4. Advantages
Most effective, long-term reversible contraception
available
Most methods offer complete privacy
Require no planning before intercourse
Disadvantages
Require a visit to a healthcare professional
May cause common hormonal side effects
Products containing estrogen may be associated with
rare, but serious health risks
Not effective against STD
5. Daily Use
Oral Contraceptive Pill
– Combination pill
– Progestin-only pill
Nondaily Use
Injectable contraceptive
Contraceptive patch
Hormone-releasing
intrauterine system
Emergency Contraception
6. 1. The Combination Pill
Contain Synthetic Estrogen/Progestin
Modern E2 Dosage ≤ 50 Mcg
Despite Diversity, Side Effects and Efficacies
Similar
Requires Patient Compliance
May Be Monophasic or Triphasic
9. Advantages:
Highly effective
Provides noncontraceptive health benefits
Private
Does not require vaginal insertion
Allows to control cycle
Disadvantages:
Must be taken daily
Side effects may lead to discontinuation
Associated with rare, but serious health risks, such as
blood clots and stroke
10. Non-Contraceptive Benefits of OCPs
Improvement
Dysmenorrhea
Acne
Hirsutism
Anemia
Cycle Regulation
Reduction Risks
Colorectal Cancer (18-40%)
Endometrial Cancer
PID (10 – 70%)
Osteoporosis
Osteopenia
Cleveland Journal of Medicine 2004
11. Mechanism of Action
Suppresses LH / FSH Release
(E2 FSH, P LH)
Progestin Thickens Cervical Mucus and Alters
Endometrium
Major Effect Is Anovulation and Impairment of
Sperm Transport and Oöcyte Implantation
12. Side Effects
Breakthrough Bleeding (≤ 25%)
Amenorrhea
Breast Tenderness, Nausea
? HTN
? Weight Gain
14. 2. The Contraceptive Patch (Evra Patch)
Advantages:
Efficacy comparable to OCPs
Weekly application encourages compliance
Does not require vaginal insertion
Disadvantages:
Application site reactions may occur
May not be as effective in women weighing
more than 198 pounds
May produce side effects similar to OCPs, with
higher rate of transient breast pain
Noncontraceptive health benefits theoretically
similar to combination OCPs, but not as well
documented
May be visible on the skin
OCP = Oral Contraceptive Pill
15. 3. The Progestin-Only Pill
Progestins:
Norethindrone
Norgestrel
Advantages:
Useful for women with
contraindications to estrogen
Use with postpartum women who are
breastfeeding
Does not require vaginal insertion
Disadvantages:
Higher pregnancy rate than
combination OCPs
More sensitive to missed pills than
combination OCPs
Associated with abnormal bleeding
and other side effects
16. 4. Injectable Hormonal Contraception
Advantages:
Highly effective
Convenient three month administration schedule encourages
adherence
Private
Useful when estrogen should be avoided
Decreases risk of endometrial cancer
Disadvantages:
Irregular bleeding and amenorrhea frequently occur
Weight gain, abdominal pain, and depression are common side
effects
Prolonged use may decrease bone mass
20. 5. Emergency Contraception
Indications
-standard of care for women not protected by
efffective contraception.
-No contraception was used
-Condom broke, slipped, leaked etc….
-Missed more 2 or more days of ocp’s
-Highly effective 75%
-Effective up to 120 hours after unprotected sex
-Will not disrupt or harm developing pregnancy
J Adolesc Health. 2004;35:66-70.
21. FDA Approved Emergency Contraceptive Kits
PREVEN KIT
- Contains 4 pills
- EE 50 ug.
- Levonorgestril
0.25 mg.
- 2 pills 12 hourly
for 2 doses
Plan B Kit
- contains 2 pills
- Levonorgestril
0.75 mg
- 1 pill 12 hourly for
2 doses
22. The Yuzpe Regimen:
Two Doses of:
EE 0.1 mg with
dl-norgestrel 1.0 mg
Administered 12
hours apart
First dose taken within 120
hours of unprotected
intercourse
The Combination Pill
Advantages:
Prevents approximately 75% of
unintended pregnancies
Disadvantages:
Increased incidence of side
effects due to high estrogen
component
High rate of nausea (50%) and
vomiting (20%) may limit
adherence
EE = Ethinyl Estradiol
23. The Progestin-Only Pill
Advantages:
More effective than Yuzpe regimen
Better tolerated than Yuzpe regimen
May be taken as a single dose
May be preferable for women with history
of idiopathic thrombosis
Disadvantages:
Associated with a moderate degree of side
effects including nausea, vomiting,
dizziness, and fatigue
Plan B
(levonorgestrel 0.75 mg)
Levonorgestrel:
Single dose of 1.5 mg or two
doses of 0.75 mg taken 12
hours apart
First dose administered within
120 hours
24. ACOG GUIDELINES (Emergency Contraception)
-Should be offered or made available for (UPSI)
- Levonorgestril only regime is more effective &
less side effects than combined regime
- 1.5 mg Levonorgestril can be taken single dose
or 2 divided doses (0.75 mg) 12-24 hrs. apart
- An anti-emetic can be taken 1 hr before 1st dose
- Prescription of EC in advance can increase
availability and use.
