PERKEMBANGAN KONTRASEPSI

TERKINI
Biran Affandi
Klinik Raden Saleh
Departement Obstetri & Ginekologi
Facultas Kedokteran , Universitas Indonesia/
Rumah Sakit Dr. Cipto Mangunkusumo, Jakarta
Affandi B. Perkembangan Kontrasepsi Terkini. Peringatan Hari Kontrasepsi Sedunia , BKKBN , Jakarta , 30 September 2014

OBJECTIVES:
1.To overview basic principles of
family planning
2.To overview the possible
pattern of contraceptive
methods
3.To review new contraceptives
4.To recommend practical points
Affandi B. Perkembangan Kontrasepsi Terkini. Peringatan Hari Kontrasepsi Sedunia , BKKBN , Jakarta , 30 September 2014

PERENCANAAN KELUARGA
1. Seorang wanita telah dapat melahirkan,
segera setelah ia mendapat haid yang pertama
(menarche)
2. Kesuburan seorang wanita akan terus
berlangsung, sampai mati haid (menopause)
3. Kehamilan dan kelahiran yang terbaik, artinya
risiko paling rendah untuk ibu dan anak,
adalah antara 20-35 tahun
4. Persalinan pertama dan kedua paling rendah
risikonya
5. Jarak antara dua kelahiran sebaiknya 2-4
tahun
Affandi, 1984
Affandi B. 1978

POLA PERENCANAAN KELUARGA

Fase

Fase

Fase

Menunda
Kehamilan

Menjarangkan
Kehamilan

Tidak Hamil
lagi

2-4

20
Affandi, 1984

Affandi B. 1978

35

Possible patterns of intervention to

fertility

Ideal Contraceptive

100% effective
readily reversible
use not related to intercourse
easy to use
cheap
readily available
no side effects
does not affect sexual pleasure
health benefits

Contraceptive Options

CDC , 2014

Condom effectiveness at a glance

When used correctly and consistently, condoms are an effective means of preventing
pregnancy
When used correctly and consistently, condoms are an effective means of preventing
STD/HIV
Today's condom is manufactured with greater precision
Condom use is improved by the right lubricant

Affandi B. Perkembangan Kontrasepsi dan Kesehatan Reproduksi . Expert Meeting , BKKBN , Jakarta ,3 Feb 2009

Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan 28-30 July 2008

Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan 28-30 July 2008

Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan 28-30 July 2008

Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan 28-30 July 2008

Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan 28-30 July 2008

Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan 28-30 July 2008

Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan 28-30 July 2008

Cervical Cap:Leas Shield

Cervical Cap yang terbuat dari
Silicone yang bisa dipakai ulang
Kerjanya sebagai Penghalang
Sperma untuk masuk
Efektivitasnya 85-90%
(tergantung dari spermicida dan
tingkat paritas)
Perlu dibantu Provider pada awal
pemakaian
Dipasang segera sebelum
berhubungan intim dan
dibiarkan 8 jam setelahnya
Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan 28-30 July 2008

PIL KB
Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan 28-30 July 2008

MEKANISME KERJA PIL KB

* Mencegah pematangan dan pelepasan
sel telur
* Mengentalkan lendir leher rahim, sehingga
menghalangi penetrasi sperma
* Membuat selaput lendir rahim tidak siap
untuk menerima dan menghidupi hasil
pembuahan
(Leon Speroff, et.al., 2001, Oral Contraception, A Clinical Guide for Contraception; 2: 39-40)

Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan 28-30 July 2008

Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan 28-30 July 2008

Seasonale

Pack berisi
91 Pil
84 Pil aktif (Pink)
7 Inaktif Pil (Putih)

Dosis
kombinasi
rendah:

EE
30 g
LNG 150 g

Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan 28-30 July 2008

KONTRASEPSI IDEAL ?
Efektivitas maksimal
Efek samping minimal
Memberikan keuntungan tambahan ?

OC Plus
(EE + CPA)
Manfaat:
1. Kontrasepsi
kontrol siklus yang baik
aman untuk jangka panjang

OC Plus
(EE + CPA)

Manfaat Tambahan:
2. Kulit halus dan cantik

mengatasi masalah kulit langsung pada

akarnya menghilangkan jerawat dan
hirsutisme secara cepat dan efektif
Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan 28-30 July 2008

Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan 28-30 July 2008

The Contraceptive Patch

Ortho Evra

INJECTABLE CONTRACEPTIVE 2003

Formula

Period

Status

monthly

1.
2.
3.
4.
5.

DMPA 25 mg + EC 5 mg
Net-En 50 mg EV 5 mg
Net-En 20 mg
DMPA 50 mg + EE 10 mg
Others

Market
Market
Phase II
Market

2-3 months

1.
2.
3.

