transmission that would
have occurred without condoms.
Protect best against STIs spread by discharge, such as
HIV, gonorrhea, and chlamydia. – Also protect against
STIs spread by skin-to-skin contact, such as herpes and
human papillomavirus.
2/20/2023 Reena Bhagat 29
30. Side effects: None
Known Health Benefits
Help protect against:
Risks of pregnancy
STIs, including HIV May
help protect against:
Conditions caused by STIs:
Recurring pelvic
inflammatory disease and
chronic pelvic pain
Cervical cancer
Infertility (male and female)
Known Health Risks
Extremely rare:
• Severe allergic reaction
(among people with
latex allergy)
2/20/2023 Reena Bhagat 30
31. Condoms( Female)
Sheaths, or linings, that fit loosely inside a woman‘s
vagina, made of thin, transparent, soft film.
Have flexible rings at both ends
– One ring at the closed end helps to insert the condom
– The ring at the open end holds part of the condom outside
the vagina
Female condoms are made of various materials, such as
latex, polyurethane, and nitrile.
Work by forming a barrier that keeps sperm out of the
vagina, preventing pregnancy. Also helps to keep infections
in semen, on the penis, or in the vagina from infecting the
other partner.
2/20/2023 Reena Bhagat 31
33. How Effective??
Effectiveness depends on the user: Risk of pregnancy or
sexually transmitted infection (STI) is greatest when
female condoms are not used with every act of sex. Few
pregnancies or infections occur due to incorrect use,
slips, or breaks.
Protection against pregnancy:
As commonly used, about 21 pregnancies per 100 women
using female condoms over the first year.
When used correctly with every act of sex, about 5
pregnancies per 100 women using female condoms over
the first year.
2/20/2023 Reena Bhagat 33
34. Contd..
Return of fertility after use of female condom is stopped: No
delay
Protection against HIV and other STIs:
Female condoms reduce the risk of infection with STIs,
including HIV, when used correctly with every act of sex.
Side effects: None
Known Health Benefits Help protect against:
Risks of pregnancy
STIs, including HIV
Known Health Risks: None
2/20/2023 Reena Bhagat 34
35. 2. Diaphragms
oA soft latex cup that covers the cervix. Plastic and
silicone diaphragms may also be available.
oThe rim contains a firm, flexible spring that keeps the
diaphragm in place.
oUsed with spermicidal cream, jelly, or foam to improve
effectiveness.
oMost diaphragms come in different sizes and require
fitting by a specifically trained provider.
oWorks by blocking sperm from entering the cervix;
spermicide kills or disables sperm. Both keep sperm
from meeting an egg.
2/20/2023 Reena Bhagat 35
36. How Effective??
Effectiveness depends on the user: Risk of pregnancy is
greatest when the diaphragm with spermicide is not used
with every act of sex.
As commonly used, about 17 pregnancies per 100
women using the diaphragm with spermicide over the
first year.
When used correctly with every act of sex, about 16
pregnancies per 100 women using the diaphragm with
spermicide over the first year.
Return of fertility after use of the diaphragm is
stopped: No delay
2/20/2023 Reena Bhagat 36
38. Diaphragms
Protection against STIs:
May provide some
protection against
certain STIs but should
not be relied on for STI
prevention
Side Effects: Some users
report the following:
Irritation in or around
the vagina or penis
Other possible physical
changes: Vaginal lesions
2/20/2023 Reena Bhagat 38
39. Contd..
• Insert the diaphragm less than 6 hours before having
sex
• Leave the diaphragm in place at least 6 hours after
having sex but no longer than 24 hours.
• Leaving the diaphragm in place for more than one day
may increase the risk of toxic shock syndrome. It can
also cause a bad odor and vaginal discharge. (Odor and
discharge go away on their own after the diaphragm is
removed.
2/20/2023 Reena Bhagat 39
40. Contd..
Known Health Benefits
Help protect against:
Risks of pregnancy
May help protect against:
Certain STIs (chlamydia,
gonorrhea, pelvic
inflammatory disease,
trichomoniasis)
Cervical precancer and
cancer
Known Health Risks
Common to uncommon:
Urinary tract infection
Uncommon:
Bacterial vaginosis
Candidiasis
Rare:
Frequent use of nonoxynol-9
may increase risk of HIV
infection
Extremely rare: Toxic shock
syndrome
2/20/2023 Reena Bhagat 40
41. 3. Cervical Cap
• A soft, deep, latex or
plastic rubber cup that
snugly covers the cervix.
• Comes in different sizes;
requires fitting by a
specifically trained
provider.
2/20/2023 Reena Bhagat 41
42. How effective?
Effectiveness depends on the user: Risk of pregnancy is
greatest when the cervical cap with spermicide is not
used with every act of sex.
Women who have given birth: One of the least
effective methods, as commonly used.
As commonly used, about 32 pregnancies per 100
women using the cervical cap with spermicide over the
first year.
When used correctly with every act of sex, about 26
pregnancies per 100 women using the cervical cap over
the first year.
2/20/2023 Reena Bhagat 42
43. Contd..
More effective among women who have not given
birth:
As commonly used, about 16 pregnancies per 100
women using the cervical cap with spermicide over the
first year.
When used correctly with every act of sex, about 9
pregnancies per 100 women using the cervical cap over
the first year.
Return of fertility after use of cervical cap is stopped:
No delay
Protection against sexually transmitted infections: None
2/20/2023 Reena Bhagat 43
44. Contd..
• Insert the cervical cap any time up to 42 hours before
having sex.
Removing
• Leave the cervical cap in for at least 6 hours after her
partner‘s last ejaculation, but not more than 48 hours
from the time it was put in.
• Leaving the cap in place for more than 48 hours may
increase the risk of toxic shock syndrome and can
cause a bad odor and vaginal discharge.
2/20/2023 Reena Bhagat 44
45. Barrier Methods: Mechanical
Advantages:
o Comparatively Inexpensive
oDo not require medical consultation
Disadvantages:
oDemonstration by trained person needed for proper
use.
oFailure most common- due to displacement of device
oCervicitis( inflammation of cervix) & local irritation
2/20/2023 Reena Bhagat 45
47. Spermicides
• Sperm-killing substances inserted deep in the vagina,
near the cervix, before sex.
• Nonoxynol-9 is most widely used. Others include
benzalkonium chloride, chlorhexidine, menfegol,
octoxynol-9, and sodium docusate.
