Mansoura Manchester Programme Semester: 1 First year 1 November 2022 Mansoura Manchester Programme Contraception By Mohamed Taman Lecturer of obstetrics and gynecology Mansoura university 1 November 2022 Mansoura Manchester Programme Objectives (ILOs) q Introduction on normal fertilization and implantation q Definition of contraception q Different methods of contraception and how they act q Summary 1 November 2022 Mansoura Manchester Programme Physiology of ovulation -ve Feed back Hypothalmo-pituitary –ovarian Axis Ovulation Normal fertilization and implantation D3 D5 Normal implantation D3 D5 Normal pregnancy Normal conception 1 November 2022 Mansoura Manchester Programme Contraception • Definition: Prevention of conception by any method other than abstinence • Prevent Ovulation Fertilization Implantation 1 November 2022 Mansoura Manchester Programme Ideal contraceptive method q No ideal method. q Accepted by couple. q Reliable. q Available. q Reversible & doesn't affect fertility. q Cheap. q Safe q Easy to use. q No medical supervision. q Effective. q Doesn't affect sexual relationship. 1 November 2022 Mansoura Manchester Programme Classifications 1 November 2022 Mansoura Manchester Programme Classifications 1 November 2022 Mansoura Manchester Programme Natural contraception 1 November 2022 Mansoura Manchester Programme Lactational Amenorrhea Method q Defection Ø LAM is a temporary family planning method based on the natural effect of breastfeeding on fertility. q LAM requires 3 conditions. 1) Menstruation has not returned. 2) The baby is fully breastfed 3) First 6 months after delivery. 1 November 2022 Mansoura Manchester Programme LAM(mechanism of action) ØPreventing ovulation. Prolactin 1 November 2022 Mansoura Manchester Programme LAM Advantages q It is a natural family planning method q No side effects. q It supports optimal breastfeeding, q Providing health benefits for the baby & mother. q No direct cost for family planning Disadvantages q Not highly effective Frequency q Every 2-3 hours / day 1 November 2022 Mansoura Manchester Programme Safe period 1 November 2022 Mansoura Manchester Programme Barrier methods Mechanical • a) Male: Condom. • b) Female: Condom, vaginal diaphragm & cervical cap. Chemical: Spermicides. (nonoxynol-9) 1 November 2022 Mansoura Manchester Programme Barrier methods Barrier Methods, Spermicides Advantages q Can prevent sexually transmitted disease q Condoms can be used during the postpartum period. q Use of diaphragms and cervical caps should be delayed until uterine involution q Available q Cheap q Can be used easily Disadvantages q Not highly effective q May lead to pelvic congestion q Less compliance Hormonal methods • Progesterone only • Estrogen &Progesterone q Progesterone only pills (POPs) q Combined oral pills q Progesterone only injectable q Combined injectable q Subdermal implants q Vaginal ring. q Progesterone medicated IUCDs q Skin patch 1 November 2022 Mansoura Manchester Programme Progestin Only Pills What Are POPs? q It contains very low doses of a progestin q Do not contain estrogen, so can be used during breastfeeding q Progestin-only pills (POPs) are also called “minipills” 28 pills Mechanism of action Fertilization Implantation Local effect Mechanism of action qThickening of cervical mucus, q↓ Sperm penetrability. q↓ Tubal motility qUnreceptive endometrium 1 November 2022 Mansoura Manchester Programme Advantages qNo estrogenic side-effects of COCs. qCan be given to • Breastfeeding • Older age • Smokers • Diabetics • Hypertensive. 