26. ParaGard (CuT380A),
Very Effective (~ TL), Reversible
Risks OVERBLOWN
Does Not Protect Against STD’s
Can Remain for ≤ 10 Years
27.
28. Mechanisms of Action
NOT ABORTIFACIENT!!!!!!!!
Prevents Conception:
– Sperm Transport Inhibited
– Sperm Survival / Capacitation
Diminished
Prevents Implantation: hCG Levels = 0
29. Work-up
History: STD’s, Sexual History, Ectopic
PEx: Size / Configuration of Uterus
Cervical Cultures, Pap
Counseling
30. Contraindications
High Risk for STD’s
Abnormal Uterine Bleeding
Current Pelvic Infection (GC, Chl)
Actinomyces on Pap
???Nulliparity
Pregnancy
Wilson’s Dz, Cu Allergy (both rare)
31. Complications
PID: Usually 20 Insertional Contamination
– Unproven Role for Prophylactic ABx
Hypermenorrhea
Expulsion
Perforation (< 0.1%)
Failure: IUD Should be Removed
??Ectopic
32. 1. The Copper Intrauterine Device (IUD)
Advantages:
Highly effective
May be efficacious if inserted up to 7
days after intercourse
Generally well tolerated
Disadvantages:
Not cost effective for short-term use
Not recommended for women with a
sexually transmitted disease
34. 3. Levonorgestrel Intrauterine System
Advantages:
Highly effective
Stays in place for up to five years, limiting
adherence concerns
Private
Decreases menstrual blood loss
Disadvantages:
Requires professional insertion and removal
Abnormal bleeding, dysmenorrhea, and
pelvic, abdominal and back pain
May not be appropriate for women with
increase STD risk
36. Advantages
- Preferred by many who have occasional
intercourse
- Useful alternatives for those who want to avoid
hormonal side effects
- Some methods available without prescription
- Some methods offer limited protection against
sexually transmitted disease
37. Disadvantages
-Not as effective as hormonal methods
-Efficacy is highly dependent on consistent and correct
use
-Require fitting by healthcare provider
-Require vaginal insertion and removal by the patient
that may be difficult or unacceptable
-Require concomitant use of spermicide
-Associated with an increased risk of urinary tract
infection and toxic shock syndrome
39. Advantages:
Can be inserted hours before
intercourse
Does not require removal
between
acts of intercourse
1. Diaphragm
40. Disadvantages:
-Should not be used with suspected or confirmed latex
allergy
-Requires prescription and fitting by healthcare provider
-Requires insertion and removal
-Spermicide must be applied before each use
-Must stay in place for at least six hours after last intercourse
-May increase risk of urinary tract infections and toxic shock
syndrome
41. 2. Male Condom
Advantages:
Provides greater protection against STDs
than any other method of contraception
Provides substantial protection against
pregnancy when used with a spermicide
Does not require a prescription
Can be used with other methods
Inexpensive and widely available
42. Disadvantages:
Can only be used for one act of intercourse
Can break or slip during use
May decrease sexual pleasure
May interfere with spontaneity
Requires cooperation of male partner
44. 1-Natural family planning techniques
(Fertility Awareness Methods)
2-Contraceptive effect of breast feeding
(Lactational Amenorrhea Method)
3- Withdrawal
45. 1. Rhythm-standard days method (SDM)
For women with menstrual
cycles between 26 & 32 days.
Avoid unprotected IC day #9-
19
70-80% effective
Assumes ovulation about day
#14
46. 2. Withdrawal Method
80-90% effective
Always available
Requires motivation,
sense of timing
Some sperm present in
pre-ejaculatory fluid
Psychological issues
53. Monopolar Coagulation
Laparoscopic
•Proposed in 1937 by Anderson
•Complications
•Bowel Burn
•Longer portion of
tube is damaged
•Failures and ectopic
pregnancy
1. Peterson LS Contraceptive use in the United States: 1982 -90. Advance Data: From Vital Health Statistics February 1995; 260 1-8
Failure Rate:7.5/1000
54. Bipolar Coagulation
Laparoscopic
Introduced in 1973 by Jacques Rioux
Benefits
•Most Common method
of Laparoscopic
sterilization Complications
•Formation of
uteroperitoneal fistulas
•High rate of Ectopic
Pregnancy
•Potential for Bowel Burns
•Reversals are potentially
more difficult due to the
extent of tube damage
1. Peterson HB, et al. The risk of pregnancy after tubal sterilization: Findings from the U.S. Collaborative Review of Sterilization. Am J obstet. Gynecol. 1996; 174 (4):1161-1170
Failure Rate:24.8/10001