FAMILY PLANNING NATURAL METHOD These family planning methods predict the fertile days of each menstrual cycle and advise sexual abstinence during these days STANDARD DAYS METHOD The couple must avoid unprotected intercourse during cycle days 8 through 19 A prerequisite is a regular monthly cycle of 26 to 32 days; othemmise, iis not very successful They may use cycle-beads or may mark the calendar to identify the fertile days ‘CALENDAR RHYTHM METHOD The woman must count the number of days in her shortest and longest menstrual cycle during a 6-to 12-month span Eleven days are subtracted from the longest cycle duration to identify the last fertile day. While, eighteen days are subtracted from the shortest cycle duration to calculate the first fertile day. During the interval of these fertile days, unprotected sexual intercourse must be avoided. TEMPERATURE RHYTHM METHOD This method predicts the day of ovulation by detecting a slight change in basal body temperature of around 0.4°F days before the ovulation Itis most effective when the couple abstains for unprotected sexual intercourse from the first day of menstruation until the 3° day of increased basal body temperature CERVICAL MUCUS METHOD BILLINGS METHOD: Abstinence is advised from the frst of menstruation until 4 day of slippery mucus discharge. . TWO-DAY METHOD: The woman isnot fertile if she did not note mucus discharge on the day of intercourse or the day prior - SYMPTOTHERMAL METHOD: This combines the cervical mucus method to identify start of fertile period and basal body temperature method to identify end of fertile period. Itentails more complex application but does not necessarily improves the failure rate. 3. Famity PLANNING | 17‘TABLE~3.1. When to Start the Different Family Planning Methods early METHOD ene ba Y Not advised First day of menstruation * Quick start: onthe dayof | prescription but with at method for fist? days |» Sunday statist Sunday ter onset of menstation bt wis altemaive method forts do Combination Oral erating Contraceptive Pills not exclusively breastfeeding, start 3 weeks postpartum, For mothers who are breaste ding exclusively, ovulation during the fist 10 weeks atter delivery is unlikely The timing of initiation of Within 5 days of menstruation DMPAis controversial in breasteding patients. Depot medroxyprogesterone _| The World Health Organization acetate (DMPA) recommends thatinjetable depot medroxyprogesterone acetate should not be used Progestin Only Fill before 6 weeks postpartum. Implant Before discharge Within 5 days of menstruation 7 week postpartum or when “Anytime inthe cle Intrauterine Device uterine involution is completed at 3 to 6 weeks postpartum Progesterone only regimen as | « Combined regimen or progesin soom as possible after unprotected | only ssoanas posible ater intercourse until 72 hours after unprotected intercourse until 72 hours after ‘Yuzpe Regimen/Emergency + 4 low dose pills within 72 Contraception hsafter unrpotected coitus followed by another 4 lon dose pills ater 12 bs *# OR: 2 high dose pills followed by another 2 pil after 12h Lactational Amenorthea Immediately postpartum Not applicable | VI. COMBINATION ORAL CONTRACEPTIVE PILLS > Mechanism of Action Estrogen Suppresses FSH thereby blocking ovulation Stabilizes endometrium which prevents breakthrough bleeding Progesterone ‘Suppresses LH Thickens cervical mucus Renders endometrium unfavorable for implantation 18 | PERINATAL CARE2 eee cee DD eee ere eee . Administration Pill is taken daily, ideally at the same time each day. The hormone pills are taken for a specified time followed by placebo pills, where withdrawal bleeding is expected. The duration of time taking the hormone, or the placebo depends on the product regimen. Contraindications Previous stroke Prior MI Hypertension ‘Smokers Older age>35 years old Diabetes Thrombophilia Migraine headaches with visual aura or other focal neurologic signs Active hepatitis Side Effects Altered drug efficacy Increase, total cholesterol, HDL, VLDL, decrease LDL Increase fibrinogen and clotting factors Increase angiotensinogen production Increase sexhormone binding globulin levels Increase Té and thytoid-binding proteins Increase risk of stroke, myocardial infarction, VTE, and pulmonary embolism in those with risk factors prior to pill use Cholestasis and cholestatic jaundice Benefits Increased bone density Reduced menstrual blood loss and anemia Decreased risk of ectopic pregnancy Improved dysmenortheal from endometriosis Fewer premenstrual complaints Decreased risk of endometrial and ovarian cancer Reduction in various benign breast diseases Inhibition of hirsutism progression Improvement of acne Prevention of atherogenesis Decreased incidence and severity of acute salpingitis Decreased activity of rheumatoid arthritis 3. Famity PLANNING | 1920 ‘VII. PROGRESTIN ONLY PILLS > Mechanism of Action Cervical mucus thickening Endometrial atrophy = Administration The minipil shouldbe taken each day, strongly advised to be taken atthe same time each if delayed for 4 hours, another contraception method should be done forthe next 48 hous, 2 Contraindications Pregnancy © Livertumors Breast cancer * SLE Component allergy © APAs Severe, decompensated cirrhosis Side effects Irregular menstrual bleeding Weight gain Loss of bone mineral density Benefits Does not affect milk production in lactating mother meee ‘Vill, LACTATIONAL AMENORRHEA > Physiologic Basis The prolactin hormone, responsible for milk production, also suppresses the FSH and LH thereby inhibiting the return of normal menstrual cycle including ovulation All conditions must be present to use lactational amenorrhea as contraceptive Menstruation has not yet returned Infantis less than 6 months old Infantis fully breastfed most of the time Benefits No cost No side effects Promotes breastfeeding which is beneficial to both mother and child DP eee PERINATAL CARE