1 November 2022 Mansoura Manchester Programme How to use? q 28 pills or 35 pills. q All pills in POPs packs are active. q First pill & follow the arrows q One pill each day q Start the first pill from the next pack on the very next day. Progestin Only Injectable Mechanism of action q It has higher doses of progesterone q Prevention of ovulation. q It has local effect as POP q It is given every 3 months q Deep IM injection into the hip region or upper arm 1 November 2022 Mansoura Manchester Programme Contraindications q Blood pressure ≥160 /100 mm Hg q History of breast cancer q History of ischemic heart disease or cerbrovascular stroke q Unexplained vaginal bleeding q DM complicated with (nephropathy, retinopathy, & neuropathy) q Severe liver cirrhosis & Liver tumor 1 November 2022 Mansoura Manchester Programme Subdermal Implants Mechanism of action q It has higher doses of progesterone q Prevention of ovulation. q It has local effect as POP q It is placed for 3-5 years q Sud dermal insertion in the inner aspect of non dominant arm 1 November 2022 Mansoura Manchester Programme Mechanism of action Implanon insertion Implanon removal Hormonal methods • Progesterone only • Estrogen &Progesterone q Progesterone only pills (POPs) q Combined oral pills q Progesterone only injectable q Combined injectable q Subdermal implants q Vaginal ring. q Progesterone medicated IUCDs q Skin patch 1 November 2022 Mansoura Manchester Programme Combined Oral Contraceptive Pills COCS Ø Pills contain 2 hormones progestin & Estrogen Ø Preventing (ovulation). 21 pills 1 November 2022 Mansoura Manchester Programme Mechanism of action Central effect Local effect Contraindications q Liver disease (such as severe cirrhosis) q History of heart disease or stroke q Current VTE(Thrombosis) q History of breast cancer. q Migraine. qSmoking qHigh blood pressure qDM qAge ≥ 35 years q Epilepsy 1 November 2022 Mansoura Manchester Programme Combined Monthly Injectables Mechanism of action Ø Contains2 hormones progestin & Estrogen Ø Preventing ovulation Ø It has local effect Ø Given every month Ø Given as IM injection 1 November 2022 Mansoura Manchester Programme Mechanism of action Central effect Local effect Contraindications qThe same as COCs qCannot be used with certain medications. 1 November 2022 Mansoura Manchester Programme antiepileptic Intrauterine device 1 November 2022 Mansoura Manchester Programme IUCD Mechanism of action • Local sterile inflammatory reaction in uterine cavity Implantation q Prevent implantation. q Sperm immobilization. q Phagocytosis of sperms & zygote. q Acceleration of uterine & tubal motility → ↑↑ rate of expulsion of zygote. 1 November 2022 Mansoura Manchester Programme Local effect How to use? q Insertion: •Timing: • 1) Interval insertion: • a) Last day of menses • b) At any time provided that pregnancy is surely excluded. • • 2) Postpartum: • a) Immediate postpartum:. • c) Delayed postpartum: After 4 weeks of birth. Not good 3) Postabortion: Immediately or after 4 weeks of abortion. q Removal: • Timing: On request or after expiry. q Duration of use: 10 years . 1 November 2022 Mansoura Manchester Programme Contraindications q Pregnancy. q Cervical, endometrial or ovarian cancer. q Unexplained vaginal bleeding. q Current or recent pelvic infection. q Malformed uterine cavity. 1 November 2022 Mansoura Manchester Programme Warning symptoms • P: Pain (may be ectopic pregnancy). • A: Amenorrhea (may be pregnancy). • I: Inability to feel threads. • N: Noticeable discharge è fever (infection). 1 November 2022 Mansoura Manchester Programme Surgical contraception Irreversible Permanent method 1 November 2022 Mansoura Manchester Programme Different methods effectiveness 1 November 2022 Mansoura Manchester Programme Summary 1 November 2022 Mansoura Manchester Programme Questions? 1 November 2022 Mansoura Manchester Programme Question 1: • Which of the following is a suitable method of contraception for newly married couples ? A. B. C. D. E. COC POP IUCD LAM Subdermal implant 1 November 2022 Mansoura Manchester Programme References • Williams Obstetrics, 25e F. Gary Cunningham, Kenneth J. Leveno, Steven L. Bloom, Jodi S. Dashe, Barbara L. Hoffman, Brian M. Casey, Catherine Y. Spong • National or International: Department book and Ten teacher book 1 November 2022 Mansoura Manchester Programme
