FAMILY PLANNING. CONTRACEPTION.
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
Corina Cardaniuc, Stelian Hodorogea,Mihail Surguci
FAMILY PLANNING. CONTRACEPTION.

Reasons of family planning:
pregnancy planning
limiting the number of children
avoiding medical risks of pregnancy
controlling the world population
FAMILY PLANNING. CONTRACEPTION.

Birth control techniques and methods include:
Contraception (the prevention of fertilization),
Contragestion (the prevention of blastocyst
implantation) and
Abortion (the removal or expulsion of a fetus
or embryo from the uterus).
FAMILY PLANNING. CONTRACEPTION
The ideal contraceptive should be safe, harmless,
and not interfere with the sexual enjoyment of
either partner.
 The failure rate of any method of contraception is
judged by the Pearl Index (PI): the number of
women having regular intercourse who become
pregnant within a year out of 100 couples using
the method.
Number of pregnancies
 PI= --------------------------------------------- x 100
Number of couples using the method

FAMILY PLANNING. CONTRACEPTION

There is no perfect contraceptive. All
contraceptives have advantages and
disadvantages, which must be integrated
carefully with the patient’s status. Therefore,
careful individualization is necessary to avoid
undesirable side effects and to optimize
patient acceptance.
METHODS OF CONTRACEPTION
BEHAVIORAL ALTERNATIVES




Coitus interruptus ("interrupted sexual intercourse"), is the
practice of ending sexual intercourse before ejaculation. This
is the oldest and a widely practiced method.
Is moderately effective in preventing pregnancy. Average
Failure Rate: 27%
Advantages:
- requires no devices
- involves no chemicals or artificial hormones
- is available in any situation at no cost
Disadvantages :
- the occurrence of pregnancy from semen escaping before
ejaculation or semen deposition at the vaginal introitus
- may prevent complete satisfaction to both partners
- does not offer complete protection from STDs
BEHAVIORAL ALTERNATIVES
Total abstinence
Abstinence is 100% effective in preventing
pregnancy
 AVERAGE COST: No cost
 Advantages:
- almost 100% effective
- protection against STD's
- free
- no prescription is needed
LACTATIONAL AMENORRHEA METHOD (LAM)
The lactational amenorrhea method (LAM) is a
method of avoiding pregnancies which is based
on the natural postnatal infertility that occurs
when a woman is amenorrheic and fully
breastfeeding. If not combined with chemicals
or devices, LAM may be considered natural
family planning.
 EFFECTIVENESS: 98% if no menses has
occurred, only breast feeding is used to feed
the baby, at least every four hours during the
day and every six hours through the night, or
prior to six months of age for the baby
LACTATIONAL AMENORRHEA METHOD (LAM)


ADVANTAGES:
- effective immediately
- does not interfere with intercourse
- no side effects
- no cost
- gives infants passive immunity
- decreased post-partum bleeding
DISADVANTAGES:
- offers no STD protection
- highly effective only until period returns or up to 6 months
- may need to use a lubricant because of vaginal dryness
- must feed on demand and at least 6-10 times a day
including night feedings
- not reliable if period has returned.
NATURAL FAMILY PLANNING
Natural birth control methods teach women to
determine the fertile phase of their menstrual
cycle.
 Four Basic Methods:
 basal body temperature,
 cervical mucus changes,
 excretion of LH (luteinizing hormone - the ovulation
triggering hormone) and
 menstrual calendars
 The BEST METHOD is to combine all of them into
one called the Sympto-Thermal Method

BASAL BODY TEMPERATURE METHOD

The woman should refrain from intercourse
seven days before the temperature rise until
four days after. Temperature changes do not
predict ovulation before it happens. To be
completely safe, the woman should consider
unsafe days from the first day of your period
until the fourth day after the temperature rise.
BASAL BODY TEMPERATURE

Basal body temperature is the body temperature
measured immediately after awakening and before
any physical activity has been undertaken. In women,
ovulation causes an increase of one-quarter to onehalf degree Celsius in basal body temperature (BBT).
Monitoring of BBTs is one way of estimating the day of
ovulation. The tendency of a woman to have lower
temperatures before ovulation, and higher
temperatures afterwards, is known as a biphasic
pattern.
CERVICAL MUCUS METHOD

Checking the cervical mucus for consistency
may assist in determination of ovulation.

After the period, there are a few days when
there is no mucus. These are called dry days
and are safe. Then the mucus changes to the
slippery, clear pattern a few days before
ovulation. This is the beginning of an unsafe
(THE MOST UNSAFE) time. The amount of
mucus becomes the greatest just before
ovulation.
CERVICAL MUCUS METHOD
Finger Testing
A finger-tip is used to test the capacity of the
cervical mucus to stretch. It may feel sticky and
break easily, or it may feel smoother and slippery
like raw egg white and stretch between the
thumb and first finger, from a little up to several
inches before it breaks.
FINGER TESTING
Sensation
at Vulva
Finger Test
Appearance
Moist
or
Sticky
Early Mucus
Scanty
Thick
White
Sticky
Holds its shape
Wetter
Transitional Mucus
Increasing Amounts
Thinner
Cloudy
Slightly Stretchy
Slippery
Highly Fertile Mucus
Profuse
Thin
Transparent
Stretchy
(like raw egg white)
THE CALENDAR METHOD
The calendar method is based on working out
the fertile period from previous cycles (by
careful documentation of the woman’s
menstrual cycle). This method is also known as
the 'Rhythm Method'.
 Average Failure Rate: 13-20%
 For a woman with very regular cycles, it may be
possible to predict the day of ovulation.
 The unsafe period lasts from 7 days before the
day of ovulation to 4 days after ovulation.

