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Hormonal contraception
1-combined OCP
2-combined hormonal patches
3-progesterone only pills
-progesterone only pills
-Injectable
-Subdermal implants
Intrauterine contraception
-Copper intrauterine device (IUD)
-Hormone-releasing IU system (IUS)
 Barrier methods
-Condoms
-Female barriers
 Coitus interruptus
 Natural family planning
 Emergency contraception
 Sterilization
-Female sterilization
-Vasectomy
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Combined OCP (COC)
-COC `the pill` was first licensed in the UK in 1961.
-it contains a combination of 2 hormones
(synthetic oestrogen and progesterone)
-COC is easy to use & offers a very high degree of
protection against pregnancy with other beneficial
effects.
-Most brands contain 21 pills…one pill to be taken
daily, followed by a 7 days pill free interval.
-there are some also some every day preparation
that include seven placebo pills that are taken
instead of having a pill free interval.
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COC acts both centrally & peripherally
-Inhibition of ovulation is by far the most important
effect.
-both oestrogen and progesterone suppress the
release of pituitary FSH and LH which prevents
follicular development within the ovary and
therefore ovulation.
-Peripheral effects include making the
endometrium atrophic and hostile to an implanting
embryo ans altering cervical mucous to prevent
sperm ascending into the uterine cavity.
CNS (depression-headache)
 GIT (N-V-weight gain-gall stonecholestatic jaundice)
 Genitourinary (cystitis-bleeding-vaginal
discharge-growth of fibroids)
 Breast (breast pain-increased risk of
breast cancer)
 Facial pigmentation
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Higher dosages of oestrogen and
progesterone are strongly liked to
increased risks of both arterial & venous
thrombosis
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COC users generally have light-painless
and regular menstrual bleeding & therefore
COC can be used to treat heavy or painful
bleeding.
It will also improve pre-menstrual syndrome
Reduce the risk of pelvic inflamatory
disease
COC offers long term protection against
both ovarian and endometrial cancers.
It can also be used as a treatment of Acne.
CVS
-ischemic heart disease
-hypertension
-arterial or venous thrombosis
 Acute or severe liver disease
 Breast cancer
 Generalized migraine
 Obesity
 DM & smoking
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A contraceptive transdermal patch
containing oestrogen and progesterone
has been developed and releases
norelgestromin 150ug & ethinylestradiol 20
ug per 24 hours
 Patches are applies weekly for 3
weeks,after that there is a patch free week.
 Contraceptive patches have same risks
and benefits as COC and although they
are relatively more expensive ,may have
better compliance.

Progesterone only has contraception has
many similar features in terms of mode of
action and side effects
 They don’t contain estrogen so they are
extremely safe and can be used if a
woman hascardiovascular risk factors
 Although the failure rate of POP is
greater than COC
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Injectable progesterone(2 types)
1-Depot medroxyprogesterone acetate
150mg (Depo-provera or DMPA)
2-Norethisterone enanthate 200mg
(Noristerat)
-most woman choose Depot provera
and each injection lasts around 12-13
weeks.
-it is given by deep IM injection
Implanon consists of a single silastic rod that
is inserted subdermally under local
anaesthesia into the upper arm.
 It releases the progesterone etonogestrel
25-70ug daily.
 It lasts for 3 years and thereafter can be
easily removed.
 It is useful for women who have difficulty
remembering to take a pill and who wants
highly effective long term contraception.
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All POP works by a local effects on
cervical mucous (making it hostile to
ascending sperm) & one the
endometrium (making it thin and
atrophic) thereby preventing
implantation & sperm transport
Absent menstrual bleeding
 Functional ovarian cyst
 Breast tenderness
 Acne
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Modern IUDs are highly effective methods of
contraception but are not widely used.
Fitting of IUDs should be performed by trained
healthcare person only & is a brief procedure
associated with mild to moderate discomfort
A fine thread is left protruding from the cervix
into the vagina and the IUDs can be removed
in due to course by traction on this thread
IUDs protects against both IU and ectopic
pregnancy,but if pregnancy occur there is a
higher chance than normal that it will be
ectopic pregnancy.
Plastic IUDs (these are not used now a
days)
 Copper IUDs
 Hormone-releasing IUDs
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Most women now a days will use the
smaller copper bearing IUDs which are in
various shape
 They cause much less menstrual
disruption than the older plastic devices.
 Most copper bearing IUDs are licensed
for between 3 and 5 years of use but
some lasts longer upto 10 years.
 The more copper wire a device has the
more effective it is.
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Levonorgestrel-releasing IUDs
ADVANTAGES
DISADVANTAGES
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-Highly effective
-persistent spottin
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-Dramatic reduction in
-progesterone side
Menstrual blood loss
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-Protection against PID
effects.e.g,acne
breast tenderness
All IUDs induce an inflammatory response
in the endometrium which prevents
implantation.
 However copper-bearing IUDs work
primarily by a toxic effect on sperm
which prevents fertilization
 Hormone releasing IUDs prevents
pregnancy by a local hormonal effects
on crevical mucous and endometrium.

