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Nursing Tutor
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Contraceptive methods
I. Spacing methods
1. Barrier methods
(a) Physical methods
(b) Chemical methods
(c) Combined methods
2. Intra-uterine devices
3. Hormonal methods
4. Post-conceptional methods
5. Miscellaneous
1 Male sterilization
2 Female sterilization.
Barrier methods
Physical methods:
2. Diaphragm
3. Vaginal Sponge
Condom
Male Condom is the most widely known
and used barrier device by the males
around the world.
In India, it is better known by its trade
name NIRODH, a sanskrit word, meaning
prevention. Condom is receiving new
attention today as an effective, simple
"spacing" method of contraception,
without side effects. In addition to
preventing pregnancy, condom protects
both men and women from sexually
transmitted diseases.
Condom prevents the semen from
being deposited in vagina.
Easily available
Safe and inexpensive
Easy to use
Don’t require medical supervisions
No side effect
Light compact and disposable
Provide protection against pregnancy as well as STDs.
Disadvantages
Practice at insertion, privacy for this to be carried out and facilities for
washing and storing the diaphragm precludes its use in most Indian
families, particularly in the rural areas. Therefore, the extent of its use
has never been great.
Disadvantages contd…
1. Non-medicated
2. Medicated
are usually made of polyethylene or other polymers; in addition, the
medicated or bioactive IUDs release either metal ions (copper) or
hormones (progestogens).
Non Medicated Intra uterine devices
pregnancy
The Planned Parenthood Federation of America (PPFA has described the ideal IUD
candidate as a woman :
After childbirth
• immediately after delivery of placenta
(post-placental insertion)
• four to six weeks after childbirth
After spontaneous or induced abortion
• immediately after 1st trimester abortion (aseptic).
• after 2nd trimester abortion it is advisable to wait till involution of
uterus is complete.
Menstrual cycle
• can be inserted any time, during menstrual cycle, if reasonably sure that
woman is not pregnant and has not been having sex without contraception.
• insertion during menstruation offers following advantages :
– pregnancy is ruled out
– insertion is easier due to open cervical canal
– any minor bleeding caused by insertion is less likely to upset the client
Information to the client after Copper T insertion
She can expect some cramping for a day or two after insertion, vaginal
discharge for a few weeks after insertion and slightly heavier menstrual period
with possible bleeding between the menstrual periods during first few months
after insertion
follow-up visit after 3-6 weeks or after next menstrual period to ensure that
IUD is in place and no infection has developed.
information about kind of IUD and when to have her IUD removed or
replaced.
when she should see a nurse or
doctor after IUD insertion?
Hormonal contraceptives currently in use and/or under study may be classified as follows:
A. Oral pills
1. Combined pill
2. Progestogen only pill (POP)
3. Post-coital pill
4. Once-a-month (long-acting) pill
5. Male pill
Classification contd…
1. Injectables
2. Subcutaneous implants
3. Vaginal rings
Combined pill
The combined oral contraceptive pill is often just called "the pill". It
contains artificial versions of female hormones oestrogen and
progesterone, which are produced naturally in the ovaries.
If sperm reaches an egg (ovum), pregnancy can happen. Contraception
tries to stop this happening usually by keeping the egg and sperm apart
or by stopping the release of an egg (ovulation).
The combined pill is one of the major spacing methods of contraception.
The "original pill" which entered into the market in the early 1960s
contained 100-200 mcg of a synthetic oestrogen and 10 mg of a
progestogen. Since then, a number of improvements have been made to
reduce the undesirable side-effects of the pill by reducing the dose of both
the oestrogen and progestogen.
At the present time, most formulations of the combined pill contain
no more than 30-35 mcg of a synthetic oestrogen, and 0.5 to 1.0 mg
of a progestogen. The debate continues about the minimum effective
dose of the progestogen in the pill which will produce the least
metabolic disturbances.
When to take Combined pill
The standard way to take the pill is to take 1 every day for
21 days, then have a break for 7 days, and during which
menstruation occur. When the bleeding occurs, this is
considered the first day of the next cycle.
The pill should be taken everyday at a fixed time, preferably
before going to bed at night. The first course should be started
strictly on the 5th day of the menstrual period, as any deviation in
this respect may not prevent pregnancy. If the user forgets to take
a pill, she should take it as soon as she remembers, and that she
should take the next day's pill at the usual time.
Types of pills
Mala-N
Mala-D
It contains Levonorgestrel 0.15 mg and Ethinyl estradiol 0.03 mg.
Mala-D in a package of 28 pills (21 of oral contraceptive pills and 7
brown film coated 60 mg ferrous fumarate tablets) is made available to
the consumer under social marketing at a price of Rs. 3 per packet.
Mala-N is supplied free of cost through all PHCS, urban family welfare
centres, etc.
Progestogen-only pills
Injectable contraceptives
DMPA
Progesterone and estrogen
DMPA-SC
NET-EN
104mg
150 mg/every 3 months
200mg/every 2months
Side effects
Unpredicted bleeding
Amenorrhea
Anxiety
Contraindication
Breast cancer
Genital cancers
Undiagnosed uterine bleeding
High blood pressure
Cardiac abnormality
Breast feeding women with a baby less than 6 weeks of age
Advantages
Highly effective
Reversible contraceptive
Combine injectable contraceptives
Menstrual Regulation
Menstrual Induction
Oral abortifacient
Miscellaneous
1. Abstinence
2. Coitus interrupts
3. Safe period
5. Breast feeding
3. Symptothermic methods
Basal body temperature
Cervical mucus method
Symptothermic methods
The doctor first numbs the scrotum of the client with a local anaesthetic.
They then make 2 small cuts in the skin on each side of scrotum to
reach the tubes that carry sperm out of testicles (vas deferens).
Each tube is cut and a small section removed. The ends of the tubes are
then closed, either by tying them or sealing them using heat.
The cuts are stitched, usually using dissolvable stitches that go away on
their own within about a week.
Non-Scalpel Vasectomy (NSV)
The doctor first numbs the scrotum with local anaesthetic. They then make a
tiny puncture hole in the skin of scrotum to reach the tubes. This means they
don't need to cut the skin with a scalpel.
The tubes are then closed in the same way as a conventional vasectomy, either
by being tied or sealed.
There's little bleeding and no stitches with this procedure. It's thought to be
less painful and less likely to cause complications than a conventional
vasectomy.
Misconceptions
Autoimmune response
Psychological
Post operative advise