COURCE: B.

Sc (N) IV Year
MIDWIFERY & OBSTETRICAL NURSING

UNIT:XII- FAMILY WELFARE PROGRAMME

METHODS OF CONTRACEPTION

Dr.LATHA VENKATESAN,PRINCIPAL

Mrs.T.KUMUDHA,VICE PRINCIPAL
 LEARNING OBJECTIVES

The student will be able to:

 define contraception

 enlist the various methods of contraception

 explain the different methods in temporary methods

of contraception

 compare the methods with its merits and demerits

 discuss about the types in permanent methods of

contraception
 INTRODUCTION

Contraception is the intentional prevention of

conception through the use of various devices, sexual
practices, chemicals, drugs, or surgical procedures.
Some barrier methods, like male and female
condoms, also provide twin advantage of protection
from sexually transmitted diseases.
 DEFINITION

The term contraception includes all

measures,either temporary or permanent method
designed to prevent pregnancy due to coital
act.

D C.DUTTA
 METHODS OF CONTRACEPTION

Temporary methods Permanent methods

Barrier method Female sterilization

Natural contraception Male sterilization

Intra uterine devices

Steroidal
contraception
 SPACING METHODS

Barrier methods

Intra uterine devices

Hormonal methods

Post conceptional methods

Miscellaneous
 TERMINAL METHODS

– Male sterilization

– Female sterilization

– The term conventional contraceptive is used to

denote those methods that require action at the time
of sexual intercourse, e.g.,condoms,spermicides etc.
 BARRIER METHODS/OCCLUSIVE METHODS

● A variety of Barrier methods , suitable for both men

&women are available.

● The aim of these method is to prevent live sperm from

meeting the ovum.

● The main contraceptive advantage is the absence of

sideeffects associated with pill &IUD
 ADVANTAGES

Reduction in the
incidence of pelvic
inflammatory

Protection from
sexually transmitted Protection from the
diseases, risk of cervical cancer
 DISADVANTAGES

High degree of motivation

Less effective than either the pill or

the loop .

Effective if they are used

consistently and carefully
 PHYSICAL METHODS

1.CONDOM

2.DIAPHRAGM

3.VAGINAL SPONGE

CONDOM : is an effective simple spacing method of

contraception.In India it is better known by its trade
name NIRODH,a sanskrit word, meaning prevention.
 CONDOM

The condom is fitted on the erect penis before

intercourse & must be held carefully when
withdrawing it from vagina to avoid spilling seminal
fluid in to the vagina after intercourse
Advantages
– Easily available
– Safe &inexpensive
– Easy to use &not require medical supervision
– No side effects
– Light,compact &disposable
– Provides Protection against pregnancy also
against STD
Disadvantages
– It may slip off or tear during coitus due to incorrect
use
– Interfere with sex sensation locally about which
some complain while others get used to it
 FEMALE CONDOM

It is a pouch ,made of polyurethane, which lines the

vagina. An internal ring covers the cervix &an external
ring remains outside the vagina.

Advantage: It is an effective barrier to STD infection.

Disadvantage: High cost &acceptability are the major

problems.
 DIAPHRAGM

It is a vaginal barrier method & also known as Dutch

Cap. It is a shallow cup made of synthetic rubber or
plastic material.

The diaphragm is inserted before sexual intercourse

&must remain in place for not less than 6 hours after
sexual intercourse. A spermicidal jelly is always used
along with the diaphdragm.
DIAPHRAGM
 ADVANTAGES & DISADVANTAGES

 Advantages

 Total absence of risks &medical contra indications

Disadvantages
 Trained person is needed to demonstrate the
technique of inserting the diaphragm

 After delivery it can be used only after the involution

 Possibility of a toxic shock syndrome.

 VAGINAL SPONGE

It is a small polyurethane foam sponge measuring

5cmx2.5cm,saturated with the spermicide,nonoxynol-9

Advantage:

● It doesn't affect hormone level

Disadvantage:

● Less effective than diaphragm & doesn't protect

against the STD
 CHEMICAL METHODS

The commonly used modern spermicides are surface

active agents which attach themselves to spermatozoa

& inhibit oxygen uptake &kill sperms.

