This document provides information on various contraceptive methods. It discusses hormonal methods like oral contraceptives (birth control pills), injections (Depo-Provera), implants (Norplant), and the vaginal ring. It also covers barrier methods, including condoms, diaphragms, spermicides, and cervical caps. Surgical sterilization options for both females (tubal ligation) and males (vasectomy) are described. The document concludes with behavioral methods like withdrawal and fertility awareness/natural family planning. Considerations for choosing a method include effectiveness, cost, safety, comfort/ease of use, and future fertility.

1. contraception
DR Manal Behery
2014

2. Definition of Contraception
• Contraception = “Against Conception”
• The intentional prevention of pregnancy
through the use of various devices, agents,drugs,
sexual practices or surgical procedures.

3. Expanding Methods Mix

4. How do you choose?

5. Top five factors to consider when selecting a
method of fertility control.
•Cost
•Effectiveness of protections from STDs
•Safety and side effects
•Comfort and ease of use
•Reversibility and future fertility

6. The only 100% effective way to
prevent pregnancy and STD
is to be sexually
Abstinent
or to Postpone
sexual involvement.

7. Four Types of Birth Control
• Hormonal Methods
• Barrier methods!
• Surgical Methods
• Behavioral Methods

9. Hormonal Methods
• Oral Contraceptives
(Birth Control Pill)
• Injections (Depo-Provera)
• Implants (Norplant I & II)
• Vaginal ring

10. Oral contraceptive pills (OCP)
• Oral contraceptive made
from synthetic
hormones
• 97%-99% effective
• Combined pill or mini-pill

11. Birth Control Pills
• Women must have a pap smear to get a prescription for
• birth control pills
• Pills DO NOT prevent STD’s

12. Combined pill
• Contains estrogen and progestin
• 21-day or 28-day form
• Monophasic or multiphasic (fewer
side effects)

13. Mini-pill
• Contains only progestin
• Used continuously 28 days
• Effect: thickens the cervical
mucus and makes the lining
of the uterus less receptive
to implantation
• Indicated because of
medical reasons and women
breatsfeeding

14. How does the pill work?
• Stops ovulation
• Thins uterine lining
• Thickens cervical mucus

15. Pro’s
• ↓ Acne
• ↓ Hair growth
• ↓Breast cysts
• ↓ Ovarian cysts
• ↓ Ovarian carcinoma
• ↓ Dysmenorrhea
• ↓ Endometrial carcinoma
• ↓ PID
• ↓ Risk of ectopic
pregnancy
• ↓ Anemia
• ↓ Osteoporosis

16. Contraindications
• Absolute: CV diseases, liver damage,
hormone-dependent tumors
• Relative: age >35 + another risk
factor (smoking, DM etc.)

17. Con’s
• ↑ Risk of CV disease
• ↑ Risk of breast cancer
• ↑ Risk of cervical cancer
• ↑ Risk of thromboembolic
episodes
• ↑ Risk of liver adenoma
• Lipid metabolism disorders
• Nausea
• Depression
• Post-pill amenorrhea
• Weight gain
• Breast tenderness

18. Taking the Pill
• Once a day at the same time everyday
• Use condoms for first month
• Use condoms when on antibiotics
• Use condoms for 1 week if you miss a pill or take
one late
• The pill offers no protection from STD’s

19. Injection or "shot"—
• Women get shots of the
hormone progestin in the
buttocks or arm every
three months from their
doctor.
• It is 97–99% effective at
preventing pregnancy.

20. Depo-Provera (the shot)

21. How does the shot work?
• The same way as the Pill!
• Stops ovulation
• Stops menstrual cycles!!
• Thickens cervical mucus

22. SIDE EFFECTS
• Extremely irregular menstrual bleeding and
spotting for 3-6 months!
• NO PERIOD  after 3-6 months
• Weight change
• Breast tenderness
• Mood change
*not every woman has side-effects!

