Dr Fahmi I. EL-URI
METHODS OF
CONTRACEPTION
Methods of Contraception

Contraception is the prevention of
conception by methods other than
abstinence , its used to limit the size of
family
( birth control )
or
( Family planning)
Ideal Contraception
An ideal contraception should fulfill the
following:
 Highly efficient
 Free from unwanted side effect
 Absolute safety
 Simplicity of use
 Reversible
 Well tolerated
Methods of Contraception
The following is an overview of the
currently available methods of
contraception:
Barrier Methods
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The condom
Diaphragms and
cervical caps
Spermicides
Hormonal Methods
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Oral contraceptives
Injectable contraceptives
Implants
Other Methods
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Intra uterine devices
Periodic abstinence/
NFP natural family
Planning ( I. e safe
period )
Sterilization
IUCDs
Barrier Methods
The condom
 Simple
 Effective methods of contraception- 98%
success rate
 Without side effects
 Available
 Reduce the risk of STDs including the acqui
immune deficiency syndrome ( AIDS)
 40 MILLION COUPLES RELY ON CONDO
GLOBALLY
Diaphragms and Cervical Caps
and The Sponge
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The diaphragms and cervical caps should be
used with spermicide
Failure rate 5-10 %
The sponge is known in the U.K and the USA
Advantage of the sponge in that it can be left
for 24 hours in the vagina ,besides that one
size fits all women
Success rate 85- 95 %
Diaphragm
Spermicides

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In the form of creams, gel aerosols,
melting suppositories and foaming
tablets
Used alone
Failure rate 10- 15 %
Hormonal Methods
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Oral contraception
three types:
Combined monophasic pill: most commonly
used ( combination of estrogen and
progestogen)
Triphasic combined pill : estrogen and
progestogen but the ratio varies during the
month to mimic the natural hormonal pattern
in the menstrual cycle
Progestogen only pill : mini pill
Combined Oral Contraceptives
Advantages
 These are simple to use and highly
effective
 No special preparation is necessary
before intercourse
 The pill may relieve irregular menstrual
periods, cramps and premenstrual
tension
Combined Oral Contraceptives
Advantages (continue….)
 Less likely to get cancer of the uterus
 Less suffering from ovarian cysts
 Much less likely to suffer from ectopic
pregnancy
 Fewer attacks of rheumatoid arthritis
Disadvantages:
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Some women have difficulty
remembering to take their daily pill
Some women experience side effects
such as nausea, breast tenderness or ,
weight gain or loss, headache ,
depression and spotting or bleeding
between menstrual periods
Disadvantages
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The estrogen -containing contraceptives
present increased risk of serious
disorders due to blood clotting in some
women ( low dose is recommended)
A woman should not take the combined
pill while breast -feeding an infant
Disadvantages

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Oral contraceptives sometimes interact
with other drugs. This can result in
diminished contraceptive effectiveness
or interference with another drug’s
activity
Average annual failure rate including
patient error and omissions: 2.6
unwanted pregnancies per 100 couples
P.s.

Healthy women not smoking under 35
years the risk of taking combined pill are
very small by comparison with risks
associated with pregnancy and child
birth
Progestogen Only Pill ( mini pill)
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Has higher failure rate than combined
pill
Suitable for lactating mother
Action

By the interference with the passage of
sperm through the cervical mucous,
also affect the endometrium making it
less suitable for implantation of the
embryo
Side Effects
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Headache
Nausea
Intermittent bleeding
Thrombosis
Hypertension
further research under taken to
develop a once month pill
Hormonal Contraception
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The designation of first , second or third
generation progestins derives from the timing
of introduction of each product containing
these various progestins into the market
place
All progestins used In oral contraceptives are
derivatives of 19 nor-testerone
Norgestimate, gestodene and desogestrel are
cumulatively referred as third generation OCs
Injectable Contraceptives