• Available in foaming tablets, melting or foaming
suppositories, cans of pressurized foam, melting film,
jelly, and cream.
• Work by causing the membrane of sperm cells to break,
killing them or slowing their movement. This keeps
sperm from meeting an egg.
2/20/2023 Reena Bhagat 47
48. How Effective?
• Effectiveness depends on the user: Risk of pregnancy is
greatest when spermicides are not used with every act
of sex.
• One of the least effective family planning methods.
• As commonly used, about 21 pregnancies per 100
women using spermicides over the first year.
• When used correctly with every act of sex, about 16
pregnancies per 100 women using spermicides over the
first year.
• Return of fertility after spermicides are stopped:
No delay
2/20/2023 Reena Bhagat 48
49. Contd…
• Protection against sexually transmitted infections
(STIs): None. Frequent use of nonoxynol-9 may
increase risk of HIV infection.
• All women can safely use spermicides except those
who:
Are at high risk for HIV infection
Have HIV infection
• Side Effects: Some users report the following:
Irritation in or around the vagina or penis
Other possible physical changes: Vaginal lesions
2/20/2023 Reena Bhagat 49
50. Contd..
Known Health Benefits
Help protect against:
Risks of pregnancy
Known Health Risks
Uncommon:
Urinary tract infection,
especially when using
spermicides 2 or more
times a day
Rare:
Frequent use of
nonoxynol-9 may increase
risk of HIV infection
2/20/2023 Reena Bhagat 50
51. Vaginal contraceptive sponge (widely
available as Today)
The sponge is a doughnut-
shaped device
Made of soft foam coated with
spermicide, (polyurethane with
1gm of nonoxynol-9) as a
spermicide.
It releases spermicide during
coitus, absorbs ejaculate and
blocks the entrance of cervical
canal.
2/20/2023 Reena Bhagat 51
54. a. Combined Oral Contraceptives( COCs)
• Pills that contain low doses of 2 hormones—a
progestin and an estrogen—like the natural hormones
progesterone and estrogen in a woman‘s body.
• Combined oral contraceptives (COCs) are also called
―the Pill,‖ low-dose combined pills, OCPs, and OCs.
• Work primarily by preventing the release of eggs from
the ovaries (ovulation).
2/20/2023 Reena Bhagat 54
55. Contd..
• Commonly available as
‗Nilocon White’ or
‗Gulaf’.
• Its one cycle contains 21
hormonal tablets and 7
Iron tablets.
• The composition of each
white colored tablet
contains Levonorgestrel
0.15 mg, Eithinyl Estradiol
0.03 mg and each brown
tablet contains Ferrous
Fumarate 75 mg.
2/20/2023 Reena Bhagat 55
56. How Effective?
• Effectiveness depends on the user: Risk of pregnancy is
greatest when a woman starts a new pill pack 3 or more
days late, or misses 3 or more pills near the beginning or
end of a pill pack.
• As commonly used, about 7 pregnancies per 100 women
using COCs over the first year.
• When no pill-taking mistakes are made, less than 1
pregnancy per 100 women using COCs over the first
year (3 per 1,000 women).
• Return of fertility after COCs are stopped: No delay
• Protection against sexually transmitted infections (STIs):
None
2/20/2023 Reena Bhagat 56
57. Contd..
Side Effects: Some users report the following:
• Changes in bleeding patterns, including:
Lighter bleeding and fewer days of bleeding – Irregular
bleeding – Infrequent bleeding – No monthly bleeding
• Headaches
• Dizziness
• Nausea
• Breast tenderness
• Weight changes
• Mood changes
2/20/2023 Reena Bhagat 57
58. Contd..
• Acne (can improve or worsen, but usually improves)
• Other possible physical changes: Blood pressure
increases a few points (mm Hg). When increase is due to
COCs, blood pressure declines quickly after use of
COCs stops.
Known Health Benefits
• Help protect against:
oRisks of pregnancy
oCancer of the lining of the uterus (endometrial cancer)
oCancer of the ovary
oSymptomatic pelvic inflammatory disease
2/20/2023 Reena Bhagat 58
59. Contd..
• May help protect against:
oOvarian cysts
oIron-deficiency anemia
• Reduce:
oMenstrual cramps
oMenstrual bleeding problems
oOvulation pain
oExcess hair on face or body
oSymptoms of polycystic ovarian syndrome (irregular
bleeding, acne, excess hair on face or body)
oSymptoms of endometriosis (pelvic pain, irregular
bleeding)
2/20/2023 Reena Bhagat 59
60. Contd..
Known Health Risks
Very rare:
• Blood clot in deep veins of legs or lungs (deep vein
thrombosis or pulmonary embolism)
Extremely rare:
• Stroke
• Heart attack
2/20/2023 Reena Bhagat 60
61. b. Progestin Only Pills(POPs)
Pills that contain very low doses of a progestin like the
natural hormone progesterone in a woman‘s body.
Do not contain estrogen, and so can be used throughout
breastfeeding and by women who cannot use methods with
estrogen.
Progestin-only pills (POPs) are also called ―minipills‖ and
progestin-only oral contraceptives.
Work primarily by:
Thickening cervical mucus (this blocks sperm from meeting
an egg)
Disrupting the menstrual cycle, including preventing the
release of eggs from the ovaries (ovulation)
2/20/2023 Reena Bhagat 61
62. How Effective?
Effectiveness depends on the user: For women who have
monthly bleeding, risk of pregnancy is greatest if pills
are taken late or missed completely.
Breastfeeding women:
As commonly used, about 1 pregnancy per 100 women
using POPs over the first year.
When pills are taken every day, less than 1 pregnancy
per 100 women using POPs over the first year (3 per
1,000 women).
2/20/2023 Reena Bhagat 62
63. Contd..
Less effective for women not breastfeeding:
As commonly used, about 7 pregnancies per 100 women
using POPs over the first year.
When pills are taken every day at the same time, less
than 1 pregnancy per 100 women using POPs over the
first year (3 per 1,000 women).
• Return of fertility after POPs are stopped: No delay
• Protection against sexually transmitted infections
(STIs): None
2/20/2023 Reena Bhagat 63
64. Contd..
Side Effects: Some users report the following:
• Changes in bleeding patterns, including:
For breastfeeding women, longer delay in return of
monthly bleeding after childbirth (lengthened
postpartum amenorrhea) – Frequent bleeding – Irregular
bleeding – Infrequent bleeding – Prolonged bleeding –
No monthly bleeding.