FOUR CATEGORIES
1.Foams:Foam tablets ,foam aerosols
2.Creams:Jellies &pastes -squeezed from a tube
3.Suppositories -inserted manually
4.Soluable films-C-film inserted manually.
CHEMICAL METHODS
 NATURAL FAMILY PLANNING METHODS

Coitus
Abstinence Safe period
interrupts

Basal body
Symptothermic Cervical mucus
temperature
method methods
method

Breast feeding
 MECHANISM OF ACTION
• Fertility signs and symptoms observed during
women's menstrual cycles are caused by
changes in women's estrogen and progesterone
levels.
• Estrogen: changes cervical secretion
• Peak day : the cervical secretion will be clear,
sticky, slippery
• Progesterone counteracts action of estrogen
causes the cervical secretion to dry up and form
a mucus plug that prevents sperms from traveling
through the cervix
 INTRA-UTERINE DEVICES

Intrauterine devices are usually made of poly ethylene

or other polymers .
TYPES OF IUD:
• Non-medicated or inert - First generation IUDs
• Medicated iuds or bio active IUDs releases either
metal ions(copper) -Second generation IUDs
• Hormones (progestogens) - Third generation IUDs
FIRST GENERATION IUD

Comprise the inert or non medicated device,usually

made of polyethylene or other polymers.e.g.,Lippes
Loop

SECOND GENERATION IUD

A number of copper bearing devices are now

commercially available.

Earlier devices: Copper-7, Copper-200

Newer devices: T Cu-220,T Cu-380 A

•
 INTRA-UTERINE DEVICES

 Multiload devices:ML-Cu-250,ML-Cu-375
 The newer copper IUDs-Multiload devices &variants
of the T devices offer the further advantage of having
an effective life of at least 5 years .
 They can be left in place safely for the time ,unless
specific medical or personal reasons call for earlier
removal.
 ADVANTAGES OF COPPER DEVICES

Low expulsion rate

lower incidence of side effects,e.g.,pain&bleeding

Easier to fit even in nullipara

Better tolerated by nullipara

Increased contraceptive effectiveness

Effective as post-coital contra ceptives,if inserted
within 3-5 days of unprotected intercourse
 THIRD GENERATION IUD

 Hormonal devices which release hormone slowly.

 E.g., progestasert (T-shaped device filled with 38 mg

of progesterone the natural hormone)

 LNG-20 (releasing 20 mcg of levonorgestrel)

 The levonorgestrel releasing IUD has an effective life

of 10 years.
 MECHANISM OF ACTION OF IUD

• The IUD Causes a foreign –body reaction in the

uterus causing cellular &biochemical changes in the
endometrium &uterine fluids &it is believed that these
changes impair the viability of the gamete &thus
reduce its chances of fertilization
• Medicated IUDs produces other local effects &
Copper ions may affect sperm motility by altering the
biochemical composition of cervical mucus
 MECHANISM OF ACTION OF IUD

• Hormone- releasing devices increases the viscosity

of cervical mucus &thereby prevent sperm from
entering the cervix.

• Maintain high levels of progesterone & low levels of

oestrogen ,thereby sustaining an endometrium
unfavourable to implantation
 ADVANTAGES

Simplicity in insertion procedure

No hospitalization is required,
Takes only few minutes
Long lasting as required
Inexpensive
No side effects associated with hormonal
pills
Highest continuation rate
No need of motivation to take pill daily
 CONTRAINDICATIONS

ABSOLUTE RELATIVE

Suspected pregnancy Anemia

Menorrhagia
PID PID
Vaginal bleeding Purulent cervical
discharge
Ca cervix,uterus Distortions of uterine
&adenexa cavity due to congenital
mal formation
Ectopic pregnancy Unmotivated person
IDEAL CANDIDATE FOR IUD INSERTION

