CONTRACEPTIVE UPDATE

By

E. Ejiro Emuveyan
Professor of Obstetrics & Gynaecology
Department of Obstetrics & Gynaecology
College of Medicine, University of Lagos
P.M.B. 12003
Lagos
MALTHUSIAN CONCERNS

 TOO MANY PEOPLE REPRODUCING TOO RAPIDLY

 RETARDS ECONOMIC GROWTH

 DESTROYS THE ENVIRONMENT

 OVERSTRETCHES SOCIAL SERVICES

 EXACERBATES POVERTY

 FUELS CONFLICT
WORLD POPULATION
PROFILE 1
Beginning of last century 2b

1970
 4b

2000
 6b

Rate of increase
 1.6%

Estimated doubling time

 42 yrs
World Population Profile 2
 1/3 under 15 years of age

 25% live in developed or industrialised countries with low fertility

rates

 75% live in less developed countries that are characterized by high

fertility rates, high maternal and infant mortality and low life
expectancy

 Number of women in reproductive age increased between 1990 and

2000 by about 200m posing great challenge to scientific community

 Need therefore for increased methods of infertility regulation

Indications for family planning

Individual


Spacers


Limiters


Avoid childbearing because of severe disease in
pregnancy


Pregnancy is life threatening to the mother as in case of
severe aortic stenosis
For all Indications, providers of Family
Planning


Must provide accurate information about benefits and risks of:
(i) Pregnancy
(ii) Contraception


To be noted specifically are:


Medical conditions that may substantially increase risk of some form
of birth control usually increase the risk associated with pregnancy to
an even greater extent.


Policy some less developed countries promote contraception in an
effort to curb undesired population growth.
Fertility Control


Most sensitive and intimate decision


Religious or philosophical convictions

 Clinician approach it with sensitivity

 Empathy, maturity and non-judgmental behaviour

How Socio-Economic Changes Affect
Contraceptive Practice

 Adolescents experiencing higher pregnancy rates

 Women in later stages of reproductive lifespan now

tending to delay childbearing until in their 30s and 40s.

 Demographic Shift more women aged 30-44 years than

those aged 15-29 years. needs of women with divergent
social or economic circumstances.
CONTRACEPTIVE PREVALENCE

Worldwide (1991)-38.1m (51%) use effective methods

Nigeria (1998) 6%
Ghana 20%
Benin 9%
Guinea-Conakry 2%
Kenya 33%
Tanzania 16%
HISTORY OF FAMILY PLANNING

 Religious and Moral Issues

 Natural Family-Planning
 Coitus interruptus - Oldest method (17th century)
 Abstinence - Total/Periodic

 Rev. Thomas Malthus - One of the founding fathers.

 1864 - Gabriel Fallopio - Linen Sheath for Coitus.

BACKGROUND HISTORY CONTINUES

 STONES IN THE WOMB OF CAMELS

 1880 - CHEMICAL AGENTS AND MECHANICAL

DEVICES (INTRAVAGINAL AND INTRAUTERINE)

 1977 - IPPF - OVER 100 COUNTRIES

METHODS

CLASSIFICATION
TRADITIONAL OR FOLK
- Coitus Interruptus
- Post coital Douche
- Lactational Amenorrhoea
- Periodic Abstinence (Rhythm, Natural Family Planning)

BARRIER
- Condom(Male and Female)
- Diaphragm
- Cervical Cap
- Vaginal Sponge
- Spermicides
METHODS

HORMONAL
- Oral
- Injectable
- Implantable Long-Acting Progestins

OTHER CONTRACEPTIVES
- IUCD
- Sterilisation
- Tubal Ligation
- Vasectomy
NATURAL CONTRACEPTION

A. PERIODIC ABSTINENCE/RHYTHM METHOD

 LONG AND CHEQUERED HISTORY
 FERTIILE PERIOD 2-3 days after ovulation
2 days before no less than 2 days after
 PROMOTED BY CATHOLICS
Types of periodic abstinence
- Calendar method
- Combined temperature/calendar method
- Cervical mucus (Billings) method
- Symptothermal method

Data subject to bias

B. COITUS INTERRUPTUS

 Oldest Method of Reversible Contraception

 Withdrawal before Ejaculation. Demands Sufficient Self

Control

 Statistics not reliable

 Failure rate - 10 Preg/100 Women Years

C. LACTATIONAL AMENORRHEA METHOD

 Women Less Fertile When Nursing

 Exclusive Breast Feeding for Six Months Supplemental

Feedings Alters Patterns Of Lactation/Intensity Of
Infant Suckling.