Breastfeeding also affects a woman‘s bleeding patterns.
• Headaches
• Dizziness
• Mood changes
2/20/2023 Reena Bhagat 64
65. Contd..
• Breast tenderness
• Abdominal pain
• Nausea
• Other possible physical changes: For women not
breastfeeding, enlarged ovarian follicles
• Known Health Benefits: Help protect against: Risks
of pregnancy
• Known Health Risks: None
2/20/2023 Reena Bhagat 65
66. Progestin-Only Injectables( Depo Provera)
oThe injectable contraceptives depot medroxyprogesterone
acetate (DMPA) and norethisterone enanthate (NET-EN)
each contain a progestin like the natural hormone
progesterone in a woman‘s body.
oDo not contain estrogen, and so can be used throughout
breastfeeding, starting 6 weeks after giving birth, and by
women who cannot use methods with estrogen.
oGiven by injection into the muscle (intramuscular
injection). The hormone is then released slowly into the
bloodstream.
oWork primarily by preventing the release of eggs from the
ovaries (ovulation).
2/20/2023 Reena Bhagat 66
67. Dose: 150 mg IM
Provide protection for 3
months.
2/20/2023 Reena Bhagat 67
68. How Effective?
• Effectiveness depends on getting injections regularly: Risk
of pregnancy is greatest when a woman misses an
injection.
• As commonly used, about 4 pregnancies per 100 women
using progestin-only injectables over the first year.
• When women have injections on time, less than 1
pregnancy per 100 women using progestin-only injectables
over the first year (2 per 1,000 women).
• Return of fertility after injections are stopped: An average
of about 4 months longer for DMPA and 1 month longer
for NET-EN than with most other methods
• Protection against sexually transmitted infections (STIs):
None
2/20/2023 Reena Bhagat 68
69. Contd..
Side Effects: Most users report some changes in monthly
bleeding.
• Typically, these include, with DMPA: First 3 months: –
Irregular bleeding – Prolonged bleeding At one year: –
No monthly bleeding – Infrequent bleeding – Irregular
bleeding
• Some users report the following:
Weight gain
Headaches
Dizziness
Abdominal bloating and discomfort
2/20/2023 Reena Bhagat 69
70. Contd..
Known Health Benefits: DMPA Helps protect against:
• Risks of pregnancy
• Cancer of the lining of the uterus (endometrial cancer)
• Uterine fibroids
• May help protect against:
• Symptomatic pelvic inflammatory disease
• Iron-deficiency anemia
• Reduces:
• Sickle cell crises among women with sickle cell anemia
• Symptoms of endometriosis (pelvic pain, irregular bleeding)
Known Health Risks: None
2/20/2023 Reena Bhagat 70
71. Implants( Jadelle)
• Small plastic rods, each about the size of a
matchstick, that release a progestin like the
natural hormone progesterone in a woman‘s
body.
• A specifically trained provider performs a minor
surgical procedure to place one or 2 rods under
the skin on the inside of a woman‘s upper arm.
• Do not contain estrogen, and so can be used
throughout breastfeeding and by women who
cannot use methods with estrogen.
2/20/2023 Reena Bhagat 71
72. Contd..
Types of implants:
Jadelle: 2 rods containing levonorgestrel, highly
effective for 5 years
Implanon NXT (Nexplanon): 1 rod containing
etonogestrel, labeled for up to 3 years of use (a recent
study shows it may be highly effective for 5 years).
Implants are small flexible rods that are placed just
under the skin of the upper arm.
Provide long-term pregnancy protection. Very effective
for 3 to 5 years, depending on the type of implant.
Immediately reversible.
2/20/2023 Reena Bhagat 72
73. Work primarily by:
- Preventing the release of eggs from the ovaries (ovulation)
- Thickening cervical mucus (this blocks sperm from reaching
an egg)
2/20/2023 Reena Bhagat 73
74. How Effective?
One of the most effective and long-lasting methods:
Far less than 1 pregnancy per 100 women using implants
over the first year (1 per 1,000 women).
Less than 1 pregnancy per 100 women over the duration
of use.
Return of fertility after implants are removed: No delay
Protection against sexually transmitted infections (STIs):
None
2/20/2023 Reena Bhagat 74
75. Contd..
• Side Effects : Some users report the following:
• Changes in bleeding patterns, including: First several
months to a year: – Lighter bleeding and fewer days of
bleeding – Prolonged bleeding – Irregular bleeding –
Infrequent bleeding – No monthly bleeding
• After about one year: – Lighter bleeding and fewer days
of bleeding – Irregular bleeding – Infrequent bleeding –
No monthly bleeding
• Headaches
• Abdominal pain
• Acne (can improve or worsen)
2/20/2023 Reena Bhagat 75
76. Contd...
• Weight change
• Breast tenderness
• Dizziness
• Mood changes
• Nausea
• Other possible physical changes: Enlarged ovarian
follicles
2/20/2023 Reena Bhagat 76
77. Contd..
Known Health Benefits
Help protect against:
• Risks of pregnancy, including ectopic pregnancy
• Symptomatic pelvic inflammatory disease
May help protect against:
• Iron-deficiency anemia
• Reduces: Risk of ectopic pregnancy
• Known Health Risks: None
2/20/2023 Reena Bhagat 77
78. Contd..
• Complications
Uncommon:
Infection at insertion site (most infections occur within the
first 2 months after insertion)
Difficult removal (rare if properly inserted and the provider is
skilled at removal)
Rare:
Expulsion of implant (expulsions most often occur within the
first 4 months after insertion)
Extremely rare:
There are a few reports of implants found in another place in
the body due to improper insertion, for example, in a blood
vessel.
2/20/2023 Reena Bhagat 78
79. Combined Patch( EVRA)
• A small, thin, square of flexible plastic worn on the body.
• Continuously releases 2 hormones—a progestin and an
estrogen, like the natural hormones progesterone and
estrogen in a woman‘s body— directly through the skin
into the bloodstream.
• The woman puts on a new patch every week for 3 weeks,
then no patch for the fourth week. During this fourth week
the woman will have monthly bleeding.
• Also called Ortho Evra and Evra.