23. Contraceptive patch
• Transdermal delivery system
• Effect: same as OCP
• Application: stuck on skin every week
• Side effects: same as OCP, greater risk (con)
• Pro: better compliance

24. The Patch

25. IMPLANTS
• Physically inserted in simple 15 minute outpatient
procedure
• Plastic capsules the size of paper matchsticks inserted
under the skin in the arm
• 99.5% effectiveness rate

26. Norplant Implant

27. Contraceptive implants
• Slow release of a progestin
over a period of three years
• Effect: prevents the release of
the egg from the ovary
(ovulation); promotes thick
cervical mucus
• Application: inserted in the
upper arm under local
anesthesia
• Side effects: irregular
bleeding
• Pro: fertility rapidly returns

28. Implanon
• Contains 68 mg etonogestrel
• Single rod implanted subdermally on day 1-5 of
cycle
• Last for 3 years.
• Works by thickening cervical mucus and also
inhibits ovulation
• Extremely effective in pregnancy prevention >
99%
• Irregular bleeding common side effect

29. What if….
…the condom broke or
slipped off...
…you forgot your
regular birth control...
…you were forced to
have sex...
Association of Reproductive Health Professionals

30. Emergency Contraception (ECP)
• Must be taken within 72 hours of the act of
unprotected intercourse or failure of contraception
method
• Must receive ECP from a physician
• 75 – 84% effective in reducing pregnancy

31. How EC ACT?
• Floods the ovaries with high amount of hormone
and prevents ovulation
• Alters the environment of the uterus, making it
disruptive to the egg and sperm
• Two sets of pills taken exactly 12 hours apart

32. Emergency Contraceptive Pills:
Combined VS Progestin only
Preven
plan A
Plan B

33. Morning-after pill
• Side effects:
nausea,abdominal pain,
fatigue, headache, dizziness,
and breast tenderness

34. NuvaRing – The Ring 92% - 99%

35. Vaginal Ring (NuvaRing)
• 95-99% Effective A new ring is inserted into the vagina each
month
• Does not require a "fitting" by a health care provider,
• does not require spermicide, can make periods more regular and
less painful,
• no pill to take daily, ability to become pregnant returns quickly
when use is stopped.

36. Hormonal
• Pill
– Daily
– Emergency
(not recommended as
a regular form of birth
control)

37. Hormonal
• Pill
• Patch
Patch

38. Hormonal
• Pill
• Patch
• Injection

39. Hormonal
• Pill
• Patch
• Injection
• Ring

40. Hormonal
• Pill
• Patch
• Injection
• Ring
• Progesterone IUD IUD

41. Hormonal
• Pill
• Patch
• Injection
• Ring
• Progesterone IUD
• Implantable device

42. How Often Do You Take It?
Method Frequency
Pills Every day

43. How Often Do You Take It?
Method Frequency
Pills Every day
Patch Once a week

44. How Often Do You Take It?
Method Frequency
Pills Every day
Patch Once a week
Ring Once a month

45. How Often Do You Take It?
Method Frequency
Pills Every day
Patch Once a week
Ring Once a month
Injection Every 3 months*
Implant (Implanon®) Every 3 years*

46. How Often Do You Take It?
Method Frequency
Pills Every day
Patch Once a week
Ring Once a month
Injection Every 3 months*
Implant Every 3 years*
IUD Every 5 years*

47. How Often Do You Take It?
Method Frequency
Pills Every day
Patch Once a week
Ring Once a month
Injection Every 3 months*
Implant Every 3 years*
IUD Every 5 years*

48. BARRIER METHOD
• Prevents pregnancy blocks the egg and
sperm from meeting
•
• Barrier methods have higher failure
rates than hormonal methods due to
design and human error

49. BARRIER METHODS
• Spermicides
• Male Condom
• Female Condom
• Diaphragm
• Cervical Cap

50. SPERMICIDES
• Chemicals kill sperm in the vagina
• Different forms:
-Jelly -Film
-Foam -Suppository
• Some work instantly, others require pre-insertion
• Only 76% effective (used alone), should be used in combination with
another method i.e., condoms