 Amnenorhoea Must Be Maintained

 2% Pregnancy Rate If Properly Used.

HISTORY OF ORAL CONTACEPTION

HISTORY
19th Century- Lack of follicular development
in pregnancy
1921 - Ludwig Haberlandt
1929 - Oestrogen Synthesized
1934 - Progesterone synthesized
1959 - First OC (Norethynodrel - Mentranol)
1960 - Progressive lower dose pills.
TYPES

(A) Combined Oral Contraceptives (COCS).

Sequential - E Pill 15-16 days followed E/P for 5 days
Problem: Than normal incidence of
endometrial cancer
Phasic - Monophasic, Biphasic, Triphasic
28 days regimen (last 7 days placebo)

(B) Progesterone only pill/Minpill (POP)

Taken everyday (Microdose nonstop
progestins)
Efficacy less than that of COC and occasional causes
amenorrhoea

(C) Post Coital Contraceptive pill/morning - After

pill
 E only Yuzpe, Danazol, Mesopristone
 Follow up and initiate another
contraceptive method
USAGE & FAILURE RATES

 60 m current users worldwide

 Affected by age, family size, Politics

 FAILURE RATES
 COC 0.2 - 1 per 100 woman years
 POP 0.3 - 5 per 100 woman years
PCC varies with types
STANDARD DAYS METHOD

General information:
• You keep track of your menstrual cycle to know the days you can get
pregnant (fertile days).
• Ideal for women whose menstrual cycles are usually between 26-32 days
along.
• You use a calendar or Cyclebeads, a string of color-coded beads, to track
the days you can get pregnant, you must not likely to get pregnant.
• On the days you can get pregnant, you must abstain from having
unprotected sex, or you can use a condom or other barrier method.
• Safe for a woman with HIV/AIDS, even if she takes antiretroviral (ARV)
medicines.
• Does not protect against sexually transmitted infections (STIs), including
HIV.
• Requires partner’s cooperation
Effectiveness for pregnancy prevention: Pregnancy rate in
first year of use is:

- Correct use (no unprotected sex on fertile days) – 5

pregnancies per 100 women (5%)
- Typical use – 12 pregnancies per 100 women (12%)
How method works:
• Mark a calendar or use CycleBeads to attack the days when
you can get pregnant. You also track the days when you are
not likely to get pregnant.
• The days you can get pregnant are days 8 to 19 of your
menstrual cycle.
• On those days, you must abstain from having vaginal sex to
avoid getting pregnant, or you can also use a condom or other
barrier method.
Important facts:

There are no costs and no supplies needed.

• Allows you to adhere to religious or cultural norms about contraception.
• You will need counselling on how to use the method correctly.
• During the 12 days when you can get pregnant, you must abstain from
unprotected sex or use a barrier method. This may be difficult for some couples.
• Does not protect against STIs, including (HIV).
• Use condoms (male or female) if you feel at risk for STIs, including HIV.

Method not advised if you:

• Do not have menstrual cycles that are between 26 to 32 days along.
• Are not willing or able to abstain from sex or use a condom or other barrier
method during the days you can get pregnant.
• Cannot keep track of the days of your menstrual cycle.
• Have not had at least 3 consecutive menstrual cycles since giving birth.
• Have not resumed menstruation after discontinuing a hormonal method.
Side effect: None

How to use:
If using CycleBeads:
Each bead represents day of your menstrual cycle. The RED bead
marks the first day of your monthly bleeding. All BROWN beads
mark the days when you are not likely to get pregnant. All
WHITE beads mark the days you can get pregnant.
1) On the first day of your monthly bleeding, move the black ring to the RED
bead. Also mark that day on a calendar. This will help you remember
where to put the ring if you forget to move it one day.
2) Move the ring to the next bead each day. Always move the ring in the
direction marked by the arrow.
3) Move the ring even on the days you have your monthly bleeding.

