CONTRACEPTION

SHAMS ATRASH
 DEFINITION
.Contraception is a mean used to prevent pregnancy
It blocks the conception
?HOW DOES CONTRACEPTION WORKS
:It can work at different levels of the fertilization pathway

 Keeps away the sperm from the egg

 Stops egg production
 Prevent the fertilized egg from attaching to the lining of the womb
 BARRIER METHODS
Condom
Diaphragm/cervical cap
Contraceptive sponge
spermicide
Both females and males condoms aims to prevent
CONDOMS
sperm entry into the vagina

according to calculations done by Human Life

International based on data from the
authoritative Contraceptive Technology (21st Edition,
2018) and other sources.1
 DIAPHRAGM/CERVICAL CAP
A contraceptive diaphragm or cap is a circular dome made of thin, soft silicone that's inserted into the vagina
.before sex
.It covers the cervix so sperm cannot get into the womb (uterus) to fertilize an egg
.When used correctly with spermicide, a diaphragm or cap is 92-96% effective at preventing pregnancy

A disadvantage is catching a sexually transmitted infection (STI) when using a diaphragm or cap. So usage
.of condoms as well for protection is recommended
.Another is the development of cystitis was observed after the usage
INTRAUTERINE DEVICES
 HORMONES REVIEW
Estrogen
Development of internal/external genitalia breasts, female fat
.distribution
.Growth of follicle, endometrial proliferation
INCREASE myometrium excitability
Upregulation of estrogen, LH, and progesterone receptors;
feedback inhibition of FSH and LH, then LH surge
stimulation of prolactin secretion decrease prolactin effect on the
breast
Increase transport proteins
.Increase HDL and decrease LDL
 HORMONES REVIEW
Progesterone
Stimulation of endometrial glandular secretions and spiral artery development
 Production of thick cervical mucus  inhibit sperm entry into the uterus
Prevention of endometrial hyperplasia
Increase body temperature
Decrease estrogen receptor expression
Decrease LH/FSH secretion
Maintain pregnancy
Decrease myometrium contraction
Decrease prolactin action on breast
PROGESTERONE ONLY BIRTH
CONTROL
Progestin-Only Pills: With typical use 9% of women will get pregnant during the first year
of using progestin-only pills. With perfect use; people never forget to take a pill and always
take them at the same time every day < 1% of women will get pregnant during the first
.year of using progestin-only pills
.The pills come in packs of 28 and should be taken one a day at the same time each day

:The progestin in the pills has several effects in the body that help prevent pregnancy

The mucus in the cervix thickens, making it difficult for sperm to enter the uterus and fertilize an
.egg

Progestin stops ovulation, but it does not do so consistently. About 4 in 10 women who use
.progestin-only pills will continue to ovulate

.Progestin thins the lining of the uterus

PROGESTERONE ONLY BIRTH
CONTROL
women may have less bleeding or stop having periods altogether while taking these pills.
.This can be helpful for women who have heavy or painful periods
.progestin-only pills can be used immediately after childbirth
Does not affect the chances of getting pregnant after stopping the medication

!!BUT
this method does not protect from TSI and can cause irregular
.bleeding and spotting
PROGESTERONE ONLY BIRTH
CONTROL

patient at high risk for or have had breast cancer: some studies have shown an association with progestin-only birth
.control and breast cancer

.liver disease: Some evidence has shown that progestin can potentially damage the liver

anti-seizure medications: Some anti-seizure medications break down hormones in the body and may reduce the
.effectiveness of a progestin-only pill

bariatric surgery: Bariatric surgery may affect the way the body absorbs these medications and may make them less
.effective
 PROGESTERONE ONLY BIRTH
CONTROL SIDE EFFECTS
:Progestin-only birth control pills share common side effects, some of which will resolve over time. They may include

Headache
Nausea
Spotting or irregular vaginal bleeding
Amenorrhea
Breast tenderness
Weight gain
MISSED PILL
 MEDROXYPROGESTERONE ACETATE (DMPA)
The birth control injection contains the hormone depot medroxyprogesterone acetate (DMPA). This hormone
.protects against pregnancy for 13 weeks. A total of four injections a year while using this form of birth control
.Injections are given by an ob-gyn or other health care professional
.first shot within the first 7 days after the start of the period, no additional birth control method is needed
 first shot more than 7 days after the start of the period, a need to use an additional birth control method or avoid sex for the
.next 7 days
The injection is most effective when you get it every 13 weeks. Injections can be given up to 2 weeks late (15 weeks from the
.last injection)

DMPA has benefits that are not related to birth control, including
reducing the risk of cancer of the uterus if used long term .1
reducing pelvic pain caused by endometriosis .2
may relieve certain symptoms of sickle cell disease and seizure disorders. It may reduce the bleeding .3
.associated with uterine fibroids. And it may protect against pelvic inflammatory disease (PID)
 .The implant is more than 99% effective
.The implant can be taken out if you have side effects

