Dr. Mona A.

Almushait
 Methods of Contraception
Methods of Contraception
I. Combined Oral contraceptive pills
Depot medroxyprogesterone acetate injections
Hormonal Transdermal patches and Vaginal rings
Products
II. Barrier Male condoms, Diaphragms
Caps, Female condoms, Spermicides
and
Behavioral Withdrawal, Fertility awareness method,
Natural family planning
Methods
III. Longer Term Progestin implants and Intrauterine devices

IV. Sterilization Female sterilization and Vasectomy

1. Combined Hormonal Products
Combined Estrogen and
Progesterone Contraceptives

 Oral contraceptive pills

 Monthly injections
 Transdermal patches
 Vaginal rings
 Mode of action:
 Suppression of the LH surge (to prevent ovulation) → to
inhibit ovulation

 Thickening of the cervical mucus (to prevent sperm

entering the upper genital tract)

 Other mechanisms:
→ slowing of tubal transport
→ atrophy of the endometrium
 Complications of Estrogen–Containing
Contraceptives:
 Thromboembolism
 Post pill amenorrhea
 Cerebrovascular accidents
 Increased in Cholelithiasis (cholestatic
jaundice)
 HTN
 Benign hepatic tumors (Hepatoma)
 Headache in the week off
 Contraindications to the Use of
Estrogen–Containing Contraceptives
ABSOLUTE
 Arterial thrombosis
 Venous thrombus (Thromboembolism)
 Pulmonary embolism
 Coronary vascular disease, IHD → cardiomyopathy, vascular
heart disease
 Past cerebrovascular accident
 Pulmonary HTN
 Current pregnancy
 Breast cancer within the last 5 years
 ABSOLUTE Cont’d
 Endometrial cancer
 Hepatic tumor or abnormal liver function, Dubin–
Johnson or Rotor syndrome, known gallstones
 Unexplained abnormal uterine bleeding
 Age >35 and cigarette smoking
 Uncontrolled hypertension
 History of melanoma
 Hyperlipidaemia, focal and crescendo migraine
 Trophoblastic disease
RELATIVE
 Risk factor for arterial disease
 Complicated prolonged Diabetes
 Estrogen–dependent neoplasm
 Depression, Hyperprolactinemia
 Severe varicose veins
 Hypertriglyceridemia
 Increasing age, smoking, obesity, migraine
 Progestin–Only Hormonal Methods of
Contraception
(POPs)
 PoPs are taken as a continuous preparation, in
28 day packs.
 Taken at the same time each day
Mode of action:
 Thicken the cervical mucus
 Inhibit ovulation
 Twining the endometrium
 Safe → when oestrogen–containing pills cause side effects, or
contraindicated
 Smokers, immediately post–partum, breastfeeding, risk of DVT,
hypertension, migraine, or diabetes, PMS
 Pills most frequently used by breastfeeding women
Side effects:
 Menstrual changes
 Amenorrhea
 ↑ functional ovarian cyst
 ↑ risk of ectopic pregnancy
 Acne, headache, breast tenderness, nausea, irregular bleeding
 Weight change
 ↑Breast cancer diagnosis
 DMPA (Depo–Provera) 150 mg every 3 months, I.M.
 Suppresses gonadotropins to inhibit ovulation
 Change cervix mucus (thickening)
 Twining endometrium
Advantages:
 High efficacy
 No need to remember to take a pill
 Use when oestrogen contraindicates
 No increased in ovarian cyst or risk of ectopic pregnancy
 Disadvantages:
 Delayed of fertility, weight gain, irregular bleeding and
amenorrhea
 ↑ risk of Osteoporosis due to long term Medroxy
progesterone acetate
Contraindications:
 Pregnancy

 Severe arterial disease

 Undiagnosed vaginal bleeding

 Liver disease
 Transdermal Patch
 Appliedonce a week to the abdomen, buttock,
upper outer arm.

 The patch releases 150 µg of norelgestromin and

20 µg of ethinyl estradiol to inhibit ovulation.

 3-consecutive 7-day pathches (21 days) are

applied followed by 1 patch free week per cycle.
Advantages:
 Very effective
 Rapidly reversible

Disadvantages:
 Requires a prescription
 Skin reactions
 Slight increase in risk of VTE compared
with COCs
 Vaginal Ring
 A thin, transparent, flexible ring that contains
oestrogen/progestogen hormones.
 It stops ovulation and thickens the cervical mucus.
Advantages:
 Easy to use
 Can be worn for 3 weeks
Disadvantages:
 Does not protect against STD
 Spotting
 Increased vaginal discharge
 II. Barrier and
Behavioral Methods
 Male Condom
Advantages:
 ↓transmission of STD, HIV, Chlamydia and
Gonorrhea
 Easily obtained

Disadvantages:
 Allergy
 Loss of sensation
 Slippage/breakage
 Diaphragm and Cap
 To be filled and coated with spermicide
 84% to 94% effective for pregnancy prevention
 Must be left in place for at least six hours.

