1. Family Planning （计划生育）

4. Conception requires Juxtaposition of the male and female gametes at the optimal stage of maturation Transportation of the conceptus to the uterine cavity at a time when the endometrium is supportive of its continued development and implantation.

5. 精卵结合 子 宫 输卵管 卵巢 卵巢排卵 精 子 抑制排卵 杀灭精子，使精子失去活力 阻断精子和卵子相遇 改变子宫内膜使受精卵无法着床 避孕的有效途径 宫颈粘液变稠厚，精子不能穿透 阻断精子和卵子结合

6. I. Oral contraceptives (1) Short-acting (2) Long-acting (3) Vacation pill II. Long-acting contraceptive injection III. Slow-releasing contraceptives IV. Transdermal patch Systemic Contraceptives Types of the systemic contraceptives

8. Components: (1) Estrogens: Ethinylestradiol ， EE ( 炔雌醇 ) (2) Progestogens: Norethindrone, Megestrol, cyproterone etc. 1. Compound Norethindrone Tablets 复发炔诺酮片 ( 避孕片 1 号 ) Components: EE 35μg, Norethindrone 0.6mg 2. Compound Megestrol Acetate Tablets 复方甲地孕酮片 ( 避孕片 2 号 ) Components: EE 35 μg, Megestrol 1.0mg 3. Compound Levonorgesterel Tablets 复发左旋炔诺孕酮片 （ D- 甲炔诺酮片、 复方左旋 18 甲基炔诺酮片） Components: EE 30 μg, Levonorgesterel 0.15mg Tablets Monophasers

10. Rekers 1988 头疼 恶心 乳房胀痛 n = 808 side effects of Marvelon headache nausea Breast swealing pain

11. Biphasers Ovidal (CTR24) 去氧孕烯双相片 Components: 1st phase (day 1 ～ 7): EE 40μg, Desogestrel ( 去氧孕烯 ) 0.025 mg 2 nd phase (day 8 ～ 21): EE 30μg, Desogestrel ( 去氧孕烯 ) 0.125mg Systemic Contraceptives

13. Tablet Triphasers Levonorgesterel Triphaser Tablets 左炔诺孕酮三相片 ( 左旋 18 甲三相片 ) Components: 1st phase (day 1 ～ 6): EE 30μg, Levonorgesterel ( 左炔诺孕酮 ) 0.050mg 2 nd phase (day 7 ～ 11): EE 40μg, Levonorgesterel ( 左炔诺孕酮 ) 0.075mg 3rd phase (day 12-21) EE 30μg, Levonorgesterel ( 左炔诺孕酮 ) 0.125mg Systemic Contraceptives

19. 2. Morning sickness-like reaction VitB6 20mg, VitC 100mg, anisodamine ( 山莨菪碱 )10mg tid po for 7 days. 3. Weight gain P (containing weak androgen activity): stimulating anabolism ( 合成代谢） E: causing sodium and water retention 4. Pigmentation (moth patch) ( 蝴蝶斑 ) 5. Others Headache, breast swelling pain, appetite increase, skin rash, pruritus ( 瘙痒 ), etc. Side effects

34. Systemic Contraceptives Contraindications 1. Malignant or precancerous diseases and patients with uterine or breast masses 2. Hematopathy and thrombotic diseases 3. Severe cardiovascular diseases 1) P->lipid metab ->coronary artherosclerosis 2) E->blood coagulation↑->myocardiac infarction 3) E->renin activity↑->hypertension

35. 4. Endocrine diseases: diabetes, hyperthyroid dysfunction 5. Lactation 6. Oligohypomenorrhea or older than 45 years old 7. older than 35 years old smoking wemen 8. delivery within half a year or menses not recovery 9. Hepatitis and nephritis 10. Psychotic ( 精神病患者 ) Systemic Contraceptives Contraindications

38. 2. Long-acting Tablets (96% ～ 98%) Components: Quinestrol , Progestogens 1) Compound Quinestrol Monthly Tablets 复方炔雌醚片 ( 长效避孕片 1 号，复方炔雌醚月服片 ) Components: Quinestrol 3mg Chlormadinone acetate ( 氯地孕酮 ) 12 mg 2) Three in one Compound Quinestrol Monthly Tablets 三合一炔醚片 Components: Quinestrol 2mg Chlormadinone acetate ( 氯地孕酮 ) 6 mg Norgesterel ( 炔诺孕酮 ) 6 mg Systemic Contraceptives

40. Long-acting contraceptive injection 1. Compound Hydroxyprogesterone Caproate Injection 复方己酸羟孕酮避孕针 ( 避孕针 1 号 ) Components: Hydroxyprogesterone Caproate 250mg Estradiol Valerate 5mg 2. Compound Megestrol Acetate Injection ( Inj.Mego-E ) 复方甲地孕酮避孕针 ( 美尔伊避孕针、甲孕雌醇避孕针 ) Components: Megestrol 25mg 17β-Estradiol 3.5mg

41. 3. Norethisterone Enanthate Injection 庚炔诺酮避孕针 Components: Norethisterone Enanthate 炔诺酮庚酸酯 200mg can be used in lactation menstrual disorder ↑ Long-acting contraceptive injection