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Has proven to be highly effective
method of fertility regulation
The most widely available injectable
contraceptive in the U.K , Germany ,
New Zealand , Sweden and many
countries all over the world
Injectable Contraceptives
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Contents: synthetic progesterone,
administered once every three months
Side effects: headache, dizziness,
weight gain , menstrual disturbances,
no life threatening complications such
as CV effects seen with Ocs.
Implants
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The recent development in the field of
hormonal contraception
Six capsules which are implanted under
the skin of the arm and provide
contraception for five years
It should be put in the place by a trained
health worker and at the end of the five
years the capsules can be removed
Implants

Proper aseptic techniques should be
used during insertion and removal to
avoid infection at the site of implant
Implants Side Effects
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Irregular bleeding in the first few months
followed by amenorrhea
Norplants are non-biodegradable
( biodegradable = absorbed by the
body)
A two rod, 18 month implant is being
developed as well
IUDs
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These are plastic or metal devices which
are placed in the uterus to prevent
pregnancy
More than 60 million women around the
world use IUDs
Common available IUDs :lippes loop
copper T
copper 7
Multi load
Nova T
Side Effects of IUDs
Expulsion
 Perforation
 Heavy and prolonged bleeding
P.S
Superiority of copper released IUDs over
plastic devices in the terms of perforation,
expulsion, and continuation rate
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Periodic Abstinence
Advantage: not requiring mechanical or
medical measures – accepted by certain
religious groups
 This method of family planning is based
on attempts to identify the fertile period of
the menstrual cycle, which occurs around
the time of ovulation and abstaining from
intercourse during this time = calendar
method
( I. E. day 9 to day 19 in 28 days regular
cycle)
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Periodic Abstinence
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1.
2.
This method is less effective than
techniques that record BBT and
monitor consistency of the cervical
mucus both of these undergo changes
at the time of ovulation
NFP methods can be used both:
To prevent pregnancy
To plan pregnancy
Periodic Abstinence

Side effects:
not present
due to inexperienced couples and not
well motivated, the pregnancy rate can
be as high as 25%
Sterilization
Male sterilization ( vasectomy)
safe operation, out patient procedure
under local anesthesia
 Female sterilization
mini lapratomy under local or general
anesthesia
* laparoscope's------- Coagulation
------- Rings
------- Clips
All to obstruct tubal patency, prevent
pregnancy
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Conclusion
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The world population is around 6 billion ,
four hundred million couples are
practicing a family planning, many
couples around the world who are
motivated to practice family planning lack
the sources or the methods suitable for
their needs.
At least one method may be suitable for
each couple at any given time in order to
plan their families avoid unwanted
pregnancy.
Emergency Contraception or
Post-Coital Contraception :
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Since 1984 , the Yuzpe method has
been used to reduce ‘ risk of pregnancy
by administering two doses of ‘ following
medication 12 hrs apart & within 72hrs
of unprotected intercourse :
100 microgram Ethynil oestradiol plus.
500 microgram Levonorgestrel .
Continue :

The endometrium is made unfavourable
for implantation & there is interference
with normal corpus luteum function . If
taken before ‘ preovulation estrogen
surge, ovulation can be inhibited . The
medication is often administered with an
antiemetic to reduce nausea & vomiting,
which occur in up to 50% of patients .
Continue :
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The failure rate is 2-5 %, depending on ‘
time in ‘ cycle at which it is taken .
Counselling is essential so that ‘ patient
understands ‘ implications of ‘ failure
rate & so that she makes sure she is
followed up, especially if she has not a
period but also to decide on future longterm contraception .
Continue :
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More recently , this method has been
superceeded by : Levonelle-2 ( x2 tabs
of 750mg Levonorgestrel ) which is
available over ‘ counter .
Another method of emergency
contraception is to insert an IUCD within
5 days of unprotected intercourse , this
can be removed after ‘ patient’s next
period or left in situ as a contraception .