51. Foam
• 80-85% effective
• Works immediately
• Effective for an hour
• Over the counter
• No douching for 6 hours after
intercourse
• 20% have burning (reaction)

52. Film
• 80-85% effective
• Works 10 min after
insertion
• Effective for an hour
• Over the counter
• No douching for 6 hours
after intercourse
• 20% have burning
(reaction)

53. MALE CONDOM
• Most common and effective barrier method when used properly
• Latex and Polyurethane should only be used in the prevention of
pregnancy and spread of STD’s (including HIV)

54. MALE CONDOM
• Perfect effectiveness rate = 97%
• Typical effectiveness rate = 88%
• Latex and polyurethane condoms are
available
• Combining condoms with spermicides
raises effectiveness levels to 99%

55. Female Condom
• 95% effective
• Protects against some STDs
• Noisy
• Use extra lubrication

56. Proper Use and Placement of a
Female Condom
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57. DIAPRAGHM
• Perfect Effectiveness Rate = 94%
• Typical Effectiveness Rate = 80%
• Latex barrier placed inside vagina during
intercourse
• Fitted by physician
• Spermicidal jelly before insertion
• Inserted up to 18 hours before intercourse and can
be left in for a total of 24 hours

58. DIAPHRAGM
The diaphragm is a flexible rubber cup that is filled with
spermicide and self-inserted over the cervix prior to
intercourse. The device is left in place several hours
after intercourse. The diaphragm is a prescribed device
fitted by a health care professional and is more
expensive than other barrier methods, such as condoms

59. Proper Use and Placement of a
Diaphragm
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60. CERVICAL CAP
• Latex barrier inserted in vagina before intercourse
• “Caps” around cervix with suction
• Fill with spermicidal jelly prior to use
• Can be left in body for up to a total of 48 hours
• Must be left in place six hours after sexual
intercourse
• Perfect effectiveness rate = 91%
• Typical effectiveness rate = 80%

61. Cervical Cap
The cervical cap is a flexible rubber cup-like device that is filled with
spermicide and self-inserted over the cervix prior to intercourse. The
device is left in place several hours after intercourse. The cap is a
prescribed device fitted by a health care professional and can be more
expensive than other barrier methods, such as condoms.

62. Sponge
The sponge is inserted by the woman into the vagina and covers the
cervix blocking sperm from entering the cervix. The sponge also
contains a spermicide that kills sperm. It is available without a
prescription

63. Copper and levonorgestrel-releasing IUD

64. Intrauterine Devices (IUD)
• T-shaped object placed in the
uterus to prevent pregnancy
• Must be on period during
insertion
• A Natural childbirth required to
use IUD
• Extremely effective without using
hormones > 97 %
• Must be in monogamous
relationship

69. What are the most cu ( IUD ) used today ?
Today two types of cu IUD are used mostly Multiload
(left) and cupper T (right) :

70. Levonorgestrel Intrauterine system
• The LNG IUS is made of flexible plastic
• The LNG IUS contains a progestin hormone
called levonorgestrel which has been used
in birth control pills since the 1970s
• The safety of levonorgestrel has been
proven by clinical use also in sub-dermal
implants and intrauterine systems since
decades

71. Mirena: Theoretical Mechanism
of Action
• Cervical mucus
thickened
• Sperm motility and
function inhibited
• Endometrial effects
• Ovulation inhibited
(in some cycles)
Jonsson B et al. Contraception 1991;43:447-458.
Nilsson CG et al. Fertil Steril 1984;41:52-55.
Videla-Rivero L et al. Contraception 1987;36:217-226.