Advantages:
 Easy use
 Protection from sexually transmitted infections

Disadvantages:
 Cystitis
 Skin irritation
 Female Condom
 A lubricated polyurethane

Advantages:
 Prevents the transmission of infection
 No hormonal side effects

Disadvantages:
 Loss of sensation
 Can break or leak
 Jelly
 Jellies come in tubes and are usually used
with a diaphragm or cervical cap.

 It allows for immediate protection, which

lasts for about 1 hour.
 Vaginal Contraceptive Sponge
 Small, donut-shaped foam that
contains a spermicide

 A non hormonal barrier method of

birth control
 Vaginal Contraceptive Foam
Advantages:
 It kills the sperm
 It blocks the semen fluids from entering the cervical
canal
 No hormones are involved
Disadvantages:
 Irritation
 No protection against infection
 Film
 A paper-thin translucent film that
contains a spermicide

 Its is placed in the vagina or near the

cervix where it dissolves in seconds

 It is effective for about one hour

 Behavioral Methods
 Natural family planning
Tracking basal body temperature

Checking the consistency of cervical mucus

→ Moist, sticky, white pre–ovulation, clear, copious and
stretchy spinnbarkheit → The most fertile time

 Time in cycle
→ Ovulation occurs every 12–16 days before a period
→ Pain from ovulation, breast change → less

 Lactational amenorrhea

 Withdrawal or coitus interruptus

 III. Longer Term
Progestin Implants and
Intrauterine Devices
Implant
 It is placed in the s/c layer of the medial
aspect of a woman’s upper arm to release
steady amounts of Levenogestrel → 5 years
 Have low circulatory levels of progestin
 Suppress ovulation and change cx mucus
 Twining endometrium
 Disadvantages:
 Vaginal spotting
 Weight gain
 Hair or skin changes
 Headaches
 Depression
 Decreased libido
Levenogestrel–Releasing Intrauterine
System (LNG–IUS)
 Contains 52 mg of Levenogestrel

 20 µg of Levenogestrel every 24-hr.

 T–shape

 Effective for at least 5 years

Mode of action:
 Thickens the cx mucus
 Twins the endometrium→atrophic endometrium
 Inhibition of ovulation

Disadvantages:
 Amenorrhea
 Irregular bleeding for the first 3 months
 ↑ functional ovarian cyst
 Expulsion and perforation
 Contraindications:
 Pregnancy
 Active liver disease
 Severe arterial disease
 Undiagnosed irregular bleeding
 Mechanical heart valves
 Untreated STD
 Hx of ovarian or endometrial carcinoma
 Copper T380A I.U.D.
Mode of action:
 Copper is spermicidal
 It is inserted in the first 7 days of cycle with antibiotics cover
 Inflammatory changes to prevent implantation
Disadvantages:
 Pregnancy with I.U.C.D.
 Increased rate of Ectopic pregnancy
 ↑ Menorrhagia
 ↑ PID
 Perforation and expulsion
 Actinomycosis → cx smear
 Lost coil
IV. Female sterilization

and Vasectomy
 Sterilization
 Permanent sterilization is the most common method of birth control used.
 Mini Laparotomy sterilization
 Laparoscopic sterilization

Advantages: Disadvantages:
 Permanent birth control  Does not protect against
 Immediately effective STD
 Requires surgery
 Requires no daily attention
 May not be reversible
 Not messy
 Possible regret
 Cost-effective in the long
run  Possibility of Post Tubal
Ligation Syndrome
 FILSHIE CLIP TUBAL LIGATION
 One common form of laparoscopic (camera) sterilization is the use of
Filshie clips to occlude both fallopian tubes.
HULKA CLIP STERLIZATION
 One common form of female sterilization is the use of Hulka clips to
block the fallopian tubes.

VASECTOMY (interruption of the vas deferens)

It is a minor surgical procedure wherein the vasa deferentia

of a man are severed, and then tied/sealed in a manner which
prevents sperm from entering the seminal stream.
Risks include:
 Infection

 Bleeding

 Scrotalpain or swelling at the time of

the procedure