1 / 45

Comprehensive Guide to Contraception Methods

Learn about various contraception methods including sterilization, oral and injectable steroids, barriers, and natural family planning. Understand effectiveness, complications, and implications for different populations.

dderry
Download Presentation

Comprehensive Guide to Contraception Methods

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CONTRACEPTION

  2. Objectives • Describe the advantages, disadvantages, failure rates, and complications associated with the following methods of contraception • Sterilization • Oral steroid contraception • Injectable steroid contraception • Implantable steroid contraception • Barrier methods • Natural family planning

  3. Abstinence • Mechanism: excludes sperm from female reproductive tract • Effectiveness: 0% failure rate • Ideal for adolescents at high risk for pregnancy and STD’s including HIV • Complications: None

  4. Breastfeeding:Lactation Amenorrhea Method (LAM) • Mechanism: Suckling causes increased prolactin, which inhibits estrogen production and ovulation • 2% typical use failure rate in 1st six mos. • Candidates: • Amenorrheic women < 6 mos post-partum who exclusively breastfeed (90% of nutrition is breast milk) • Women free of blood-borne infections • Women not on drugs that could effect baby Kennedy KI. et al., Contraceptive Technology.2004

  5. LAM Complications • Breastfeeding may increase the risk of mastitis • Return of fertility or ovulation may precede menses. • 33-45% ovulate during 1st 3 months. • Encourage backup form of contraception

  6. Barrier Methods:Male Condoms

  7. Barrier Methods:Male Condoms • Sheaths of latex, polyurethane, or natural membranes that may or may not have spermicide. • Mechanism: Barrier that prevents sperm and infections from entering vagina. • Effectiveness: 15% typical use failure rate. • Candidates: • Couples not in mutually monogamous relationships • Couples in which one partner has an STD/HIV • Couples starting other types of birth control • Couples who can’t use hormonal methods Warner DL, et al. Contraceptive Technology. 2004

  8. Barrier Method:Female Condom • Disposable single use polyurethane sheath placed in vagina. • Flexible movable inner ring at closed end used to insert into vagina. • Flexible outer ring to cover part of the introitus. • Mechanism: Prevents passage of sperm and infections into the vagina. • Failure rate is high at 21% with typical use. Hatcher et al. Managing Contraception.2004

  9. Barrier Method:Female Condom • Candidates the same as for male condoms. • Female condom is reusable only if the partner does not have an STD. • Disadvantages: • Awkward and difficult to place • Most users do not enjoy using female condom (88% of women and 91% of men) • Many couples complain about noise of condom

  10. Female Condom: “Reality”

  11. Barrier Method:Cervical Cap • Thimble- shaped latex rubber device which has an inner ring that provides suction to keep cap on the cervix. • Spermicide is placed inside the cap before being placed on the cervix to kill sperm. • 4 sizes: 22, 25, 28, 31 mm. • Mechanism: barrier that prevents sperm migration into cervical canal

  12. Barrier Method:Cervical Cap • Advantages: • May decrease risk of GC, Chl, and PID • Can be placed 6 hours prior to intercourse • Can remain in vagina up to 48 hours for multiple acts of intercourse • Disadvantages: • No protection against HIV • Poor fit especially in parous women • Failure Rate: As high as 32% in parous women and 16% in nulliparous women • Patient must leave in place at least 8 hours after intercourse before removing

  13. Diaphragm

  14. Barrier Method:Diaphragm • Latex rubber dome-shaped device that covers the cervix • Mechanism: prevents sperm from entering cervical canal • Three types: • Arcing Spring • Coil Spring • Wide Seal

  15. Barrier Method:Diaphragm • Typical use failure rate: 16% in one year • May reduce risk of GC, Chl, PID • Risks: • No protection from HIV • Difficult to place around cervix • May fall out in women with pelvic relaxation • May cause vaginal erosions & infections • May cause reaction in latex allergic • Toxic Shock Syndrome • Urinary Tract Infections