Net-En 200 mg
DMPA 150 mg
Net Microcapsul 100 mg

Market
Market
Phase I - II

6 months

1.
2.

DMPA 450 mg
Net microcapsul 200 mg

Market
Phase I II

Affandi, 2003
Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan 28-30 July 2008

Contraceptive choices
no ideal contraceptive
more methods available more likely a
couple or individual will find a suitable
method
long-acting reversible contraceptives
(LARC): Implanon, Mirena , IUD-T380A
have very low failure rates
LARCS require little action on part of
user

Strategies to improve compliance

Developing and encouraging use of
long-acting methods that require
no regular action on part of user
Improving access to information
which is provided in a form centred
on an individuals requirements
Accurate information about likely
side effects and encouragement
to continue

Long-acting reversible
contraceptives
Sub-dermal implants
Implanon
Jadelle

Intrauterine devices
Hormonal
Copper-bearing

IUD
IUD mencegah kehamilan dengan cara

Mencegah fertilisasi dengan cara

membuat sperma menjadi lemah
dan tidak mencapai tuba.
Menyebabkan reaksi peradangan di
endometrium
Mengganggu transportasi tuba
terganggu
Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan 28-30 July 2008

Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan 28-30 July 2008

Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan 28-30 July 2008

The levonorgestrel intrauterine system

wall
Uterine

system
Section of

Detail
system
intrauterine
Levonorgestrel
Affandi B. Mirena, Beyond

STATUS & DEVELOPMENT OF

IMPLANTABLE CONTRACEPTIVES 2006
TRADE NAME

PROGESTIN

IMPLANTS

DURATION

STATUS

Norplant

LNG

6 rods

5 years

Market

Implanon

ENG

1 rod

3 years

Market

Jadelle

LNG

2 rods

5 years

Market

Uniplant

NMA

1 caps

1 year

Phase III-IV

Nestrone

ST1435

1 rod

2 years

Phase III

Elcometrine

ST1435

1 caps

6 months

Market

Indoplant

LNG

2 caps

3 years

Market

Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan 28-30 July 2008

Implantable contraceptives

The Implanon rod

Rate-controlling membrane (0.06 mm)

2 mm

Core
40 mm
Core:

40% Ethylenevinylacetate (EVA)

60% etonogestrel
Membrane: 100% EVA

Implanon

Single rod 4cm x 2mm inserted under the skin of the inner surface of upper arm
Preloaded sterile applicator
Needle inserted under skin under sterile conditions
Inserter removed leaving implant in place
Insertion takes 1-2 minutes
Removal takes 2-3 minutes through a 2mm incision
Implant invisible but can be felt under skin

Implanon Mode of Action

Follicular development without
ovulation
LH surge prevented
Increased viscosity of cervical mucus
Endometrium thin but not atrophic
with weak proliferation
Pregnancy rate 0 -0.01% per year
Return of ovulation rapid on removal

Kontrasepsi Permanen tanpa

Operasi: Essure
Permanen, Non-hormonal
Keunggulannya
Tdk ada sayatan, tdk perlu anesthesi umum
Prosedur pemasangan < 1 jam (92 % wanita kembali
berkerja< 24 jam)
Efektif (99.8 % setelah 2 tahun pemakaian)
Keterbatasannya
Perlu 3 bulan sebelum efektif
Kemungkinan kegagalan insersi (microinsert)
Perlu operasi untuk mengangkat
Perlu Obgyn yg terlatih dalam hysteroscopy
Mahal ( US$ 1,500)
Affandi B. Perkembangan Kontrasepsi dan Kesehatan Reproduksi . Expert Meeting , BKKBN , Jakarta ,3 Feb 2009

Essure:
Bagaimana kerjanya ?
Merangsang tumbuhnya
jaringan parut
(scarification) didalam tuba
fallopii
Alat ini ditanamkan
kedalam masing masing
ujung tuba Falopii dengan
menggunakan kateter
khusus yang dipandu
dengan suatu hysteroscope
melalui vagina.
Occlusi (Penutupan) di
periksa setelah 3 bulan
Affandi B. Perkembangan Kontrasepsi dan Kesehatan Reproduksi . Expert Meeting , BKKBN , Jakarta ,3 Feb 2009

CONTRACEPTIVE METHOD RATIONAL CHOICE

Phase
DIFFERING

Phase
SPACING

Phase
COMPLETING

2-4

- Pill
- IUD
- Conventional
20
- Inject.
- Implant

Affandi B,1984

- IUD
- Inject.
- Pill
- Implant
- Conventional

- IUD
- Inject.
- Pill
35
- Implant
- Conventional
- Steril

- Steril
- IUD
- Pill
- Implant
- Inject.
- Conventional

Simplified Classification of Eligibility Criteria

(WHO)

WHO guidelines classify conditions that

affect medical eligibility for various
contraceptive methods into 4 categories
1

A condition for which there is no restriction for the use of

the contraceptive method

A condition in which the advantages of using the method

generally outweigh the theoretical or proven risks

A condition in which the theoretical or proven risks usually

outweigh the advantages of using the method

A condition that represents an unacceptable health risk if

the contraceptive method is used
World Health Organization. Medical Eligibility Criteria for Contraceptive Use, 4th ed. 2010.

