FAMILY PLANNING

Methods of Contraception

-Personal values

– Ability to use a method

Reproductive Life Planning correctly
• All the decisions an individual or – How the method will affect
couple sexual enjoyment

make about whether and when to

– Financial factors
have children, how many
– Status of couple’s

children to have, and how they

relationship
are spaced

– Prior experiences

– Future plans

Hormonal Contraception

Hormones that cause fluctuations in a

normal cycle that ovulation does not occur

Ideal Contraceptive

• Safe

• 100% effective

• Compatible with religious, cultural

beliefs, personal preferences of both

the user and sexual partner

• Free of side effects

• Convenient to use and easily

obtainable Depo-Provera (DMPA)

– Progestin-Only- – Combined
• Affordable and needing few Oral
Pills (POP)
instructions for effective use Contraceptives
• Free of effects after discontinuation
(COC)
and on future pregnancies


Combined Oral Contraceptives
Depo-Provera (DMPA) Progestin-Only-Pills (POP)
(COC)

• Oral contraceptives containing only also known as “pills” • Contains of
progestin

• Also known as mini-pills
natural estrogen (estradiol),
synthetic estrogen (ethynil estradiol) &

• Consist of 28 active pills, no placebo small amount of synthetic progesterone

• Should be taken everyday, even with (progestin)
menstrual flow

Benefits (Mini-pills) 21-day pills (estrogen &

Injection Hormonal Contraceptive • The progesterone content thickens

progesterone)
• 28- day pills (Estrogen, Progesterone
cervical mucus and helps prevent
& placebo)
• A single intramuscular injection of sperm entry into the cervix

• Prescribed after a pelvic examination
and Papanicolaou (pap smear)
medroxyprogesterone acetate • Ovulation may occur, but the

(DMPA) (depo-provera) endometrium does not develop fully,

implantation will not take place

• For ovulation suppressants to be
effective, women must take them
• Could be taken during breastfeeding,
consistently and conscientiously
• A progesterone given every 12
weeks to inhibit ovulation, alters the
because it does not interfere with milk

production • Taking pills at bedtime eliminates

endometrium and changes the

nausea

cervical mucus

Advantage (Mini-pills)
Contraceptive Benefits of Oral
Contraceptives
• Depo-provera contains only
• For woman who cannot take an

estrogen (danger of
progesterone, can be used thrombophlebitis), they could take this
• Estrogen – acts to suppress FSH and
during breastfeeding
mini-pills with high level of assurance LH, thereby suppressing ovulation
of effectiveness

• Reminder: do not massage

Disadvantage • Progesterone – causing a decrease in
after administration (absorb
(Mini-pills) the permeability of cervical mucus,
slowly from the muscle)
thereby limiting sperm motility and

• They could cause bleeding than
access to ova
Advantageous Effects of combination pills
• Progesterone, interferes with tubal
Depo-Provera
transport and endometrial
proliferation to such an extent

• Reduction in ectopic pregnancy,

endometrial cancer, endometriosis, decrease possibility of

reduction in frequency of sickle cell implantation

crisis

Non-contraceptive Benefits of Oral Contraceptives

Disadvantages of Depo-
Provera • Decreased incidence
– Dysmenorrhea ( due to lack of

• The woman must return to the health ovulation)

12 months care provider for a new injection

every 12 weeks for a method to remain

reliable

– Premenstrual dysphoric syndrome

and acne (due to increased level of
• Return to fertility often delayed by 6 –12
progesterone)
months

Side Effects of Depo-Provera

– Iron deficiency anemia (due to reduce

amount of blood flow)
• Irregular menstrual cycle
• Headache

• Weight gain
– Acute pelvic inflammatory disease
• Depression
(PID) and resulting tubal scarring
• May impair glucose tolerance in

women at risk for diabetes

• Increase the risk for
– Endometrial and ovarian cancer, ovarian
osteoporosis
cysts and ectopic pregnancies
from loss of bone mineral density