  16. SPERMICIDE • Most common is nonoxynol-9 • Available in creams, films, foams, gels, suppositories, sponges, and tablets • Best when used with barrier methods • 29% typical use failure rate when used alone • Provides no protection against STD’s and HIV

  17. Emergency Contraception (EC) • Any method used after unprotected or inadequately protected sexual intercourse • Three types of EC available in the United States: • High dose progestin only ( Plan B) • Yuzpe method- 13 different combined oral contraceptives (Preven) • Copper IUD ( Paragard) Dickey. Managing Contraceptive Pill Patients, 2002

  18. Emergency Contraception (EC) • Mechanism: Prevents fertilization and implantation. • Counsel patients that this method does not abort a pregnancy that is already implanted • Common in women after an assault or rape • Most women will have a cycle 21 days after completing emergency contraception • If patient does not have a cycle in 21 days, it is important to check a pregnancy test

  19. Emergency Contraception (EC) • High dose progestin-only (Plan B): • 1.5mg Norgestrel at one time or in divided doses. • Divided Dose: 1st dose within 72-120 hours of intercourse. 2nd dose 12 hours later. • One dose: Both tablets within 72-120 hours of intercourse Glaser A. Emergency post-coital contraception, New England Journal of Medicine, 1997.

  20. Emergency Contraception (EC) • Yuzpe Method (Preven) • 100mcg of ethinyl estradiol and 0.50 mg of levonorgestrel in each dose. • 1st dose within 72 hours of intercourse and 2nd dose 12 hours later

  21. Emergency Contraception (EC) • Copper IUD • Place within 5 days of unprotected coitus. • This is usually given to women who plan to use the IUD for long term birth control. • Interferes with implantation after fertilization.

  22. Intrauterine Devices

  23. Copper IUD (Paragard T 380 A) Copper is a spermicide that inhibits sperm motility and acrosomal enzyme action Lasts 10-12 years May increase bleeding and dysmenorrhea Typical use failure rate is 0.8% Mirena (Levonorgestrel) Increases thickness of cervical mucus to inhibit sperm migration Lasts up to 7 years Improves menorrhagia by 90% in most patients Causes amenorrhea in many users Typical use failure rate is 0.1% Intrauterine Devices (IUDs)

  24. IUD • Good for women in mutually monogamous relationships • Risks: • Increased risk of PID within 1st 20 days • Uterine perforation • Fainting with insertion • Expulsion • Unexpected pregnancy following poor placement

  25. Combined Oral Contraceptives(Estrogen & Progestin) • Mechanism: • Blocks ovulation • Thickens cervical mucus • Thins the endometrial lining

  26. Combined Oral Contraceptives(Estrogen & Progestin) • Ethinyl estradiol is the most commonly used estrogen in OCP’s • There are multiple forms of progestins • Monophasic: same amount of hormone in each active tablet • Multiphasic: varying amounts of hormone in each active pill • Most OCP’s have 21 active pills and 7 placebo pills

  27. Combined Oral Contraceptives(Estrogen & Progestin) • Alternate Formulations: • Seasonale: 84 consecutive hormonal pills followed by 7 days of placebo • Ovcon-35: chewable pills • Yasmin:Drospirenone which is anti-androgenic and anti-mineralcorticoid

  28. Combined Oral Contraceptives(Estrogen & Progestin) • Non-contraceptive Uses of OCPs • Dysfunctional uterine bleeding • Dysmenorrhea • Mittelschmerz • Endometriosis prophylaxis • Acne and hirsutism • Hormone replacement • Prevention of menstrual porphyria • Functional ovarian cysts

  29. Combined Oral Contraceptives(Estrogen & Progestin) Advantages: • Less endometrial cancer (50% reduction) • Less ovarian cancer (40% reduction) • Less benign breast disease • Fewer ovarian cysts (50% to 80% reduction) • Fewer uterine fibroids (31% reduction) • Fewer ectopic pregnancies • Fewer menstrual problems            --more regular           --less flow           --less dysmenorrhea           --less anemia • Less salpingitis (pelvic inflammatory disease) • Less rheumatoid arthritis (60% reduction) • Increased bone density • Probably less endometriosis