Unmet Need : Fertility Preferences of

Postpartum Women
Key Findings in Indonesia (IDHS 2012)1 :
85% of currently married women and 53% of currently
married men who have 2 living children do not want to
have more children. The percentage wanting no more
children increases rapidly with the number of living
children.

According to many DHS surveys2:

92-97% of women do not want another child within 2 years
after giving birth
But 35% of women had their children spaced at 2 years
apart or less
40% of women who intend to use a FP method in the first
year postpartum are not using one
1. IDHS 2012, chapter 6, p 63
2. Ross JA and Winfrey WL, 2001

ACOG Recommendations
LARC methods should be offered as first-line
contraceptive methods and encouraged as
options for most women
LARC methods have few contraindications
Almost all women are eligible for the implant
and IUDs
American College of Obstetricians and Gynecologists. Practice Bulletin No. 121, Long-Acting
Reversible Contraception: Implants and Intrauterine Devices, July 2011.
American College of Obstetricians and Gynecologists. Committee Opinion No. 450, Increasing Use of
Contraceptive Implants and Intrauterine Devices To Reduce Unintended Pregnancy, December 2009.

Nulliparous Women and

Adolescents
Can Be Offered LARC Methods

ACOG , 2014

CDC Medical Eligibility Criteria

Category

Restriction

No restriction

Advantages generally outweigh

theoretical or proven risks

Theoretical or proven risks usually

outweigh advantages

Unacceptable health risk

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6026a3.htm#tab3

Counseling about hormonal contraceptive options is

an important part of the clinical consultation

even if the users appear knowledgeable about

their contraceptive method, there are likely
some areas where their knowledge could be
improved.

Costa A, et al. 2010 11th Congress of the European Society of Contraception and Reproductive Health

BIRTH RATE

STILL HIGH ! ! !
4.5 5 Million/year
Affandi B. Unsafe Abortion : Indonesian Experience . 1st International Congress on Women Health & Unsafe Abortion , Bangkok , Thailand , 20-23 January 2010

FAKTA
1.Pascasalin OVULASI
dapat terjadi dalam
waktu 21 hari
2.Pascakeguguran
OVULASI dapat TERJADI
dalam waktu 11hari
Contraceptive choices for breastfeeding women .Journal of Family Planning and Reproductive Health Care 2004; 30(3): 181189

Affandi B. Kontrasepsi Terkini dan IUD Pascaplasenta . Pertemuan Koordinasi Peningkatan KB Pascapersalinan di Rumah Sakit , Makassar 31 Agustus 2010

Postplacental (preferably
within 10 minutes after
expulsion of the placenta)
and immediate postpartum
insertion during the first
week after delivery (but
preferably within 48 hours)
are convenient effective and
safe times to insert copper
IUDs.
Affandi B. Perkembangan Kontrasepsi, Teknik Penapisan dan KB Postpartum , BPMPPKB, Balikpapan , 24 Juni 2010

Teknik Pemasangan AKDR

Affandi B. Postpartum Contraception & Medical Barrier. Department of Obstetrics & Gynecology , University of Indonesia , Jakarta , 22 Sept. 2010

Affandi B. Postpartum Contraception & Medical Barrier. Department of Obstetrics & Gynecology , University of Indonesia , Jakarta , 22 Sept. 2010

Practice Points
When counselling men and women about
contraception, remember that there are many
different methods available
Balanced messages, giving the advantages
and disadvantages of oral pill, lead to greater
user acceptability and continuation. Emphasis
should be placed on the safety, efficacy & non
contraceptive benefits of Yasmin.

Affandi B. Oral Contraceptive Pills & Weight Gain, FKUI/RSCM, April 2008

Good clinical decisions are founded

on 3 essential elements:
Experience
Perspective
Evidence
Providers bring experience, perspective and evidence from their education
and clinical practice in specific communities.
Patients bring their own experience and perspectives, coloured by issues
such as geography, finance, culture and spirituality.

It is in this context and not in isolation, that available evidence

informs decisions.
Affandi B. Oral Contraceptive Pills & Weight Gain, FKUI/RSCM, April 2008

Knowing
is not enough, we

apply
Willing is not
enough, we must do
must

Goethe