4) When the ring is on a BROWN bead, you are not likely to get pregnant.
You can have unprotected sex.
If using CycleBeads continuation

1) When the ring is on a WHITE bead – between days 8 to 19- you can get
pregnant. Abstain from vaginal sex or use a condom or other barrier
method.
2) On the day your monthly bleeding again, move the ring to the RED bead
to start a new cycle. Skip over any beads that are left.
3) There is one DARK BROWN bead, if your monthly bleeding again
before you reach the DARK BROWN bead, your menstrual cycle is
shorter than 26 days
4) If you monthly bleeding does not start the day after you reach the last
BROWN bead, your menstrual cycle is longer than 32 days.
5) If more than once in a year, you have a cycle shorter than 26 days or
longer than 32 days, you should use another method.
If using a calendar:

1) On the first day of your monthly bleeding, mark that day on the
calendar. This is day 1 of your cycle.
2) Days 1 to 7 of your cycle are days when you are not likely to get
pregnant. You can have unprotected sex.
3) Days 8 to 19 of your cycle are days when you can get pregnant if you
have unprotected sex. Abstain from vaginal sex or use a condom or
other barrier method. Some couples use spermicides or withdrawal.
However, these methods are among the least effective.
4) You are not likely to get pregnant from day 20 until your monthly
bleeding begins again. You can have unprotected sex.
5) To know whether the method works for you, always check that you get
your monthly bleeding every 26 to 32 days.
Return to the health care facility any time if:

 You have any questions or problems.

 You have difficulty abstaining from sex or using a condom or other barrier
method during the days you can get pregnant. You may want to choose
another method.
 You get your monthly bleeding before you reach the DARK BROWN
bead. This means that your menstrual cycle is shorter than 26 days.
 You do not get you menstrual bleeding by the day after you reach the last
BROWN bead. This means your menstrual cycle is longer than 32 days.
 You have sex on a day when you can get pregnant (WHITE bead days or
days 8 to 19 on calendar) and want to avoid pregnancy. You can take
emergency contraceptive pills (ECPs).
 You think you may be pregnant.
HORMONAL CONTRACEPTION

HISTORY: 19TH CENTURY TO 1934

Late 19th Century: Ovarian follicles do

not develop during pregnancy

1921 - Ludwig Harberlandt First proposed Hormonal

Sterilisation

1929 - Molecular structure of Oestrogen determined

1934 - Molecular structure of Progesterone determined

FACTORS CONSIDERED TO FIND THE RIGHT
ORAL CONTRACEPTION

1. The constitutional type of the woman on the woman of

somatic and historical data.

2. Tolerance shown towards the hormonal

contraceptives previously taken and the type of side effects
occurred.

3. Contraindications because of health status

(disposition to thrombosis lactation or special conditions (only
occasional sexual intercourse).
Post-coital contraception

Four hormonal methods

1. The combined oral contraceptive pill

2. Oestrogen only

3. Progestogen only

4. Danazol

Only the combined pill is recommended

COMPOSITION AND SIDE EFFECT

Two pills (Eugynon 50 micrograms of ethinyl Oestadiol

and 250 micrograms of Levonorgestrel taken immediately
and same dose repeated 12 hours later.

Side-effects are nausea and vomitting and these can be

alleviated by the concomitant administration of an anti-
emetic.
- method should not be substituted for conventional
contraceptive practice.
- use of hormonal methods of
postcoital contraception are an emergency
procedure and should not be used repeatedly.
Vaginal Contraceptive Pill (VCP)

- Recent

- Undergoing multicentre trials

- Historical evolution from vaginal rings

INTRA-UTERINE CONTRACEPTIVES

Plastic devices placed in the uterine cavity

to prevent pregnancy
Different shapes, sizes and types

MAIN MECHANISM OF ACTION

Interference with implantation
Increase with sperm transport
Inhibit capacitation
TYPES

1. Non medicated (inert) e.g Lippes loop

2. Medicated - less bleeding and pain

(a) CU DEVICES
1st Generation - Cu 7
- Cu T
2nd Generation - Multiload 250
Nova T
3rd Generation - Multiload 375
Cu T 380 A
Flexigard 330
Cu Fix PP 330
Eficacy - 1.5 per 100 woman years

(b) Progesterone Releasing Devices

- Progestasert - levonorgestrel
- Levonova - levonorgestrel
MOST SUITABLE CLIENTS FOR IUCD ARE

- Parous women in mutually

monogamous relationship

- No current or prior history of RTIs

INJECTABLE STEROIDS

Two types are currently in use

DMPA Depot Medroxyprogesterone Acetate (up

john) Supplied in aqueous microcrystalline
suspension150mg/ml in 1ml and 3ml/vials

DNO Depot Norethisterone Oenanthate - derivative of 19

nortestosterone supplied as 200mg/ml in benzyl benzoate and
castor oil in 1ml vials.
Third may be in use in the near future.