Intrauterine Devices

– Fibrocystic breast disease

Male Condoms
(IUD)
– Possibly osteoporosis, endometriosis,
• Small plastic object that is inserted uterine myomata (fibroid uterine tumors) and
into the uterus through the vagina

progression of rheumatoid arthritis

• To prevent fertilization as well as

creating a local sterile inflammatory – Colon cancer

condition that prevents implantation

Side Effects of COC
• When copper is added it decreases
• Nausea

the possibility of sperm to cross the

uterine space and reach the ovum • Latex rubber or synthetic • Weight gain

types of ICD: sheath that • Headache

is placed over the erect • Breast tenderness

• Breakthrough bleeding
penis before

• Monilial vaginal infections

coitus to trap sperm

• Mild hypertension

• Depression

Copper –LNG-IUS Advantages of

T380 – a (mirena) Contraindications to Oral Contraceptives
T-shaped • Both
Male Condoms • Breastfeeding and less than 6
device • “Male responsibility” birth control weeks
copper T
measures available postpartum
wound with and Mirena

copper hold the • Age 35 years and smokers

• No health care visit or prescription

progesteron • Multiple risk factors for arterial

needed

e reservoir in cardiovascular disease

the stem • Helps in preventing spread of • Elevated BP

• Progesterone gradually diffuses to prevents sexually transmitted infections (STI’s) • Current history of deep vein

endometrium proliferation and thickens cervical mucus

especially HIV
thrombosis (DVT) or pulmonary
• The mirena type is effective for 5 years
embolism
.copperTis effective for 10 years Male Condoms
• Major surgery that requires
• To be effective, condoms must be
prolonged
Advantages of IUD
applied before any penile-vulvar
immobilization
• One insertion is necessary contact

• No continuing expenses
• Should be positioned that the loose
• Current history of IHD
• Does not require daily attention or interfere with

portion is at the tip of penis to collect • Stroke

sexual enjoyment

• Appropriate for woman who are at risk with COC’s the ejaculate • Complicated valvular heart
• May create lighter or fewer periods

• It must be withdrawn before the penis disease

Side Effects of IUD begins to become flaccid • Migraine with focal

• Some spotting or uterine cramping (1st 2 or 3

neurologic
weeks after IUD insertion)
Contraindication and Side
• Higher risk for Pelvic Inflammatory

symptoms and 35 years old
disease Effects of Male Condoms
• Heavier than usual menstrual flow for 2 or 3
and older
months
• Experience more dysmenorrhea

• Current breast cancer
Contraindications of IUD

• Sensitivity to • Diabetes with

• Woman whose uterus is distorted in shape
nephropathy,
• Women with valvular heart disease latex
retinopathy, vascular
• Women who are anemic

disease, 20 years
• Not recommended for women with an
duration
increased risk of STI’s
• Not recommended for women who have
• Severe cirrhosis
never been pregnant

• Woman who have a history of PID • Liver tumors



surgical methods of

family planning

Vasectomy

Tubal Ligation

• Fallopian tube are occluded by
• Small incision or puncture wound is
cautery, crushing, clamping or
made on each side of scrotum
blocking, thereby preventing passage

of both sperm and ova
• Vas deferens is cut and tied, cauterized

or plugged, blocking the passage of

• Abdominal incision (BTL)
spermatozoa under local anesthesia

.Laparoscopy
• The sperm in the remain in vas

deferens will be viable till 6 months

• Should be done after a menstrual flow

and before ovulation
• Additional birth control method should

be used until negative sperm reports

• Under general or local anesthesia
about 10 – 20 ejaculations

Posttubal Ligation Syndrome
• Followed by ejaculation of seminal fluid

• Vaginal spotting
Complication of Vasectomy

• Intermittent vaginal bleeding

• Severe lower abdominal cramping

• Hematoma at the surgical site

• Development urolithiasis
• Chronic pain
• Some men develop autoimmunity or
form antibodies against sperm