Having at least
one child

Monogamous No history of
relationship PID

Access to have Normal

treatment menstrual cycle

Willing to come
for follow up
 TIMINGS OF INSERTION

• Any time during a woman’s reproductive years except

during pregnancy
• During menstruation or 10 days of the beginning of a
menstrual period
• During the first 48 hours after delivery before the woman
leaves the hospital (immediate postpartum insertion)
• A convenient time for loop insertion is 6-8 weeks after
delivery (post puerperal insertion)
• Immediately after a legally induced first trimester abortion
SIDE EFFECTS & COMPLICATIONS

Bleeding

Expulsion Pain

Ectopic pregnancy Pelvic infection

Uterine perforation
 HORMONAL CONTRACEPTIVES

Oral pills
 Combined pills
 Progestogen only pill (pop)
 Post-coital pill
 Once-a-month pill
 Male pill
Depot (slow release) formulations
 Injectables
 Subcutaneous implants
 vaginal rings
 ORAL PILL-COMBINED PILLS

• 30-35mcg of synthetic oestrogen,&0.5-1.0 mg of

progestogen.

• The pill is given orally for 21 consecutive days

beginning on the 5th day of the menstrual cycle
followed by a break of 7 days during which period
menstruation occurs.
 ORAL PILLS

• 2 types of low dose oral pills are available under

names of MALA-N &MALA-D.

• It contains LevoNorgestrol 0.15 mg &Ethinil oestradiol

0.03 mg.
 PROGESTOGEN-ONLY PILL (POP)

• Commonly referred to as minipill or micro pill

• It contains only progestogen, which is given in small
doses throughout the cycle.
• Commonly used progestogen are Norethisterone &
levonorgestrel
 MODE OF ACTION

•It acts by inhibiting ovulation

•Producing static endometrial hypoplasia
•Alteration in character of cervical mucosa
•Interferes with motility and secretion of fallopian
Tube
 MALA -N & MALA -D

•100 to 200 mcg of synthetic oestrogen and 10 mg

Progestogen
•Mala N and mala D
•It contains levonorgestrel 0.15mg and ethinil
oestradiol 0.03mg.
•Currently lipid friendly are available (desogesterol)
 POST COITAL CONTRACEPTION
(EMERGENCY CONTRACEPTION)

Post-coital or morning after contraception is

recommended within 48 hours of an unprotected
intercourse.

Two methods are available

a)IUD

b)Hormonal : high doses of oestrogen(diethyl –

stillbestrol 50 mg daily in divided doses for 5 days

Once –a-month (long-acting) pill
• Quinestrol ,a long acting oestrogen is given in
combination with a short acting progestogen.
Male pill
• A male pill made of gossypol –a derivative of cotton –
seed oil is effective in producing azoospermia or
severe oligospermia, but as many as 10 percent of the
men may be permanently azoospermic after taking it
for 6 months.
 MODE OF ACTION OF ORAL PILLS

The mechanism of action of the combined oral pill

is to prevent the release of ovum from the ovary by
blocking the pituitary secretion of gonadotropin that is
necessary for ovulation to occur.
 ADVANTAGES

100 percent effectiveness in preventing pregnancy

Give protection against benign breast disorders

including fibrocystic disease ,fibro adenoma,ovarian
cysts,iron deficiency anemia,PID,ectopic pregnancy
&ovarian cancer
 ADVERSE EFFECTS

Cardiovascular effects Carcinogenesis- cancer

– myocardial infarction cervix
– cerebral &venous
Common effects
thrombosis
– breast tenderness
– elevation of blood pressure
– weight gain
Metabolic effects
– alter lipid & Carbohydrate – head ache & bleeding

metabolism disturbances
 CONTRA INDICATIONS
Absolute
• Arterial or venous
thrombosis
• Severe hypertension
• Ischemic heart disease
• Diabetes with vascular
complications
• Disease of liver
• Pregnancy & Breast cancer
Relative
• Age more than 40
• Smokers
• History of jaundice
• Sickle cell disease
• Post breast cancer
• Sickle cell disease
 DEPOT FORMULATIONS