CYDCLOPROVERA
MECHANISM OF ACTION

1. Inhibit ovulation by inhibiting the mid-

cycle LH surge and suppresses the cyclic variation
of oestrogen secretion by the ovaries.

2. Inhibit proliferation of the making it to

become thin and atrophic and therefore the
endometrium is unfavourable forimplantation.

3. Makes the cervical mucus to become

thick and scanty thereby inhibiting the
progression of sperm into the uterus.
ADMINISTRATION

I.M buttocks or upper arm

DMPA Must be well shaken before filling

the syringe site of injection must not be rubbed because this
disperses the injection. Amorphous white deposit is left in
the muscle which is slowly absorbed.

DNO Supplied on oily solution more difficult to inject

and may cause some discomfort.
EFFECTIVENESS

100% Effective

Pregnancy rates of 0.0 - 1.2 per 100 women years reported

for 150mg.
DMPA given every 12 weeks and 0.01 - 1.3 per 100 woman
years for 200mg DNO given every 8 weeks.
SIDE EFFECTS

Menstrual Disturbances
1. Frequent and irregular bleeding
71% women of 1st injection
2. Amenorrhoea
54% of woman after 1 year of treatment.
35% have complete Amenorrhoea during at least 1 injection
cycle.
Amenorrhoea cycles becomes less frequent with Noristerat

Management of Irregular bleeding

 With combined oral contraceptive
 Premarin 1.25 - 2.5mg daily x 21 days.
SIDE EFFECTS

3. Weight gain
Result of an increase appetite rather than fluid
retention

4. Delayed return of fertility

6 - 12 months
2 years in extreme cases
Quicker return of ovulation with DNO reported

 Women who have been treated for depression or

have been depressed while taking oral contraceptive
should not use depot contraceptive.
CONTRAINDICATIONS
ABSOLUTE
 Abnormal uterine bleeding
 Secondary amenorrhoea
 Arterial disease
 Cancer of the breast (except where used to treat endometrial cancer
and breast cancer when much larger doses are required)
 Liver disease
 Trophoblastic disease until HCG levels are normal.
RELATIVE
 Abnormal uterine bleeding - a definite established
and possibility of genital malignancy eliminated.
 Depression may be aggravated malignancy eliminated.
 Investigations of carbohydrate metabolism may be distorted.
 Women with history of thrombembolism
 B.P before treatment once controlled, DMPA can be used.
CARCINOGENIC EFFECTS

Animal studies caused concern about

Mammary tomours in female beagle dogs and
discovery of endometrial cancer in two rhesus monkeys
that received 50 times the human dose.
WHO studies after 5 years of use, users have twice risk
of carcinoma in situ
ONCE - A MONTH INJECTABLES IN USE

1. Dihydroxyprogesterone acetophenide (acetophenide 150mg

and estradiol enanthate 10mg).
DHPA/E2-EN “Deladroxate” or Perlutal
2. Deposit-Medroxyprogesterone acetate 25mg and
estraldiol cypionate 5mg DMPA/E2C; HRP11Z “Cyclofem” or
“Cycloprovera.
3. Norethisterone enanthate 50mg and estraldiol valerate
5mg NET-EN/E2V; HRP102 “Mesigyna”
4. 17 & Hydroxyprogesterone caproate 250mg andestraldiol
valerate 5mg Chinese injectible No. 1
REFERENCES
Metabolic effects of once-a-month combined injectible
contraceptives.
Contraception 1994; 49: 421-433
NORIGYNON:
A
COMBINED INJECTABLE CONTRACEPTIVE
Norigynon is a combined injectable contraceptive
that contains
5 mg Estradiol valerate + 50 mg norethisterone
enantate
NORIGYNON
COMPOSITION
NORIGYNON COMPOSITION
Mechanisms of Action

