CONTRACEPTIVES

Definition :
Prevention of conception
-Prevents unwanted pregnancies

Methods Available Temporary methods Permanent methods Emergency methods

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Definition :
Prevention of conception
-Prevents unwanted pregnancies

Methods Available Temporary methods Permanent methods Emergency methods

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Temporary Methods
1. Natural Methods a. Basal body temperature method b. Cervical mucus method (Billingsmethod) c. Calendar or Rhythm method d. Sympto-thermal method e. Coitus interruptus or Withdrawal

Artificial Methods
1. Methods not requiring medical consultation
- Condoms - Spermicides

2. Methods requiring medical consultation

- Hormonal contraceptives - Intra-uterine contraceptive devices - Caps
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Permanent Methods

1. Female Sterilization (LRT) 2. Male Sterilization (Vasectomy)

Emergency Methods
1. Hormonal (Post coital pill) 2. Copper IUCD insertion

Types of Contraceptives

Basal body temperature (B.B.T.) method

Based on the fact that ovulation occurs just

before or during the rise of B.B.T.

Should abstain from intercourse until 3days after

the temperature has risen & reached a plateau

Temperature should be recorded on waking up in

the morning & charted

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Cervical mucus method (Billings method)

Based on changes in cervical mucus consistency

that occur with ovulation

Women can be taught to recognize this change Timing of intercourse Immediately following menstruation to first sign of mucus & from 4th day after the peak symptom to until menstruation

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Calendar or Rhythm method (Safe period)

Not relaible, not suitable to unmarried couples Based on 3 assumptions
1.Ovulation occurs 142 days before menstruation 2.Sperms remain viable for 48-72 hrs. 3.Ovum remains viable for 48-72 hrs.

Method
Woman has to record menstrual cycle over 12 mont Fertile period =(shortest cycle-18days) to (longest cycle-11days) Should abstain from sexual intercourse
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Sympto-thermal method
Combination of Basal body temperature method Cervical mucus method (Billings method)

Coitus interruptus or Withdrawal Intercourse is interrupted just before ejaculation by withdrawal of penis so that emission takes place outside vagina

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Artificial Methods
A. Barrier methods

1. Condoms

Male condom (Latex)

Female condom (Polyurethane) * Reduce the risk of sexually transmitted diseases

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2. Caps

Diaphragms Vault caps Cervical caps A woman needs to be trained on how to wear these caps by a medical professional Spermicides should be used in combination to reduce failure rate

Insertion of a Diaphragm
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a. Hormonal Methods 1. Oral pills 2.Injectables 3.Implants

Mode of action 1. Inhibits ovulation by altering the hypothalamo- pituitary- ovarian feedback loop 2. Induces changes in female reproductive tract such as cervical mucus and endometrium which makes it unfavorable for sperm and ovum transport and implantation
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Oral pills 2 types

1. 2.

Combined oral contraceptive pills (C.O.C.s) Progestogen only pills (P.O.P.s)

Combined oral contraceptive pills Contains varying combinations of synthetic oestrogens & Progestogens Monophasic pills have a single combination of both hormones for the whole cycle (eg: Mitiuri) Biphasic pills have 2 different combinations of hormones for each phase of the calendar pack
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 Triphasic pills have 3 different combinations) of two hormones for each phase (eg:Trinordiole) Each pack should be started on day one of the menstrual cycle Oestrogens in the pill inhibits milk secretion Menstrual cycles are maintained
Progestogen only pills Main action is on cervical mucus Less effective than C.O.C.s Dont inhibit milk secretion
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 Injectable Hormone Preparations Long acting Progesterone injections eg: Depo Medroxy Progesterone Acetate Depo Provera dose- 150mg i.m. once in every 90 days Dont inhibit milk secretion Amenorrhea is expected Irregular bleeding ,heavy bleeding are side effects

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 Hormone Implants Long acting Progestogen Implants deposited subcutaneously in upper arm or thigh eg: Nor Plant contains the progestogen, levonogestrel Duration of actoin 5 years Amenorrhea is expected Dont inhibit milk secretion

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a. Other Artificial Methods

1) Intra-uterine contraceptive devices (IUCD) / Intra-uterine devices (IUD) Exact mode of action is not known, but * local inflammatory response induced by IUCD destroys either sperms or blastocyst * copper interferes with enzyme action and affects implantation * ovum transport is interfered
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Side effects of Pills

Dizziness, headache, nausea, abdominal pain Weight gain Inhibit lactation Irregular menstruation

Increase risk of cardiovascular diseases, hypertension, breast cancer

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 Types of IUCD 1. Inert devices (Lippes loop obsolete) 2. Bioactive (Copper T loop) 3. Hormone impregnated (Progesterone)

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 Insertion by a trained medical personnel Can be kept in situ for 5 10 years depending on the type Suitable for older , parous women in stable relationships Non-hormonal devices risk of ectopic pregnancy

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Permanent Methods
Female Sterilization Ligation and resection of tubes (LRT) Bilateral loop resection & ligation of tubes
by Mini laperotomy Laperotomy techniques Laparoscopic Poor reversibility Failure rate 2 per 100 sterilizations
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 Male Sterilization (Vasectomy) Ligation & Division of Vas Deferens through

a small incision made in the scrotum

Alternative contraceptive method (eg:condoms) should be used until 2 consecutive semen samples are negative for sperm (3/12) Poor reversibility Failure rate 3 per 100 sterilizations

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Emergency Contraception

Hormonal (Post coital pill) Copper IUCD insertion within 72 hrs of unprotected sex with a failure rate <1 % Both act by preventing implantation Hormonal (Post coital pill /Morning after pill) Pills contain 50g of Ethinyl Oestradiol & 250g of Levonogestral 2 pills to be taken immediately (within 72hrs) after unprotected sex & repeated 12hrs later Failure rate 2-4% mid cycle
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New Developments
Vaginal ring Pill patch

Current Research
Male pill to prevent spermatogenesis GnRH analogues ---------------------#############------------------30