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physiology behind contraceptive methods.pptx

physiology behind contraceptive methods.pptx

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10/27/2012

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Dr.

Niranjan Murthy HL Associate Professor Department of Physiology SSMC, Tumkur

• Preventive methods to help woman avoid unwanted pregnancies • A method or a system which allows intercourse and yet prevents conception • Include temporary and permanent methods • Cafeteria choice

Contraceptive methods
1. Spacing methods (a) Barrier methods (i) Physical methods (ii) Chemical methods (iii) Combined methods (b) Intra-uterine devices © Hormonal methods (d) Post-conceptional methods (e) Miscellaneous 2. Terminal methods (a) Male sterilization (b) Female sterilization

Barrier Methods
(a) Physical methods: (i) Condom:  Nirodh  Failure rate of 2-3/100 women years Advantages: Safe, inexpensive, easy to use, prevent STD, no side effects Disadvantages: May slip off or tear, Interferes with sexual sensation

(ii) Diaphragm: Dutch cap Synthetic rubber or plastic Spermicidal jelly is used Failure rate 1.9/100 women-years Advantages: no risks and no medical contraindications, prevents STDs Disadvantages: needs practice at insertion, privacy, cant be used immediately after child birth, Toxic Shock Syndrome

(iii) Vaginal sponge: Today Polyurethane foam sponge soaked in nanoxynol-9 Less effective than diaphragm Prevents STDs Toxic Shock Syndrome

(b) Chemical methods: Spermicides were widely used in 1960s Foams, Pastes, Jellies, Creams, Suppositories, Soluble films Modern spermicides are surface active agents- inhibit oxygen uptake of sperms Disadvantages: must be applied immediately before intercourse, high failure rate, may cause irritation

(b) Intrauterine Devices:  On-medicated and Medicated (i) First generation IUDs: inert  Lippes loop  spirals, coils, rings, bows, loops  Barium sulphate  Tails made of nylon

(ii) Second generation IUDs: Metallic copper was added Smaller devices which fit into nulliparous  copper-7; Copper T-200; T Cu-220 C; T Cu380 A; Nova T, ML-Cu-250  low expulsion rate, easier to fit, nulliparous, post-coital, more effective

(iii) Third generation IUDs: Release of hormone Progestasert Mechanism of action of IUDs: Foreign body reaction Copper alters biochemical composition of cervical mucus Hormonal devices maintain sustained high levels of progesterone

Failure rate of 3-5/100 women-years Maintained for 2-4 years Advantages: simple, Inexpensive, no systemic sideeffects, high continuation rate Contraindications: suspected pregnancy, PID, Cancer of cervix, uterus Timing of insertion: during menstruation or 10 days within the beginning; 6-8 weeks after delivery Disadvantages: Bleeding, Pain, Pelvic infection, Uterine perforation, Pregnancy, Ectopic pregnancy

(c) Hormonal contraceptives: I. Oral pills: A. Combined pill B. Progestogen only pill C. Post-coital pill D. Once-a-month pill E. Male pill II. Depot formulations: A. Injectables B. Subcutaneous implants C. Vaginal rings

Made of gonadal steroids Synthetic estrogens : Ethinyl estradiol and Mestranol Synthetic progestogens: medroxyprogesterone, norethisterone, levonorgesterol

Combined pill: Mala- N: Levonorgesterol + Ethinyl Estradiol Mala- D: Levonorgesterol + Ethinyl estradiol Package of 28 pills
Progestogen-only pill: Minipill or micropill Norethisterone or levonorgesterol Poor cycle control May lower HDL

Post-coital contraception: IUDs Hormonal pills I pill Once-a-month pill: Failure Male pill:  Gossypol a derivative of cotton-seed oil

Mechanism of OCP action: Inhibit ovulation by feedback inhibition of LH & FSH Progestogen render cervical mucus thick Progestogens inhibit tubal motility Failure rate: < 1 per 100 women-years Adverse effects: Cardiovascular side effects, cervical cancer, hypercoagulability of blood, weight gain, liver disorders, breast tenderness

(d) Postconceptional methods: (i) Menstrual regulation

(ii) Menstrual induction: prostaglandins (iii) Abortion

(e) Miscellaneous: (i) Abstinence (ii) Coitus interruptus (iii) Safe period or rhythm method (iv) Natural methods - Basal Body Temperature - Cervical mucus method (v) Breast feeding

• Rhythm method (Calendar method): Ovulation in 28 day cycle between 12-16 days Ova can survive for 1 day
Sperms can survive for 3 days Unsafe period is between 9 and 17 days in 28 day cycle Shortest cycle minus 18 days and longest cycle minus 10 days

• Basal body temperature:
Reliable for post-ovulatory period  increase in BBT by 0.5⁰ C during ovulation • Billing method:  Cervical mucus becomes slippery and watery clear during ovulation

Terminal methods
(a) Male sterilization: Vasectomy  Simple and short duration surgery  Spermatogenesis and hormonal production are not affected  Sperms are phagocytosed  Not sterile till 30 ejaculations Complications: operative complications; spontaneous recanalization; sperm granules; autoimmune response

(b) Female sterilization: Tubectomy  Laporoscopy, minilaparotomy  6 weeks after delivery

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