42. in the first month : D5 and D12 next months: D10-D12 menstrual onset 12-16 days after injection side effcts: irregular bleeding , menorrhagia in the first 3 months treatment : hemostatic , estrogen, short –acting OC Long-acting contraceptive injection

43. 1. Hypodermic implant ( 皮下埋植剂 ) (1) Norplant I (99.8%) (D- 炔诺孕酮埋植剂 I 、 左炔诺孕酮埋植剂 I) Levonorgestrel ( 左旋炔诺孕酮） 36mg×6 . For 5 years (2) Norplant II (D- 炔诺孕酮埋植剂 I 、 左炔诺孕酮埋植剂 I) LNG 70mg×2 . For 3 years no estrogen , can be used in lactation implanted on 7 days of menstrul cycle side effct: irregular blot bleeding , amenorrhea treatment : hemostatic , estrogen Slow-releasing contraceptives

46. (1) Megestrol Acetate-Silica Gel Circle (97%) 甲硅环、甲孕酮硅胶避孕环 Megestrol 200 ～ 250mg For 1 years 哺乳期首选 Contraceptive vaginal ring

47. 3. Slow-releasing injectable microglobes and microcapsules – 0.1mm For 3 months IV. Transdermal patch Systemic Contraceptives

49. Intrauterine Devices

50. 1. IUD made with inert materials Stainless steel, nylon, etc Fewer adverse reactions, but higher expulsion rate and pregnancy rate 2. IUD added with active substances 1) IUD with copper TCu-200 (1 year cumulative rate) Expulsion rate: 5.61% Pregnancy rate: 1.51% Removal rate (due to adverse effects): 9.22% Removal rate (due to other reasons): 3.62% ‘ Overall failure rate’ 19.96% 2) IUD with progestogens , zinc, PG synthetase inhibitor 3. Third generation IUD : Anchoring IUD Types of IUD

51. Mechanism 1.Primarily an aseptic inflammation reaction- foreign body macrophage ,Leukocytes ↑ - blastokinin ↓ - implantation ↓ 2.Prostaglandins velocity of embryo transport ≠ endometrial development 3. oppressed ischemic endometrium -> plasminogen ↑ - fibrinolysis ↑- blastula dissolve . IUDs

53. IUDs 1. Timing 1) 3-7 days after completion of menstruation and no recent sexual intercourse. 2) Immediately after an artificial abortion (<10 cm) 3) 3 months after a normal vaginal delivery 4) 6 months after a cesarean section 5) Day 3 of menses for progestin containing IUD 2. Selection of IUDs: depending on space of uterine cavity Procedures

54. Method

59. 1 ) Uterine bleeding Mechanical compression injuries Increased PGs and activated fibrinolysis Indomethacin ( 消炎痛 ) 25-50mg tid po aminohexanoic acid ( 氨基己酸 ), 2-4g tip po 云南白药 , 0.4g tid po Severe menorrhagia causing anaemia and requiring removal of the device 2) Pain or discomfort Colicky pain may occur for a time after insertion, particularly if the device is large. If dysmenorrhoea occurs, prostaglandin synthetase inhibitors relieve the symptom. Otherwise the possibility that it is caused by infection must be thought. Adverse effects

64. Expulsion or displacement

72. Types: (1) Male condom ( 安全套 ) (2) Female condom (3) Vaginal spermicides Nonoxynol-9 ( 壬苯醇醚膜 ) (95%) 乐乐迷避孕膜 Mechanism: Damage sperm membrane Usage: Insert into vagina 3-5 min before coitus Barrier methods

74. (1) Coitus interruptus ( 体外排精 ) (2) The safe period ( 安全期 ) (3) Postcoital douche ( 性交后冲洗 ) (4) Prolongation of lactation Natural methods

78. Mechanism 1. Prevent or postpone ovulation 2. Interfere with fertilization or implantation Methods 1 Morning-after pill ( 98% ) ( <3 days ) Steroid or nonsteroid hormones. 2. Morning-after IUD insertion Postcoital Contraception

80. Steroids (1) Levonorgestrol Tablets ( 左炔诺孕酮片 ) 毓婷 Levonorgestrel 0.75mg twice (12h) (2) Anordrin Tablets (53 号抗孕片 ) (Sugar coated) Anordrin ( 双炔失碳酯 ) 7.5mg twice . (3) Compound Levonorgesterel Tablets 复方左旋炔诺孕酮片 (EE 30 μg, LNG 0.15mg) 4 tablets twice (12h) Postcoital Contraception

84. Minilaparotomy （经腹）

87. 1. Drug induced 2. Surgical Vacuum suction ( 6 ～ 10 weeks ) Surgical curettage ( 11 ～ 14 weeks ) Artificial abortion ( 人工流产 )

89. Mechanism: Mifepristone competes with progesterone for P receptors on decidua ( 蜕膜 ). Misoprostol causes uterine contraction. Complete abortion rate: ≥ 90% Side effects and complications: (1) Digestive tract symptoms (2) Pain caused by uterine contraction (3) Bleeding usu. ＞ 14 days or even 2 months (4) Infection Drug induced abortion ( 药物流产 )

95. Uterine perforation

96. Retention of conceptus

97. For newly married couples: For couples with one child: For couples with two or more children: For lactating women: For perimenopausal women: Selection of Contraception Methods

98. thanks