• Works primarily by preventing the release of eggs from the
ovaries (ovulation)
2/20/2023 Reena Bhagat 79
81. How Effective?
• Effectiveness depends on the user: Risk of pregnancy is
greatest when a woman is late to change the patch.
• As commonly used, about 7 pregnancies per 100 women
using the combined patch over the first year.
• When no mistakes are made with use of the patch, less
than 1 pregnancy per 100 women using a patch over the
first year (3 per 1,000 women).
• A woman wears a small adhesive patch on her body at all
times, day and night. A new patch is put on each week
for 3 weeks, and then no patch for the fourth week.
2/20/2023 Reena Bhagat 81
82. Contd..
• Bleeding changes are common but not harmful.
Typically, irregular bleeding for the first few months
and then lighter and more regular bleeding.
• Pregnancy rates may be slightly higher among women
weighing 90 kg or more.
• Return of fertility after patch use is stopped: No delay
• Protection against sexually transmitted infections:
None
2/20/2023 Reena Bhagat 82
83. Contd..
Side Effects : Some users report the following:
• Skin irritation or rash where the patch is applied
• Changes in bleeding patterns: – Lighter bleeding and
fewer days of bleeding – Irregular bleeding – Prolonged
bleeding – No monthly bleeding
• Headaches
• Nausea
• Vomiting
• Breast tenderness and pain
• Abdominal pain
• Flu symptoms/upper respiratory infection
2/20/2023 Reena Bhagat 83
84. 3. Intrauterine Devices(IUDs)
IUD( a LARC) is a small, T-shaped, plastic device that is
inserted and left inside the uterus to prevent pregnancy.
After insertion, the effective contraceptive action lasts at
least 12 years.
The usual timings are:
Immediate Postpartum:
Post-placental: Insertion within 10 minutes after expulsion
of the placenta following a vaginal delivery on the same
delivery table.
Intracesarean: Insertion that takes place during a cesarean
delivery, after removal of the placenta and before closure
of the uterine incision.
2/20/2023 Reena Bhagat 84
85. contd..
Within 48 hours after delivery: Insertion within 48
hours of delivery and prior to discharge from the
postnatal ward.
Postabortion: Insertion following an abortion, if there
is no infection, Mending or any other
contraindications.
Extended Postpartum/Interval: Insertion any time after
6 weeks postpartum.
2/20/2023 Reena Bhagat 85
86. Contd..
Mode of Action
• The IUD interferes with the ability of sperm to
survive and to ascend the fallopian tubes where
fertilization occurs. It alters or inhibits sperm
migration, ovum transport and fertilization. It
stimulates a sterile foreign body reaction in
endometrium potentiated by copper.
•
2/20/2023 Reena Bhagat 86
87. Contd..
• Ideal candidates for IUD
oHas born one child
oNormal menstrual cycle
oNo pelvic inflammation
oReady to check the device
2/20/2023 Reena Bhagat 87
88. IUD Classification
First generation Second generation Third generation
Non-medicated
made up of
polyethylene.
LIPPE’S LOOP
Double ‗s‘ shaped
device, made up of
polyethylene
material.
Non- toxic, non-
tissue reactive and
extremely durable.
Made up of metal
Copper
Copper-T(Cu-T)
• Most commonly
used
• Made of Cu
• T-shaped attatched
with a nylon thread(
tail).
Hormones releasing
IUD
PROGESTASTERT
Most commonly used
T shaped device filled
with 38 mg
progesterone
Effective for 1 year
LNG- mirena
Mirena
(levonorgestrel-
releasing intrauterine
device) and Releases
20 µg of
levonorgestrel.
Effective for 5 years.
2/20/2023 Reena Bhagat 88
89. How Effective??
One of the most effective and long-lasting methods:
Less than 1 pregnancy per 100 women using an IUD
over the first year (6 per 1,000 women who use the IUD
perfectly, and 8 per 1,000 women as commonly used).
• Return of fertility after IUD is removed: No delay
• Protection against sexually transmitted infections
(STIs): None
2/20/2023 Reena Bhagat 89
90. Contd..
Side Effects: Some users report the following:
• Changes in bleeding patterns (especially in the first 3 to 6
months), including:
– Prolonged and heavy monthly bleeding – Irregular
bleeding – More cramps and pain during monthly bleeding
Known Health Benefits:
Helps protect against: Risks of pregnancy
May help protect against:
Cancer of the lining of the uterus (endometrial cancer)
Cervical cancer
Reduces: Risk of ectopic pregnancy
2/20/2023 Reena Bhagat 90
91. Contd..
Complications: Rare:
Puncturing (perforation) of the wall of the uterus by
the IUD or an instrument used for insertion. Usually
heals without treatment.
Miscarriage, preterm birth, or infection in the rare case
that the woman becomes pregnant with the IUD in
place.
2/20/2023 Reena Bhagat 91
92. Contd..
Known Health Risks:
Uncommon:
• May contribute to anemia if a woman already has low
iron blood stores before insertion and the IUD causes
heavier monthly bleeding
Rare:
• Pelvic inflammatory disease (PID) may occur if the
woman has chlamydia or gonorrhea at the time of IUD
insertion
2/20/2023 Reena Bhagat 92
93. Contd..
Contraindications for Insertion of IUCD:
1. Presence of pelvic infection current or within 3
months;
2. Undiagnosed genital tract bleeding;
3. Suspected pregnancy;
4. Distortion of the shape of the uterine cavity as in
fibroid or congenital uterine-malformation;
5. Severe dysmenorrhea;
6. Past history of ectopic pregnancy;
7. Within 6 weeks following cesarean section;
2/20/2023 Reena Bhagat 93
94. Contd..
8. STIs: Current or within 3 months;
9. Significant immunosuppression.
Additionally for CuT are:
11. Wilson disease and
12. Copper allergy.
For LNG-IUS are:
13. Hepatic tumor or hepatocellular disease (active);
14. Current breast cancer and
15. Severe arterial disease
2/20/2023 Reena Bhagat 94
95. Post coital method: Emergency contraceptives
Emergency contraception is contraception provided to
women to prevent unwanted pregnancy following an
unprotected sexual intercourse.
ECPs are sometimes called ―morning after‖ pills or
postcoital contraceptives.