Injectable
contraceptive

Vaginal rings Subdermal implants

 INJECTABLE CONTRACEPTIVES

• PROGESTAGEN-ONLY INJECTABLES
a.DMPA (Depot-medroxy progesterone acetate)

Intramuscular inj.150 mg every 3 months

b.NET-EN (Norethisterone enantate)

Im ,200 mg every 2 months

• Inhibition of ovulation by supressing the LH peak

• Cervical mucous becomes thick there by

preventing sperm penetration
COMBINED INJECTABLE CONTRACEPTIVES

It contains both estrogen and progestin

Preparations available are:

• DMPA 25mg with oestradiol

• NET –EN 50mg with oestradiol valerate 5mg

 TIME FOR FIRST INJECTION

• During the first five days of menstrual cycle

• Injection site should not be massaged given over

the gluteal muscles

Draw backs:

• Irregular bleeding

• Not suitable for nursing mothers

 IMPLANTS

• Implants are birth control

devices inserted under
the skin
 Implanon

 Norplant ll

 Uniplant

 Lng rod

implanted in a non dominant hand

 VAGINAL RING

VAGINAL RING
LNG RING IUD (LNG)
COMBINED RING
 VAGINAL RING

It contains levonorgestrel delivers 20 micro grams

of levonorgestrol / day
It should be replaced every one month
ACTION-Stop ovulation & Thickening of cervical
mucus
TIME OF INSERTION : First 5 days of periods,
ring can be placed inside for 3 weeks, Insert a new
one after 7 days of removal of last one
 TRANSDERMAL DELIVERY SYSTEMS

Nestorone (newer progestin)

 150 microgram of (progestin) and 20 micro
gram ethinyl oestradiol daily
Patches releases estrogen and progestin through
the skin preventing ovulation thickening the
cervical mucus and suppressing endometrial
growth
 TERMINAL STERLIZATION

It is a surgical method of contraception where the

reproductive function of an individual male or
female is purposefully and permanently destroyed.
 VASECTOMY

It is a permanent sterilization operation done in

the male where a segment of vas deference of
both the sides are resected and the cut ends are
ligated
After three months he need to go for confirmation of
procedure by semen analysis
 TUBECTOMY

It is an operation where resection of a segment of both

the fallopian tubes is done to achieve permanent
sterilization
 POMEROY’S METHOD

 Partial salpingectomy
Loop is formed by holding with
Allis tissue forceps
Isthmus &part of the ampulla
hold out
Base of the loop tied with the
suture
Cutting of the loop above the
tied Knot
 MADLENERS METHOD

•The loop of the area is crushed with artery forceps

crushed area is tied with black silk

•The loop is not excised

•Here the failure rate is high

CAUTERIZATION
 COMPLICATIONS

 Operative : pain, scrotal haematoma & local infection

 Sperm granules :Accumulation of sperm causes pain

& swelling (granuloma)

 Spontaneous recanalization

 Auto immune response

 Psychological : Decreased libido - diminished

sexual desire,impotence,headache,fatigue ,
 CONTRACEPTIVE EFFECTIVENESS

The failure rate of any contraceptive is calculated

in terms of pregnancy rate per hundred women in
years (hwy) of use. Pearl index

Number of accidental
pregnanciesx1200
Pregnancy failure rate/H.W.Y
Number of patients
observed x months of use
 SUMMARY

Birth control, also known as contracepion, which

permanently prevents a woman from getting pregnant
or a man from being able to get a woman pregnant,
include temporary measures such as spacing methods
& permanent measures such as vasectomy for men
&tubal ligation in women mainly to improve the health
and economical status of our country
 REFERENCE

• Park K. Text book of preventive and social medicine,

22nd edition,. M/S banarasidas bhanol publisher,
1168, prem nagar, jabalpur,. India ...

• D.C dutta text book of obstetrics 6th edition 2006 new

central book agency publications .

• Annama jacob text book of midwifery and

gynaecological nursing 3rd edition jaypee publications