:Some medicines can make the implant less effective, such as

medicines for HIV, epilepsy and tuberculosis

complementary remedies, such as St John's Wort
some antibiotics, such as rifabutin or rifampicin

https://youtu.be/opnXt3m2Nno
COMBINED ORAL CONTRACEPTIVES
Pills that contain low doses of 2 hormones a progestin and an estrogen
Work primarily by preventing the release of eggs from the ovaries (ovulation)
Approximately 9% of women become pregnant in the first year of use with combined hormonal
. contraceptives with typical use
.These methods are reversible and can be used by women of all ages
are generally used for 21–24 consecutive days, followed by 4–7 hormone-free days (either no use or
 .placebo pills)
If combined hormonal contraceptives are started within the first 5 days since menstrual bleeding started, no
.additional contraceptive protection is needed
If combined hormonal contraceptives are started >5 days since menstrual bleeding started, the woman
.needs to abstain from sexual intercourse or use additional contraceptive protection for the next 7 days
COMBINED ORAL CONTRACEPTIVES

Postpartum women who are breastfeeding should not use combined hormonal contraceptives during the 
first 3 weeks after delivery due to concerns about increased risk for venous thromboembolism ,concerns
.about potential effects on breastfeeding performance

Postpartum breastfeeding women with other risk factors for venous thromboembolism generally should not 
 use combined hormonal contraceptives 4–6 weeks after delivery

Combined hormonal contraceptives can be started within the first 7 days after first or second trimester  
abortion, including immediately post-abortion
 BEFORE INITIATION OF COMBINED
HORMONAL CONTRACEPTIVES
Women with certain conditions such as current breast cancer, severe hypertension or vascular
disease, heart disease, migraine headaches with aura, and certain liver diseases, as well as women
aged ≥35 years who smoke ≥15 cigarettes per day, should not use combined hormonal
 contraceptives

Women with thrombogenic mutations should not use combined hormonal contraceptives because of the increased risk
for venous thromboembolism

women with current breast cancer should not use combined hormonal contraceptives

Women with anemia, cervical intraepithelial neoplasia, cervical cancer, HIV infection, or other STDs can use combined
hormonal contraceptives; therefore, screening for these conditions is not necessary for the safe initiation of combined
.hormonal contraceptives

Taking BMI measures to keep a track of weight changes during medication usage is favorable
CONTRAINDICATIONS
  LATE OR MISSED DOSES
considered late when <24 hours have elapsed since the dose should have been taken. A dose is considered
.missed if ≥24 hours have elapsed since the dose should have been taken
SIDE EFFECTS
EMERGENCY CONTRACEPTION
Emergency contraception (EC) can prevent up to over 95% of pregnancies when
.taken within 5 days after intercourse

Methods of emergency contraception are the copper-bearing intrauterine devices

.(IUDs) and the emergency contraceptive pills (ECPs)

A copper-bearing IUD is the most effective form of emergency contraception

.available

Levenogestrel or the ‘Morning after pill’ can be used up to 72hrs post-

.intercourse
It is most effective if taken within twelve hours after unprotected sexual
intercourse and its efficacy reduces with time such that if taken within 24hrs it
will prevent 95% of pregnancies and
.if taken within 72hrs it will prevent 58% of pregnancies
 ULIPRISTAL ACETATE
.ella (ulipristal acetate) is a synthetic progesterone agonist/antagonist
.When taken immediately before ovulation is to occur, Ella postpones follicular rupture
.alterations to the endometrium that may affect implantation may also contribute to efficacy

Ella is supplied as a tablet for oral administration. The recommended dose is one tablet taken orally as soon as
possible, within 120 hours (5 days) after unprotected intercourse or a known or suspected contraceptive
.failure
.acts as a potent, orally active anti-progestational agent
HOW DOES ESTROGEN
CAUSE DVT AND
?INCREASE CLOTTING
Estrogen, like many lipophilic hormones, affects
the gene transcription of various proteins. Thus,
estrogen increases plasma concentrations of these
.clotting factors by increasing gene transcription

Estrogen containing oral contraceptives increase the

plasma concentration of clotting factors II, VII, X, XII,
.factor VIII, and fibrinogen
 SOURCES
https://www.who.int/news-room/fact-sheets/detail/emergency-contraception
https://shcs.ucdavis.edu/health-topic/emergency-contraception-ec
https://www.rcemlearning.co.uk/foamed/emergency-contraception/
https://www.centerwatch.com/directories/1067-fda-approved-drugs/listing/3444-ella-ulipristal-acetate
https://www.cdc.gov/reproductivehealth/contraception/mmwr/spr/combined.html#Fig2
https://www.nhs.uk/conditions/contraception/what-is-contraception/
https://www.hli.org/resources/how-effective-are-condoms/
https://wellcaremedicalcentre.org.au/mirena/
https://www.mayoclinic.org/tests-procedures/minipill/about/pac-20388306
https://www.acog.org/womens-health/faqs/progestin-only-hormonal-birth-control-pill-and-injection
https://www.verywellhealth.com/common-depo-provera-side-effects-906709
https://www.shecares.com/menstruation/birth-control-implants
FIRST AID USMLE STEP1 BOOK 2021 EDITION & STEP UP TO USMLE STERP 2 CK 5 EDITION