Increased menstrual blood loss
 Increased dysmenorrhea
 Increased risk of PID in first few weeks

Previous PID
 Previous ectopic pregnancy
 Known malformation of uterus
 Copper allergy(but hormone releasing
IUDs can used)
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CONDOMS
Male condoms are usually made of latex
rubber
They are cheap and very widely available for
purchase or free from many clinics
They have been heavily promoted in the safe
Sex compaign to prevent the STDs particularly
HIV and AIDS
Condoms of varying size and shapes are
available
Couples using condoms should be aware of
the availability of emergency contraception in
the event of a condom bursting or slipping off
during intercourse.
Some men or women may be allergic to
latex condoms or spermicide so
hypoallergic latex condoms and plastic
condoms are available
 Men must be instructed to apply
condoms before any genital contact
and to withdraw the erect penis from the
vagina immediately after ejaculation
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The diaphragm or Dutch cap is the
female barrier used most commonly.
 Other female barriers include:-cervical caps
-vault caps
-vimules
 They should all be used in conjuction
with a spermicidal cream or gel
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Diaphragm are inserted ammediately
prior to intercourse and should be not
removed earlier than 6 hours later.
 Female barriers offer protection against
ascending pelvic infection but can
increase the risk of UTI & vaginal irritation

Female condoms made of plastic are
also available (femidom)
 They offer particularly good protection
against infection as they cover whole of
the vagina and vulva
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Coitus interruptus or withdrawal is widely
practisedand obviously does not require
any medical supervision.
 It involves removal of the penis from the
vagina immediately before ejaculation
takes place.
 Unfortunately,it is not reliable,as pre
ejaculatory secretions may contain
millios of sperms & young men often find
it hard to judge the timing of withdrawal.
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Use of emergency contraception should
be considered if coitus interruptus has
taken place.
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The lactational amenorrhea
methods(LAM) is used by fully
breastfeeding mothers during the first 6
months of infant life , fully breasfeeding
gives more than 98% contraceptive
protection.
This is an extremely important method of
contraception worldwide and may be
the only one acceptable to some
couples for cultural and religious reasons.
 It involves abstaining from intercourse
during the fertile period of the month.
 The failure rate of family planning are
quite high, largerly because couples find
it difficult to abstain from intercourse
when required.
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Changes in basal body temperature
 Changes in cervical mucous
 Changes in the cervix
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The term “morning-pill” & “post-coital
contraception” have now been replaced
simply by the term “emergency
contraception”
 EC is the method that is used after
intercourse has taken place & before
implantation has occurred.
 EC should be considered if unprotected
intercourse has occurred,if there has been
failure of a barrier methods eg.burst
condoms or if COC has been forgotton
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Levonorgestrel in a single dose of 1.5mg
(Levonelle).
 It has been taken within 72 hours of an
episode of unprotected intercourse and
it is more effective the earlier it is taken.
 It is not 100% effective but but will
prevent around three-quarters of
pregnancies that would other wise has
occurred.
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Female sterilization & male vasectomy
are permanent methods of
contraception & are highly effective
 They are generally chosen by relatively
older couples who are sure that they
have completed their families
 Also chosen by the person who has
genetic disorders
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This involve the mechanical blockage of
both fallopian tubes to prevent sperm
reaching & fertilizing the oocyte.
 It can also be achieved by
Hysterectomy or total removal of both
fallopian tubes.
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Techniques
Ligation
failure
special features
disadvantage
suitable for postpartum mini laparotomy
high
rate
Diathermy may damage surrounding structures
high failure
eg.bowel & bladder
Fallope rings
easy to apply
rate
reversal
damage 2-3 cm of the tube
most difficult
Clips
technique of choice
may
not
simple to use
occlude
Laser
very expensive
whole FT
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Vasectomy involves the division of the vas
deferens on each side to prevent the release
of sperm during ejaculation
It is technically an easier , more straightforward
and quicker procedure than female sterilization
& is usually performed under local anaesthesia
Man should be advised to hand in 2 samples of
semen at 12 and 16 weeks to see if any sperm
are still present
If 2 consecutive samples are free of sperm the
vasectomy can be considered complete.
An alternative form of contraception must be
used until that time.
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Techniques
-ligation or clips
-unipolar diathermy
histological
confirmation
-No-scalpel vasectomy
china
instrument
puncture the
-silicone plug
features
most common
allow
widely used in
special
used to
skin
also used in china
avoid a skin incision
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Immediate complication such as
Bleeding ,
wound infection ,
Hematoma
Small lump may appear at the cut end of vas
deferens as a result of local inflamatory
response
These so called “sperm granulomas” may need
surgical excision
Some men will developanti-sperm antibodies
following vasectomy,,,these don’t cause
symptoms but if the vasectomy reversed ,
pregnancy may not occur because the
antibodies inactive sperms.
Contraceptive methods
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failure rate/100 women/year
Combined OCP
Progesterone only pills
Depo-provera
Implanon
Copper-bearing IUDs
Hormone-releasing IUDs 0.5
Male condom
Female diaphragm
Vasectomy
Female sterilization
0.1-1
1-3
0.1-2
0
1-2
2-5
1-15
0.02
0.13
THANK
YOU
VERY
MUCH