Suppresses ovulation

Reduces sperm transport in

upper genital tract (fallopian
tubes)

Changes endometrium
making implantation less
likely

Thickens cervical mucus

preventing sperm
penetration
Norigynon Injection Schedule
 Monthly Administration
 Can be up to 3 days early or late

 Client can keep appointment card for next

injection
Injection technique
Effectiveness of Norigynon
 In clinical trials, Norigynon has proved to be a
highly effective contraceptive

 12-month failure rates are less than 0.4%

(1/250)
Norigynon: advantages

 Highly effective
 Better cycle control
 Optimal compliance
 Reversible
 Ensures privacy
 Excellent tolerance (natural Estradiol)
Advantages contd

 Reassuring to women
 Regular contact with health services
 Rapid return to fertility
Non-contraceptive Benefits
 Decreases menstrual flow (lighter, shorter periods)
 Decreases menstrual cramps (dysmenorrhoea)
 May improve anaemia
 Favorable metabolic profile (lipid, carbohydrate, liver)
 Protects against ovarian and endometrial cancer
 Decreases benign breast disease and ovarian cysts
 Prevents ectopic pregnancy
 Protects against some causes of PID
Side-Effects & disadvantages
 Irregular bleeding, amenorrhea, heavy bleeding,
prolonged bleeding, headaches, dizziness, body
weight & mood changes.
 Require more frequent injections than POIs.
 Does not protect against STIs, including HIV
Combined Injectables: Safety
 Safety of progestins is well established

 Daily dose of estrogen is small

 Long-term safety information not yet available

 Contraindications based on those for COCs

Eligibility Criteria: who can use

Until sufficient clinical data become

available, the eligibility criteria for the use
of combined injectable contraceptives
are based on data from combined
oral contraceptives
Norigynon: user profile
 Women demanding a “normal menstrual” bleeding
pattern (less bleeding irregularities, less
amenorrhea) and high contraceptive efficacy
Who may use Norigynon?
 Women who want a highly effective easy to use
method
 Women wanting a reversible method
 Women of any age and any parity including
adolescents
 Women who are breast feeding
 Women who want discretion
 Women with sickle cell disease
 Women who can’t tolerate other methods
Who Can Use Norigynon
Women who:
 Are of any reproductive age or parity who want highly
effective protection against pregnancy
 Are breast feeding (6 months or more postpartum) or when
supplementation of infants’ diet begins (if before 6 months)
 Are postpartum and not breast feeding (may begin after third
week postpartum)
 Are post abortion clients (may begin immediately)
 Cannot remember to take a pill everyday
Who Can Use Norigynon contd
Women with:
 Anaemia
 Severe menstrual cramping (dysmenorrhoea)
 Irregular menstrual cycles
 Histories of ectopic pregnancy
Who use Should Not Use
Norigynon (WHO Class 4)
Norigynon should not be used if a woman:
 Is pregnant (known or suspected)
 Is breast feeding (< 6 months postpartum)
 Has ischemic heart disease or stroke (current or
history of)
 Has blood clotting disorders (deep vein thrombo
phlebitis or pulmonary embolism
Who use Should Not Use
Norigynon (WHO Class 4) contd
Norigynon should not be used if a woman:
 Is a smoker and age 35 years or older

 Has diabetes (> 20 years duration)

 Has headaches (migraine)

 Has high blood pressure (> 180/110)

 Has breast cancer

 Has liver tumours

 Has to undergo major surgery with prolonged bed

rest
Combined Injectables
When to begin
 Any time during menstrual cycle
 backup recommended if given after day 7

 Postpartum:
 not breastfeeding: delay 3 weeks
 breastfeeding: delay of 6 months recommended

 Postabortion: immediately
Counseling
 Clients considering the use of injectable contraception
should be clearly informed about the advantages and
disadvantages of the agents, their side-effects, their
cost, and the alternative contraceptive options.
 Where once-a-month injectables are available, clients
should be told about the differences between these
injectables and POIs.
 Women who desire a rapid return to fertility on
discontinuation of their contraceptive should be
advised to use CICs where available or another
method.
Implants

 Synthetic polymers developed to provide

sustained release of contraceptive steroids for
prolonged use.