ECPs may include
Special ECP product with levonorgestrel only
Progestin-only pills with levonorgestrel or norgestrel
Combined oral contraceptives with estrogen and a
progestin— levonorgestrel, norgestrel, or norethindrone
(also called norethisterone)
The copper-bearing IUD
2/20/2023 Reena Bhagat 95
96. Contd..
Work by:
preventing fertilization by affecting the cervical
mucus
Preventing implantation by hypermotility of
fallopian tubes and uterus.
delaying the release of eggs from the ovaries
(ovulation).
2/20/2023 Reena Bhagat 96
97. Contd..
Indications of emergency contraception:
Sexual assault
Any unprotected sex
Mistakes using contraception such as:
Condom was used incorrectly, slipped, or broke
Couple incorrectly used fertility awareness method (for
example, failed to abstain or to use another method during
the fertile days)
Failure to withdraw, as intended, before ejaculation
Woman has had unprotected sex after she has missed 3 or
more combined oral contraceptive pills or has started a new
pack 3 or more days late
2/20/2023 Reena Bhagat 97
98. Contd..
IUCD has come out of place.
Woman has had unprotected sex when she is more
than 4 weeks late for her repeat injection of DMPA.
• If a woman is breastfeeding but not using: Post-partum
Contraception and LAM) and thinks she might be at
risk of pregnancy, emergency contraception may be
used (except Estrogen containing).
2/20/2023 Reena Bhagat 98
99. Most commonly used ECP is
the POP, which contains 1.5mg
levonorgestrel. The pill is
available as either a single
dose containing dthe full
1.5mg or two doses of 0.75mg
taken 12-24 hours apart.
When to Take Them?
The sooner ECPs are taken
after unprotected sex, the
better they prevent pregnancy.
Within 120 hours or 5 days
after unprotected sex.
2/20/2023 Reena Bhagat 99
100. How Effective??
• If all 100 women used ulipristal acetate ECPs, fewer
than one woman would likely become pregnant.
• If all 100 women used progestin-only ECPs, one woman
would likely become pregnant.
• Return of fertility after taking ECPs: No delay. A woman
can become pregnant immediately after taking ECPs.
Taking ECPs prevents pregnancy only from acts of sex
that took place in the 5 days before. They will not protect
a woman from pregnancy from acts of sex more than 24
hours after she takes ECPs.
• Protection against sexually transmitted infections (STIs):
None
2/20/2023 Reena Bhagat 100
101. Contd..
Side Effects: Some users report the following:
• Changes in bleeding patterns, including:
– Slight irregular bleeding for 1–2 days after taking ECPs
– Monthly bleeding that starts earlier or later than expected
In the first several days after taking ECPs:
• Nausea
• Abdominal pain
• Fatigue
• Headaches
• Breast tenderness
• Dizziness
• Vomiting
2/20/2023 Reena Bhagat 101
102. Contd..
• Contraindication: There are no known
contraindications to the use of hormonal emergency
contraception. The dose of hormones used in
emergency contraception is small and the pills are
given for a short time, so the contraindications
associated with continuous use of combined hormonal
contraception do not apply.
• Known Health Benefits:
Help protect against: Risks of pregnancy
• Known Health Risks : None
2/20/2023 Reena Bhagat 102
103. 3. Permanent Sterilization
STERILIZATION
• It is most effective method its failure rate is 1/2000 so
in this there is permanent termination.
•
VASECTOMY( Male Sterilization)
TUBECTOMY( Female Sterilization)
2/20/2023 Reena Bhagat 103
104. a. Female Sterilization
Permanent surgical contraception for women who will
not want more children.
The 2 surgical approaches most often used:
Minilaparotomy involves making a small incision in
the abdomen. The fallopian tubes are brought to the
incision to be cut or blocked.
Laparoscopy involves inserting a long, thin tube
containing lenses into the abdomen through a small
incision. This laparoscope enables the doctor to reach
and block or cut the fallopian tubes in the abdomen.
2/20/2023 Reena Bhagat 104
106. Contd..
Also called tubal sterilization, tubal ligation, voluntary
surgical contraception, tubectomy, bi-tubal ligation,
tying the tubes, minilap, and ―the operation.‖
Works because the fallopian tubes are blocked or cut.
Eggs released from the ovaries cannot move down the
tubes, and so they do not meet sperm.
2/20/2023 Reena Bhagat 106
107. Contd..
Indications:
• Family planning purposes.
• Socioeconomic: An individual is adopted to accept the
method after having the desired number of children.
• Medico-surgical indications (therapeutic): Medical
diseases such as heart disease, diabetes, chronic renal
disease, hypertension are likely to worsen, if repeated
pregnancies occur and hence sterilization is advisable.
During third time repeat cesarean section or repair of
prolapse operation, to avoid the risks involved in the
future childbirth process, sterilization operation should
be seriously considered.
2/20/2023 Reena Bhagat 107
108. Contd..
Time of Operation:
(1) During puerperium (puerperal):If the patient is
otherwise healthy, the operation can be done 24–48
hours following delivery.
(2) Interval: The operation is done beyond 3 months
following delivery or abortion. The ideal time of
operation is following the menstrual period in the
proliferative phase.
(3) Concurrent with MTP: Sterilization is performed
along with termination of pregnancy. This is mostly
done especially in the urban centers.
2/20/2023 Reena Bhagat 108
109. How Effective?
One of the most effective contraceptive methods but
carries a small risk of failure:
• Less than 1 pregnancy per 100 women over the first year
after having the sterilization procedure (5 per 1,000).
• Effectiveness varies slightly depending on how the tubes
are blocked, but pregnancy rates are low with all
techniques. One of the most effective techniques is
cutting and tying the cut ends of the fallopian tubes after
childbirth (postpartum female sterilization).
• Protection against sexually transmitted infections ( STIs):
None
2/20/2023 Reena Bhagat 109
110. Contd..
• Side Effects: None
• Known Health Benefits
Helps protect against: Risks of pregnancy
Pelvic inflammatory disease ( PID)
Reduces: Risk of ectopic pregnancy
• Known Health Risks
• Uncommon to extremely rare: Complications of
surgery and anesthesia
2/20/2023 Reena Bhagat 110
111. Contd..
Complications of Surgery: Uncommon to extremely
rare:
• Female sterilization is a safe method of contraception.
It requires surgery and anesthesia, however. Like other
minor surgeries, female sterilization carries some risks,
such as infection or abscess of the wound. Serious
complications are uncommon.