72. LNG IUS ENDOMETRIAL EFFECTS
Ovulation
Ovulation
Menstruation
Days of the menstrual cycle Days of the menstrual cycle

73. Who can and cannot use the IUD
Most women can safely
use the IUD
But usually cannot use IUD if :
• May be
pregnant
• Gave birth
recently
(more than 2
days ago)
• Unusual
vaginal
bleeding
recently
• At high risk for
STIs
• Infection or
problem in
female organs

74. IUD Contraindications
• Pregnancy or past ectopic history
• Undiagnosed irregular bleeding
• Current or suspected pelvic or vaginal infection
• HIV or immunosuppressive therapy
• Distorted scarred uterine cavities
• Small uterus 5.5cm

75. Possible side-effects
If you choose this method, you may have some side-effects.
They are not usually signs of illness.
After insertion:
• Some cramps
for several
days
• Some spotting
for a few weeks
Other common side-effects:
• Longer and
heavier periods
• Bleeding or
spotting between
periods
• More cramps or
pain during
periods
May get less after a few
How would you feel months
about these side-effects?

76. What will happen when
Steps:
you get your IUD
Pelvic examination
Cleaning the vagina and cervix
Placing IUD in the womb
through the cervix
• May hurt at insertion
• Please tell us if it hurts
• Rest as long as you like
afterwards
• May have cramps for several
days after insertion



Afterwards:
you can check
your IUD from
time to time
Are you ready to
choose this method?
What questions do
you have?

77. What to remember
• Your kind of IUD:
• When to have IUD taken out:
• Bleeding changes and
cramps are common. Come
back if they bother you.
• Come back for a check-up in 3 to
6 weeks or after next menstrual
period
See a nurse or doctor if:
• Missed a
menstrual
period, or
think you
may be
pregnant
• Could have an
STI or
HIV/AIDS
• IUD strings
seem to
have
changed
length or are
missing
•Bad
pain in
lower
abdomen
Anything else I can
repeat or explain?
Any other questions?

78. Female and Male Sterilization
Procedure performed on a
man or a woman
permanently sterilizes
Female = Tubal Ligation
Male = Vasectomy
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79. TUBAL LIGATION
• Surgical procedure performed on a woman
• Fallopian tubes are cut, tied, cauterized, prevents eggs from reaching sperm
• Failure rates vary by procedure, from 0.8%-3.7%
• May experience heavier periods
Surgical sterilization which
permanently prevents the
transport of the egg to the uterus
by means of sealing the fallopian
tubes is called tubal ligation,
commonly called "having one's
tubes tied." This operation can be
performed laparoscopically or in
conjunction with a Cesarean
section, after the baby is delivered.
Tubal ligation is considered
permanent, but surgical reversal
can be performed in some cases

80. Laparoscopy-’band-aid’ sterilization

81. vasectomy
• Ligation of Vas Deferens tube
• Faster and easier recovery than a tubal ligation
• Failure rate = 0.1%, more effective than
female sterilization

82. During a vasectomy (“cutting the vas”) a urologist cuts
and ligates (ties off) the ductus deferens. Sperm are still
produced but cannot exit the body. Sperm eventually
deteriorate and are phagocytized. A man is sterile, but
because testosterone is still produced he retains his sex
drive and secondary sex characteristics.

83. METHODS BASED ON
INFORMATION
• Withdrawal
• Natural Family Planning
• Fertility Awareness Method
• Abstinence

84. Behavioral Methods
• Withdrawal: removing the penis from the vagina
just before ejaculation
• Abstinence or outercourse(kissing, hugging, touching)
• Fertility awareness
– Cervical mucus method
– Body temperature method
– Calendar method

85. WITHDRAWAL
• Removal of penis from the vagina before ejaculation occurs
• NOT a sufficient method of birth control by itself
• Effectiveness rate is 80% (very unpredictable in teens, wide variation)
• 1 of 5 women practicing withdrawal become pregnant
• Very difficult for a male to ‘control’

86. Natural Family Planning &
Fertility Awareness Method
• Women take a class on the menstrual cycle to
calculate more fertile times
• NFP abstains from sex during the calculated fertile
time
• Perfect effectiveness rate = 91%
• Typical effectiveness rate = 75%
• No 100% safe day-irregular periods

87. The Fertility Cycle
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