CONTRACEPTIVE METHODS

INDEX

1) Defn & Classification

2) Barrier methods

3) Intra- Uterine Devices

4) Hormonal Contraceptives

5) Post Conceptional Methods

6) Centchroman

7) Miscellaneous Methods
 CONTRACEPTIVE METHODS

Definition:
Family planning is defined as ‘a way of thinking & living that is
adopted voluntarily, upon the basis of knowledge, attitudes and responsible
decisions by individuals & couple, in order to promote the health and
welfare of the family, group and thus contribute effectively to the social
development of the country.’
Classification
I Spacing methods
1) Barrier methods
a) Physical methods
b) Chemical methods
c) Combined methods
2) IUD
3) Hormonal methods
4) Post-conceptional methods
5) Miscellaneous

II Terminal Methods
1) Male sterilization
2) Female sterilization

Conventional contraceptive - The methods that require action at the

time of sexual intercourse e.g. condom, spermicidal jelly, vaginal sponge
2) Barrier methods

i) Condom (nirodh)
Advantages –
i) Easily available
ii) Safe & inexpensive
iii) Easy to use
iv) No side effects
v) Provide protection against pregnancy STI & HIV / AIDS.

Disadvantages –
i) It can slip off or tear during coitus due to incorrect use.
ii) Interferes with sex sensation locally.

Failure rate : Varies from 2-3 to more than 20 per 100 woman years.

ii) Diaphragm ( Dutch cap)

Advantages –
i) Total absence of risk & medical contraindications

Disadvantages –
i) Trained person is required to demonstrate the technique of insertion.
ii) Toxic shock syndrome if left in place for longer time .
iii) In rural areas difficult to practice.
iv) Good vaginal tone is required

Failure rate: 1.9 per 100 woman year

iii) Female Condom
Trade name : Femidom
This is a barrier contraceptive to be used by females. It is usually
made up of polyurethane & combines the features of male condom &
diaphragm.
Structure: It is approximately 17 cm long polyurethane bag with rings at
both the ends. The smaller ring, at the close end of the pouch, is used to
facilitate insertion into the vagina and is designed to fit over the cervix.
The outer ring hangs outside the vagina preventing the device from
slipping entirely into the vagina & also protects the labia & base of mons
pubis. It is pre-lubricated with silicon.

Advantages –
i) It empowers the woman to have a choice, especially important in sex
workers to protect from genital infection.
ii) Protects women from STI & AIDS
iii) low failure rate

Disadvantages -
i) It may not be culturally accepted.
ii) High cost
iii) Interfere with sensation.
iv) Can not be reused .

Diagram
iv) Vaginal Sponge

Trade name: Today

It is a small polyurethane foam sponge 5cm x 2.5 cm, saturated with the
spermicide nonoxynol -9. It is to be inserted into the vagina prior to the
intercourse.

Advantages –
i) It offers some protection against STD & HIV /AIDS
ii) It empowers the woman to have a choice, especially important in
the sex workers.

Disadvantages -
i) High failure rate 10-20 / 100 woman-years
ii) It should used with other methods eg .condoms
iii) If used repeatedly for long time, it can cause erosions in the
vagina thereby increases the chances of HIV transmission
3) Intra- Uterine Devices
Types: Non- Medicated IUD & Medicated IUD
Non- Medicated IUDs are known as Ist generation IUD eg. Lippes loop
Medicated IUDs are II nd generation IUD- eg Cu T
III rd generation IUD –eg progestasert