• Death, due to the procedure or anesthesia, is extremely
rare.
• Complications can be kept to a minimum if appropriate
techniques are used and if the procedure is performed
in an appropriate setting by a skilled provider.
2/20/2023 Reena Bhagat 111
112. b. Male Sterilization( Vasectomy)
Permanent contraception for men who will not want more
children.
Also called male sterilization and male surgical contraception.
Non-scalpel vasectomy(NSV) is done under local anesthesia
making a tiny puncture over the stretched skin of the vasa.
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 them by cutting and
tying them closed or by applying heat or electricity (cautery).
Works by closing off each vas deferens, keeping sperm out of
semen. Semen is ejaculated, but it cannot cause pregnancy
2/20/2023 Reena Bhagat 112
113. How Effective?
• One of the most effective methods but carries a small
risk of failure: less than 2 women in every 1,000 will
become pregnant.
• Permanent. Intended to provide life-long, permanent, and
very effective protection against pregnancy. Reversal is
usually not possible.
• Involves a safe, simple surgical procedure. 3-month
delay in taking effect. The man or couple must use
condoms or another contraceptive method for 3 months
after the vasectomy.
• Does not affect male sexual performance.
2/20/2023 Reena Bhagat 113
114. Contd..
• If the partner of a man who has had a vasectomy
becomes pregnant, it may be because:
The couple did not always use another method during
the first 3 months after the procedure
The provider made a mistake
The cut ends of the vas deferens grew back together
The procedure is intended to be permanent. Reversal
surgery is difficult, expensive, and not available in most
areas. When performed, reversal surgery often does not
lead to pregnancy.
Protection against sexually transmitted infections (STIs):
None
2/20/2023 Reena Bhagat 114
116. Contd..
Advantages:
(1) The operative technique is simple and can be
performed by one with minimal training
(2) The operation can be done as an outdoor procedure or
in a mass camp even in remote villages
(3) Complications—immediate or late are few
(4) Failure rate is minimal—0.15 percent and there is a
fair chance of success of reversal anastomosis
operation (70–80 percent)
(5) The overall expenditure is minimal in terms of
equipment, hospital stay and doctor‘s training.
2/20/2023 Reena Bhagat 116
117. Contd..
Drawbacks:
(1) Additional contraceptive protection is needed for
about 2–3 months following operations, i.e. till the
semen becomes free of sperm.
(2) Frigidity or impotency when occurs is mostly
psychological.
(3) Selection of candidates: Sexually active and
psychologically adjusted husband having the desired
number of children is an ideal one.
2/20/2023 Reena Bhagat 117
118. Contd..
• Side Effects None
• Complications: Uncommon to rare:
• Severe scrotal or testicular pain that lasts for months or
years.
Uncommon to very rare:
Infection at the incision site or inside the incision
(uncommon with conventional incision technique; very
rare with no-scalpel technique;
Rare: Bleeding under the skin that may cause swelling
or bruising (hematoma).
2/20/2023 Reena Bhagat 118
120. Benefits of Family Planning
Family Planning has multiple benefits for men, women,
children, community and nation.
For saving women’s lives:
Reduce maternal mortality and morbidity by reducing
the number of pregnancies, the number of abortion and
the proportion of the births at high risk.
It has been estimated that meeting women‘s need for
modern contraceptives would prevent about one quarter
to one third of maternal deaths.
2/20/2023 Reena Bhagat 120
121. Contd..
Family Planning saves women‘s lives by:
1. Avoiding unsafe abortion.
2. Limiting risks of pregnancy and child birth
3. Limiting pregnancy to the healthiest ages, frequency
and interval
4. Improve health status of adolescents
For families:
• Health birth spacing and smaller families which
improve women‘s health.
• Improved education and status for women
2/20/2023 Reena Bhagat 121
122. Contd..
• Health birth spacing and smaller families which improve
women‘s health.
• Improved education and status for women
• Improved well being of families because of mothers survival
• Better nutrition and education for children specially girls
For Children
• Family Planning is an important part of effort to improve
infant and child survival. Family Planning saves the lives of
children by:
1. Spacing Birth
2. Limiting child bearing to the healthiest age
3. Spacing births helps assure that babies are adequately
breastfed.
2/20/2023 Reena Bhagat 122
123. Contraception forAdolescent
• World Health Organization definition of adolescence as
the period between 10-19 years of age. Adolescence is a
period of transition from childhood to adulthood and this
is not only period of growth, exploration and
opportunities, but also a time of risk taking,
experimentation, and vulnerability.
• While adolescence generally is a healthy period of life,
adolescents are often not well-informed about how to
protect their sexual and reproductive health, thus are at
potential risk of unwanted pregnancies, unsafe abortion,
STIs, and HIV.
2/20/2023 Reena Bhagat 123
124. Contd..
• They are less informed, less experienced, less comfortable, and
have fewer resources to access reproductive health services
including family planning than adults. Adolescents need special
attention, guidance and support to address their specific
concerns, problems and needs and to assist them in developing
responsible behavior and a healthy lifestyle.
The risks are
• Unintended pregnancy
• STI‘s and HIV/AIDS
• Risk of maternal & infant deaths
• Risks of unsafe abortion seeking behavior
• Secondary Sterility
2/20/2023 Reena Bhagat 124
125. Contd..
Counseling for adolescents should include discussion of
the:
Benefits of certain contraceptive methods (condoms) in
protecting against STIs (including HBV and HIV) as
well as preventing pregnancy.
Safety of contraceptive method and not affecting
long-term fertility.
Appropriate sex education that enables adolescents to
develop the knowledge and confidence to make
decisions related to their sexual behavior, including the
decision not to engage in sexual intercourse until they
are ready to do so.
2/20/2023 Reena Bhagat 125
126. Contd..
Sexuality and reproductive health with emphasis on
adolescent issues: self-esteem, appearance, negotiating
unwanted sexual advances, pressure from peers or
partners.
Address questions for adolescents on their unique
condition (irregular menstruation, change in body
structure, gender identification, personal hygiene,
menstrual health).
2/20/2023 Reena Bhagat 126
127. Contd..
Contraception for Adolescents
Barrier Methods: Condoms would be better but diaphragms
and cervical caps are invasive & they are unwilling.