 Silastic capsules pf progestagens implanted

subcutaneously or subdermally.
Implants

 Can be placed in vaginal rings

In rings problems of erosion/vaginal/cervix/vaginal

infection and inconvenience during S.I

Norplant 6 (six capsules) - 5 years protection

Multicentre trials all over the world including Nigeria
Now approved for use in several countries.

Normogestrol Acetate Uniplant - 1 year protection

multicentre trials all over the world including
Lagos/Ibadan`
CONTRACEPTIVE IMPLANTS

1987 Dr. Sheldon Segal discovered subdermal implants.

Advantages
As for injectables

Disadvantages
As for injectibles
Requires surgical procedure
CONTRACEPTIVE IMPLANTS

(i) Norplant -6 capsules (levonorgestrel)

- inserted inside inner aspect of the
upper arm above the elbow.
- provides 5 years protection
- efficacy 1st year rates 0.2% and
cumulative 5-year pregnancy rate 3.9%
- side effects are time dependent with
the rate declining by about 50% after 1 year.
- no delay in restoration of fertility
(ii) Norplant 2 capsules
(iii) ST 1435 (Nestrone)-Lactation, less lipoprotein
effects.
(iv) Uniplant (Nomegestrel Acetate)
(v) Implanon - 3 Keto-Dessogestrel
BIODEGRADABLE CONTRACEPTIVE
IMPLANTS

- Does not require removal;

(i) Capronor - single; levonorgestrel

(ii) Capronr II
(iii) Capronor III
(iv) Annuelle - 90% Norethindrone + 10%
Cholesterol.

Problems of Nonbiodegradable are those of removal

IMPLANON

 Organon International
 Simple 30 mm silastic rod
 Release the progestin 3 keto desogestrel at a
rate of 30 ug per day
 Effective for two to three years
 Removal is quick and relatively simple
 3 keto-Desogestrel may inhibit ovulation more
than levonogestrel.
Norplant 6
 Norplant subdermal contraceptive the first
represents the efforts of scientists of the Population Council
who licensed Leiras of Finland in 1983 to manufacturue and
distribute Norplant.
 Norplant is a safe, effective method of reversible fertility
regulation.
 Despite this, the apparent major shortcoming is menstrual
disorders which cause about half of all discontinuations.
 The observed menstrual changes though not associated
with a adverse alteration of haematological indices
encouraged further research at the local
mechanism underlying contraceptive induced
endometrial bleeding.
 In view of observed undesirable side effects, appropriate
counselling of potential acceptors is recommended as well
as efforts to focus scientific research aimed at resolving
some of the implants to improve continuation rates.
Norplant II

 Also from Population Council

 Two rods slightly longer than Norplant 6

capsules

 Two rods contain levonogestrel

embedded homogeneously within the silastic rod
which is covered by a thin sheath of plain silastic.

 Side-effect similar to Norplant

 Easier to implant and to remove

because there are fewer rods.
VAGINAL CONTRACEPTIVE RINGS

Method of long-term contraception which is entirely patient’s

control.
Steroids absorbed efficiently through vaginal epithelium.

Advantages
- Under patient’s control
- not coitus related
- no daily administration
- greater contraceptive effect
- milder adverse effects.
DESIGN OF VAGINAL CONTRACEPTIVE RINGS

Vaginal fornix around cervix

- homogenous ring

- shell ring

- core ring
TYPES OF VAGINAL CONTRACEPTIVE RINGS

(a)Progestogen only
(i) Levonogestrel - continuos low dose
(ii) Progesterone - 90 days use
- Natural
- Prolongs lactational amenorrhoea
- Ineffective during weaning
(iii) ST 1435 (Nestrone) - 3 weeks in 1
weeks out.
- less metabolic effects.

(b) Combination rings

(i) Levonogestrel/Ethinyl Estradiol
(ii) 3 Keto-Desogestrel/EE
(iii) Norethindrone Acetate/EE
(iv) ST 1435/EE
BARRIER DEVICES AND CHEMICAL
AGENTS

40 million couples worldwide

Over three centuries
Initially limited acceptability
Renewed interest - Aids
pandemic
FEMALE
(a) Cap
(i) Vaginal diaphragms most widely used
spermicide types coil springs, flat spring, arcing failure rate 2-20 pregnancies
per 100 women users per year of exposure.
(ii) Cervical Cap
(iii) Fem-cap
(iv) Lea’s shield
(v) Long Acting Spermicides releasing diaphragms
(vi) PH sensitive releasing devices
(b) Female condom
Design
- Pouch thin polyurethane with 2 flexible rings at each end/9one deep and the
other at the intriotus)
- Failure rate - 26% for the first year
- Overall acceptability 65-79% for women users and 75-80% for their partners.
FEMALE