Copper –T
IInd generation IUD, available as
Earlier devices- Copper 7, Copper 200
Newer devices- T Cu 220C, Nova T, Multi-load Cu 250/375
Mechanism of action -
It acts as foreign body in the uterus causing cellular & biochemical
changes in the endometrium & uterine fluids. These changes impair viability
of gamete reducing chances of implantation.
Progesterone containing IUDs affect sperm motility & capacitation.
Expulsion rate : 6 -8 %
Advantages:
Simple, inexpensive, reversible, no systemic side effects,
no need for continued motivation
Contraindications:
Absolute: Suspected pregnancy, PID, vaginal bleeding, Ca cervix,
previous ectopic pregnancy
Relative: anaemia, h/o PID, menorrhagia ,congenital anomalies
side effects: severe pain ,bleeding ,perforation ,PID ectopic pregnancy
Failure rate : 3-5 / 100 users /years
3rd generation IUD
Progetasert- T shaped device filled with 38 mg of progesterone , releases the
hormone @ 65 Mcg daily in the uterus
Levonorgestrel - releases @ 20 Mcg daily, Effective upto 10 years
4) Hormonal Contraceptives

Classified as-
A) Oral pills
1) Combined pills eg Mala D, Mala N
2) Progesterone only pills
3) Post coital pill
4) Once-a-month pill
5) Male pill
B) Depot (slow release) formulation
1) Injectables – DMPA, NET-EN
2) Subcutaneous implants – Norplant, Norplant (R)2
3) Vaginal rings

Combined pills
Trade name: Mala D, Mala N, Choice
Contents:
Norgestrol 0.3 mg, Ethynil oestradiol 0.03 mg
Mode of action- prevents the ovum formation in ovary by blocking pituitary
secretion of gonadotropins. It also makes cervical mucus thick & scanty.
Failure rate: 1/ 100 woman-years
Adverse effects-
Cardiovascular effects- hypertension, cerebral thrombosis, venous
thrombosis, myocardial infarction
Metabolic effects- reduction in HDL, increased blood glucose
Common effects- weight gain, headache, breast tenderness, break-thru
bleeding
Progesterone only pills – advised to older women to avoid cardiovascular
risks of combined pills.
Post coital pill or ‘morning after’ contraception is recommended within 72
hrs of unprotected intercourse.
In this, a double dose of the standard combined pill is given immediately,
followed by another 2 pills after 12 hrs.

Depot (slow release) formulation

Depot Medroxy progesterone acetate (DMPA) –
Intramuscular injection of 150 mg every three months
NET-EN – Norethisterone enanthate - IM inj of 200 mg every 2 months.
Mode of action: Inhibition of ovulation
Progesteronic action on cervical mucus

Adverse effects:
Disruption of normal menstruation , pronged heavy bleeding , amenorrhea
5) Post Conceptional Methods (Termination of pregnancy )

Types:
Menstrual regulation
Menstrual induction
Abortion
Menstrual regulation
Simple method
Consists of aspiration of uterine contents within 6 to 14 days of missed
periods.
complications: Immediate : Uterine perforation, trauma
late: tendency to abortion or premature labour, infertility,
menstrual disorders, increase in ectopic pregnancy, Rh isoimmnisation

Menstrual induction
Intrauterine application of 1-5 mg soln. of prostaglandin F2. This
causes disturbances of progesterone-prostaglandin balance leading to
sustained contraction of uterus for 7 minutes. Cyclic contraction lasts for 3-4
hours. Bleeding continues for 7-8 days.
6) Centchroman
Trade name: Saheli
This is non–steroidal, non-hormonal contraceptive to be used by woman.
It acts by preventing the proliferation of endometrium & thereby making it
unsuitable for embryo implantation, also affects the motility of fallopian
tubes.
Dose: 30 mg twice a week for 12 weeks , then 30 mg once a week only
Advantages : 1) No side effects as those of hormonal contraceptive
2) Low failure rate
3) Easy reversibility
Disadvantage: Prolongation of menstrual cycle in a few women.

7) Miscellaneous Methods

1) Abstinence
2) Coitus interrupts
3) Safe periods (rhythm method )
Failure rate : Very high 21 /100 woman-years
4) Natural family planning methods
Basal body temperature methods
Cervical mucus methods
Symthothermic methods
5) Breast feeding
6) Birth control vaccine : still under trial . vaccine prepared from B
subunit of HCG