Hormonal Contraception( COCs/PoPs): Suitable for
adolescents as there will be no such diseases
contraindications for adolescents. Reversible and no effect
in future fertility.
Implants are way too long covered for some adolescents.
Depo Provera: Highly recommended for adolescents who
require intermediate duration effective contraception,
especially if they had trouble with compliance while using
another method.
2/20/2023 Reena Bhagat 127
128. Contd..
IUD: Theoretically contraindicated for adolescents since
it bears a risk of pelvic infections and secondary sterility.
However, protects from illegal repeated abortions and
death.
Other Methods:
Periodic abstinence is not easy for irregular cycles
Withdrawal is not very reliable method for contraception.
2/20/2023 Reena Bhagat 128
129. Postabortion Contraception
• Women who have received safe abortion service or been
treated for abortion complications need easy and
immediate access to contraceptive services.
• Good counseling gives support to the woman who has
just been through abortion or treated for abortion
complication. In particular:
Try to understand what she has been through
Treat her with respect and avoid judgment and criticism
Ensure privacy and confidentiality
Ask if she wants someone, she trusts to be present during
counseling.
2/20/2023 Reena Bhagat 129
130. Contd..
• WHO recommends all women should receive
contraceptive information and be offered counseling,
including emergency contraception, before leaving the
healthcare facility. Post-abortion contraceptive counseling
should include the following components:
Counseling about contraceptive needs in terms of the women's
reproductive goals
Choices among various contraceptive methods
Provision of contraceptive service
Access to follow-up care
Information about the need for protection against STIs
including HIV and the importance of condom use for all
women regardless of the contraceptive method chosen.
2/20/2023 Reena Bhagat 130
131. Contd..
Time to start Postabortion Contraception
• Immediate initiation of contraception following
abortion is critical to reduce the risk of unintended
pregnancy.
• It is important to remind the woman that fertility
returns soon after abortion (even before she can
resume her normal period) whereas ovulation after
abortion takes place within 20 days but in some cases
as early as 8 days.
2/20/2023 Reena Bhagat 131
132. Contd..
Guidelines for selection of Contraception
Voluntary
female
sterilization
(Minilap)
Technically, minilap procedures usually can
be performed immediately after an abortion.
If infection or severe blood loss is present,
do not perform until fully resolved. e.g. only
when infection is fully resolved (3 months)
or injury is healed.
Voluntary male
sterilization
(Non-Scalpel
Vasectomy)
Technically, NSV procedures can be
performed at any time and timing is not
related to abortion
Progestin-only
Implants
May be inserted immediately after abortion,
preferably on the day of treatment.
2/20/2023 Reena Bhagat 132
133. Contd..
Guidelines for selection of Contraception
IUCD (CUT380 A) IUCD can be inserted immediately after
surgical abortion (If there is no
complication), preferably on the day of
treatment IUCD can be inserted in
medical abortion only when there is
completion of abortion
InjectablesProgestin only
(E.g. Depoprovera)
Can be given immediately after both
surgical and medical abortion, preferably
on the day of treatment
CoCs (E.g. Nilocon
white/Sunaulo Gulaf) and
PoPs (mini pill)
Can be given immediately after both
surgical and medical abortion, preferably
on the day of treatment
2/20/2023 Reena Bhagat 133
134. Contd..
Guidelines for selection of Contraception
Barriers (Condoms) Can be used immediately after
both surgical and medical
abortion
Fertility awareness
methods
(Natural Family
Planning Method )
Not recommended for
immediate use as postabortion
contraception
Emergency
Contraceptive Pills
May be used immediately after
abortion
2/20/2023 Reena Bhagat 134
135. Contraception for women over 35yrs/ near
perimenopause
• Menopause usually occurs between the ages of 45 to 55
years. It is important to prevent pregnancy until it is
clear that she is no longer fertile. She can use any
method if she has no medical condition that limits its
use.
• Women over the age of 35 years are in need of safe and
effective contraception because pregnancy can carry
increased health hazards (morbidity and mortality) for
mothers and their babies. Fertility declines in women
over 35 years. Pregnancies, however, are possible and
therefore contraception should be provided.
2/20/2023 Reena Bhagat 135
136. Contd..
There are specific problems related to pregnancy in this
age group:
Maternal mortality among women in their forties is
about five times greater than that of women in their
twenties.
Perinatal mortality doubles as maternal age doubles.
Chromosomal abnormalities, particularly Down‘s
syndrome, increases.
Spontaneous abortion rates increase.
2/20/2023 Reena Bhagat 136
137. Contd..
Considerations for women near perimenopause
COCs Women aged 35 and older who smoke - regardless
of how much - should not use COC.
Women aged 35 years and older who are heavy
smokers (>15 cigarettes per day) should not use
monthly injectables. These women should be
encouraged to stop smoking.
Women aged 35 or older should not use COC if
they have migraine headaches (whether with
migraine aura or not).
Low-dose COCs are contraceptive of choice for
perimenopausal women; if there is no other
contraindication, because it will regulate the
menstruation cycle and prevents pregnancy.
2/20/2023 Reena Bhagat 137
138. Contd..
Considerations for women near perimenopause
POCs
(Implants
, PoPs)
A good choice for woman who cannot use methods with
estrogen.
DMPA, if used for prolonged period of time, might
decrease bone mineral density slightly. This may increase
the risk of developing osteoporosis and possibly having
bone fractures later, after menopause.
Implants are highly recommended for women over 35
who want long-term contraception, especially if client has
had trouble using another method or does not want
voluntary sterilization.
IUCDs IUCDs could be a better choice as it is non-hormonal.
Expulsion rates fall as women grow older, and are lowest
in women over 40 years of age. Insertion may be more
difficult due to tightening of the cervical canal.
2/20/2023 Reena Bhagat 138
139. Contd…
Considerations for women near perimenopause
Condoms
(male and
female)
Only method that protects against other STIs (e.g.,
HBV, HIV).
Affordable and convenient for women who may not
have sex often.
Minilap and
vasectomy
Appropriate for clients/couples who are certain about
desire for permanent contraception
Perimenopausal woman is more likely to have
conditions that require delay, referral or caution for
female sterilization.
Emergency
contraceptive
pills
Can be used by women of any age, including those who
cannot use hormonal methods on a continuous basis.