(c) Sponge
(i) Today sponge - polyurethane and
Nonoxynol-9
Toxic to Spermatozoa
(ii) Protected

(d) Chemical agents

Foams, jellies, tablets, suppositories,
aerosols
Nonoxynol-9, Octoxynol-9, Menfegol
Male Condom

1864 - Gabriel Fallopio

Linen Sheath

20% of contraceptives use; renewed interest - Aids pandemic.

(i) Latex
Teat ended
Plain

(ii) Non-latex - polyurethane, plastics stronger, less rupture

Failure rate: 3 per 100 woman years

High risk women - “Double Dutch” method

Voluntary Surgical Contraception

FEMALE STERILISATION

Occlusion of the uterine tubes to prevent pregnancy commonest

form of permanent contraception in Europe/N-America.

SURGICAL
Commonest Approaches
(a) Minilap
(b) Laparoscopy
(c) Laparotomy
(d) Vaginal
 TUBAL LIGATION TECHNIQUES

(a) Pomeroy
(b) Madlener
(c) Fimbriectomy
(d) Salpingectomy
(e) Uchinda
(f) Irvine
E and F more effective
(i) Occlusive bands or rings: Falope
(ii) Occlusive clips - Filshie or Hulka - Clemems
(iii) Tubal diathermy (Thermocoagulation)
(iv) Hysterectomy

COMPLICATIONS
- immediate
- delayed
- long term
NON-SURGICAL

- via hysteroscopy

- by use of chemicals

- phenols

- quinacrine

- methyl cyano Accrylate

MALE STERILISATION

(I) SURGICAL
16% of contraceptive use
(i) Vasectomy
(a) Scalpel
(b) Non-scalpel - 1974: China,
Ligation
Excision (segmental)
Coagulation

(ii) Clips
(iii) Silicone rods
MALE STERILISATION

NON SURGICAL
Percutaneous Intravasal Injection of Sclerosants viz
(a) Carbolic Acid
(b) N Butyl-cyno-acrylate

OTHER MORE REVERSIBLE AGENTS INCLUDE:

(c) Polyurethane Elastomers - form plugs
(d) Styrene Malate Anhydride
OTHER MALE CONTRACEPTION

Research over 50 years

TYPES
(a) Androgens
(b) Progestogens + Androgens
(c) Danazol + Androgens
(d) Gonadotrophin Releasing Hormone (GnRH).
(e) Anti Progestogens

Problems
- continued sperm production
- histamine like effects - GnRH Antagonists
- Testosterone use viz lipoprotein changes, acne
METHODS BEING DEVELOPED

CONTRACEPTIVE VACCINES
Research has been on for a few decades

PRINCIPLES OF ACTION

TYPES

A: ANTI-PERIMPLANTATION VACCINE -
B-hCG= TT

B: HETEROSPECIES DIMER VACCINE - HSD

C: CTP VACCINE - 37 AA Carboxyl

terminal peptide of B-hCG
Linked to Diphtheria Toxoid as Carrier
METHODS BEING DEVELOPED

D: LH-RH VACCINES

E: OTHERS: - Anti-Sperm

- Anti-Ovum

- Anti-Zona Pellucida

- Recombinant Zona
Pellucida Antigens

F: MALE VACCINES
- Passive/Active
Immunisation against FSH
- Gn-RH Vaccine
CONCLUSION
Over the past 30 years, there have been significant advances in
the development of new contraceptive technologies, including
transitions from high-dose to low-dose combined oral
contraceptives, and from inert to copper-bearing and
levonorgestrel-releasing IUDs. In addition, combined injectable
contraceptives, a combined hormonal patch and ring, and
progestogen-only injectables and implants have been
introduced. However, current policies and health care practices
in some countries are based on scientific studies of contraceptive
products that are no longer in wide use, on long-standing
theoretical concerns that have been substantiated., or on the
personal preference or bias of service providers. These outdated
policies or practices often result in limitations to both the quality
of, the access to, family planning services for clients.
THANK YOU