  30. Combined Oral Contraceptives(Estrogen & Progestin) Disadvantages • Spotting especially in 1st few months • May decrese Libido • Requires daily pill intake • No protection against STD’s and HIV • Possible weight gain • Post-contraception amenorrhea

  31. Combined Oral Contraceptives(Estrogen & Progestin) • Absolute Contraindications: • Thromboembolic disorder (or history thereof) • Cerebrovascular accident (or history thereof) • Coronary artery disease (or history thereof) • Impaired liver function (current) • Hepatic adenoma (or history thereof) • Breast cancer, endometrial cancer, other estrogen-dependant malignancies • Pregnancy • Undiagnosed vaginal bleeding • Tobacco user over age 35

  32. Combined Oral Contraceptives(Estrogen & Progestin) • Relative Contraindications • Migraine headaches, esp. worsening with pill use • Hypertension • Diabetes mellitus • Elective surgery (needs 1 to 3 month discontinuation) • Seizure disorder, anticonvulsant use • Sickle cell disease (SS or sickle C disease (SC) • Gall bladder disease.

  33. Choosing The Right OCP’s • Endometriosis: Choose a pill with a strong progestin to create a pseudo-pregnancy state • Functional Ovarian Cysts: High dose monophasic pill may be more effective • Androgen excess: Choose a pill with high estrogen/progestin ratio to reduce free testosterone and inhibit 5areductase activity • Breastfeeding: Progestin -only pill

  34. Transdermal: Ortho Evra • Delivers 20 mcg of ethinyl estradiol and 150 mcg of norelgestromin daily • Takes 3 days to achieve a steady state of hormone in the blood stream • Patch is replaced once per week for 3 consecutive weeks • Worn on abdomen, buttocks, upper outer arm, or upper torso • Do not place on the breast

  35. Transdermal: Ortho Evra • Advantages: • Only has to be replaced once per week • May be taken continuously • Disadvantages: • May slip off- provide pt. with an emergency patch • Patch may be less effective in women who are > 198 pounds

  36. Vaginal Contraceptive Ring: NuvaRing • Combined hormonal contraception consisting of a 5.4 cm diameter flexible ring • 15 mcg ethinyl estradiol and 120 mcg of desogestrel • Mechanism: suppresses ovulation • Typical use failure rate: 8%

  37. Vaginal Contraceptive Ring: NuvaRing • Place in vagina and remove after 3 weeks • Allow withdrawal bleeding and replace new ring • Steady low release state • Advantage is patient only has to remember to insert and remove the ring 1x/ month • May be placed anywhere in the vagina

  38. Depo Provera • 150 mg IM every 3 months • Contraceptive level maintained for 14 weeks • Failure Rate: 3% typical use failure rate • Mechanism: • Thickens cervical mucus • Blocks the LH surge • Initiate treatment during the first week of menses

  39. Advantages Long acting Estrogen-free Safe in breast-feeding Can be used in sickle-cell disease and seizure disorder Pt. does not have to take daily Increases milk quality in nursing mothers Disadvantages Irregular bleeding (70% in first year) Breast tenderness Weight gain Depression Slow return of menses after stopping use Decreases HDL cholesterol Depo Provera

  40. Female Sterilization • Interrupts the patency of fallopian tubes- thereby preventing fertilization • Failure rate: Depends on method used -ranges from 0.8-3.7% • May be performed through a mini-laparotomy incision , laparoscopically, or transcervically

  41. Female Sterilization

  42. Male Sterilization

  43. Male Sterilization • Vasectomy: ligate or cauterize the vas deferens • Mechanism: interrupts vas deferens preventing passage of sperm into seminal fluid • May be done under local anesthesia • Cheaper than female sterilization • Failure rate: < 0.15% • Use contraception until completely azospermic for two consecutive sperm counts ( usually takes 12 weeks or 10-20 ejaculations) • Does not affect ability to have an orgasm

More Related