Fertility
awareness
methods
Lack of regular cycles during perimenopausal period
makes difficult to use these methods reliably
2/20/2023 Reena Bhagat 139
140. Contd..
Relieving Symptoms of Menopause:
Women experience physical effects before, during, and
after menopause:
ohot flashes,
oexcess sweating,
odifficulty to hold urine, or increase in nocturnal
frequency of urine,
ovaginal dryness that can make sex painful, and
odifficulty sleeping.
2/20/2023 Reena Bhagat 140
141. Contd..
Providers can suggest ways to reduce some of these
symptoms:
• Deep breathing from the diaphragm may make a hot
flash go away faster.
• Meditation and yoga could be helpful, as it helps in
relaxation and joint mobility.
• Eat foods like soybeans, Tofu, soya nuggets and green
vegetables.
• Eat foods rich in calcium (such as dairy products, beans,
carom seeds and fish).
2/20/2023 Reena Bhagat 141
142. Contd..
• Engage in moderate physical activity (walking and
some weight bearing exercises) to help slow the loss of
bone density that comes with menopause.
• Vaginal lubricants or moisturizers can be used if
vaginal dryness persists and causes irritation. During
sex, use a commercially available vaginal lubricant,
water, or saliva as a lubricant if vaginal dryness is a
problem.
• Refer to a gynecologist if vaginal dryness is persistent;
she might need local hormonal cream.
2/20/2023 Reena Bhagat 142
143. Contraception and STI including HIV
• Sexually Transmitted Infections and family planning
services overlap substantially.
• STI/HIV are frequently encountered in family
planning clients, especially among certain high-risk
groups (e.g., clients who have more than one sexual
partner).
• Furthermore, some contraceptive methods have a range
of characteristics— from protecting against STI/HIV
transmission to reducing the risk of complications from
STI/ HIV infection.
2/20/2023 Reena Bhagat 143
144. Contd..
The main linkages between contraception and STI/HIV
services are:
• Prevention of STI/HIV transmission
• Opportunity for client screening for STI/HIV
• Counseling on FP as well as STI/HIV prevention
• Treatment of STI and its consequences from the same
FP outlets.
2/20/2023 Reena Bhagat 144
145. Safer Conception for HIV Serodiscordant Couples
When a couple wants to have a child and one partner has
HIV while the other does not (a serodiscordant couple),
counseling on care and treatment is done on the following
basis:
The partner with HIV should take antiretroviral (ARV)
therapy consistently and correctly until HIV is suppressed
to the point that it cannot be detected.
If the partner with HIV is not virally suppressed on ARV
therapy, the partner who does not have HIV (HIV-
negative) can consider taking pre-exposure prophylaxis
(PrEP) during the period when they are trying to
conceive.
2/20/2023 Reena Bhagat 145
146. Contd..
• If the woman has HIV but the man does not, a safe
option for conception is artificial insemination with the
uninfected partner‘s semen. Both partners should be
properly screened and adequately treated for any other
STI before trying for conception.
2/20/2023 Reena Bhagat 146
147. Contraception and STI/HIV
• Family planning providers can talk to clients about how
they can protect themselves both from STI, including
HIV, and pregnancy (dual protection).
• Choosing a Dual Protection Strategy Every family
planning client needs to think about preventing STI
including HIV—even people who assume they face no
risk.
• The provider can discuss what situations place a person
at increased risk of STI including HIV and clients can
think about whether these risky situations come up in
their own lives. If so, they can consider 5 dual protection
strategies.
2/20/2023 Reena Bhagat 147
148. Contd..
Strategy 1: Use a male or female condom correctly
with every act of sex.
One method helps protect against pregnancy and STI
including HIV.
Strategy 2: Use condoms consistently and correctly
plus another family planning method.
Adds extra protection from pregnancy in case a condom
is not used correctly.
May be a good choice for women who want to be sure
to avoid pregnancy but cannot always pressure their
partners to use condoms.
2/20/2023 Reena Bhagat 148
149. Contd..
Strategy 3: If both partners know they are not
infected, use any family planning method to prevent
pregnancy and stay in a mutually faithful
relationship.
Many family planning clients are in this group and thus
are protected from STI including HIV.
Depends on communication and trust between partners.
2/20/2023 Reena Bhagat 149
150. Contd.
Strategy 4: Engage only in safer sexual intimacy that
avoids intercourse or otherwise prevents semen and
vaginal fluids from coming in contact with each other’s
genitals.
This strategy will not prevent syphilis, genital herpes, or
infection with human papillomavirus. These infections
may spread even through skin-to-skin contact.
Depends on communication, trust, and self-control.
If this is a person‘s first-choice strategy, it is best to have
condoms at hand in case the couple desire to have sex.
2/20/2023 Reena Bhagat 150
151. Contd..
Strategy 5: Delay or avoid sexual activity (either
avoiding sex all the time or abstaining for a longer
time).
This strategy is always available in case a condom is not
at hand.
If this is a person‘s first-choice strategy, it is best to have
condoms at hand in case the couple desire to have sex.
People at high risk of HIV infection can take PrEP—
pre-exposure prophylaxis. This daily treatment with oral
antiretroviral drugs greatly reduces the chances of
infection if exposed to HIV.
2/20/2023 Reena Bhagat 151
152. Counseling Outline and Clinical
Recommendations
Method Remarks Regarding STI
COCs No protection against STI including HBV, HIV.
If high risk behavior or previous STI detected in
screening history, concurrent use of condoms is
recommended.
POCs
(Implants
and Depo)
No protection against STI including HBV, HIV.
If high-risk behavior or previous STI detected in
screening history, concurrent use of condoms is
recommended.
Condoms
(male and
female)
Protect against STI including HBV, HIV. • To be
fully effective, condoms must be worn at all times
during genital contact, and with every act of
intercourse.
2/20/2023 Reena Bhagat 152
153. Method Remarks Regarding STI
IUCDs No protection against STI including HBV, HIV.
Should not be used by women at risk for or with
clinical findings of STI. If such a client insists on
using an IUCD, concurrent use of condoms is
required.
Should not be used by women with current, recent
(less than 3 months) or having recurrent PID.
If there is clinical findings of vaginal infection
(candidiasis or bacterial vaginosis), treat and recheck
before IUCD is inserted.
Minilap
and NSV
No protection against STI including HBV, HIV.
If high-risk behavior or previous STI detected in
screening history, concurrent use of condoms is
recommended.
2/20/2023 Reena Bhagat 153