DETERMINATION OF LH SURGE
The laboratory determination of abrupt surge of
LH and progesterone with ovulation is the most
reliable method of determining ovulation.
 Ovulation predictor kits can be used with the
temperature charts to more accurately pinpoint
your day of ovulation. They work by detecting
the small amounts of LH that is present in the
urine before ovulation. There is a rise in the
amount of LH in the body approximately 24
hours before ovulation. This increase is
registered by a color change.

NATURAL FAMILY PLANNING
Effectiveness
 95-98% effective with perfect use
 75-88% for typical use
Benefits
 Has no negative health side effects
 An alternative for women who cannot or do not want to use hormonal
methods
 Consistent with many religious beliefs and lifestyles
 Encourages male involvement
Disadvantages
 Provides no protection from sexually transmitted infections
 Requires time to learn (usually 3 to 6 cycles)
 Requires discipline to chart fertility signs and follow the rules to avoid
pregnancy
 Difficult to use with irregular periods.
 Illness can alter temperature.
 Vaginal infections can alter cervical mucus changes
BARRIER CONTRACEPTION
MECHANICAL

Barrier methods place a physical impediment
to the movement of sperm into the female
reproductive tract.
MALE CONDOM
Male Condom Is penile sheath made of latex or polyurethane or animal membrane that
serves as a barrier.
 Mechanism of action: Prevents sperm from reaching the cervix. The addition of a
vaginal spermicide makes the method very effective. EFFECTIVENESS: 80-90%
(INCREASES IF USED WITH SPERMACIDE);
Advantages:
 Widespread availability
 Low cost
 Protection against STD
 No prescription needed
 Safe
 Fertility returns upon discontinued use
Disadvantages:
 manufacturing defects;
 if withdrawal of the penis occurs after detumescence, semen may leak into the
vagina
 both partners may complain of decreased sensation during intercourse
 woman may be allergic to spermacidal or latex.
 can be used only once
 may interfere with spontaneity
FEMALE CONDOM
Female condom is a latex or polyurethane membrane (bag) that can be
inserted into the vagina. It has a higher rate of pregnancy than the male
condom. EFFECTIVENESS: 75-85% AVERAGE
ADVANTAGES:
 Protects against some sexually transmitted diseases
 No prescription needed
 Fertility returns immediately upon discontinued use
 Can be inserted anytime - up to eight hours before intercourse
 Medically safe
DISADVANTAGES
 Decreased vaginal sensation
 May be difficult to insert
THE CERVICAL CAP
The cervical cap is a barrier device covering the cervical portion. The
cervical cap is the smallest cervical barrier. It is made of rubber or
plastic. Depending on the type of cap, it stays in place by suction to the
cervix or to the vaginal walls. Cervical caps should not be left in place
for >48-72 hours to avoid infection. The cap must be used with a
spermicide, which destroys sperm.
EFFECTIVENESS:
 85% for women who have never a a baby
 70% for women who have had a baby
ADVANTAGES
 Safe
 Fertility returns immediately with discontinued use
 Disposable cap does not need to be fitted nor needs a prescription
 Can be inserted several hours before intercourse
THE CERVICAL CAP
DISADVANTAGES
 Must be individually molded for every patient because
cervical anatomy varies greatly
 Limited sizes available
 Must be left in place 6-8 hours after intercourse
 Must be used each time
 May become dislodged
 Some women may be allergic to spermicides, latex
 Need more frequent pap smears the first 1-2 years of use
because it may cause changes in the cells of the cervix
 It doesn't protect against STIs, and the cap itself isn't
protective
 MUST stay in place at least 8 hours after the last sex act
VAGINAL DIAPHRAGM
Vaginal diaphragm is a soft, rubber dome that forms a
barrier to prevent sperm from reaching the cervix. It
covers the cervix and is held securely in place behind
the pubic bone and rear wall of the vagina.
They are made in various sizes and for maximum
safety must be used with a spermicide jelly or cream.
EFFECTIVENESS: 85%
ADVANTAGES
 Safe
 Fertility returns immediately with discontinued use
 Can be inserted 2-3 hours before lovemaking
 May reduce the risk of cervical cancer
 Some STD protection
VAGINAL DIAPHRAGM
DISADVANTAGES
 Must be fitted by a health care professional
 Needs prescription
 Must be left in place 6-8 hours after intercourse but no
more than 24 hours
 Must be used each time
 May become dislodged
 Some women may be allergic to spermicides, latex
 Must be replaced periodically
 Must apply spermicide with each new act of intercourse
 May have an increase in urinary tract infections
 May decrease spontaneity
CHEMICAL CONTRACEPTIVES
Douching after coitus
 Douching immediately after intercourse is a
time honoured but ineffective method. The
intent of the method is to wash semen out of
the vagina before sperm can enter the cervix.
 It does not affect those sperm which have
already passed up the cervical canal.
SPERMICIDES
Spermicides contain a chemical called nonoxynol-9. It comes in the form of
cream (only for use with diaphragms), gel, foam, film, or suppository. All of
these agents require insertion into the vagina before each coitus. By inserting
spermicide in the vagina, in front of the cervix, it destroys sperm on contact.
EFFECTIVENESS: 80%
ADVANTAGES
 Available without a prescription
 No known risk to general health
 Fertility returns immediately upon discontinued use
 Some protection from bacterial infections and pelvic inflammatory disease
DISADVANTAGES:
 Less effective than other methods
 Must wait 8 hours before taking a bath or douche
 Usually last only one hour
 Side effects: Vvginal irritation, some women are allergic to spermicides
 Need insertion at least ten minutes before intercourse
 Nonoxynol-9 does not protect against STIs
CONTRACEPTIVE SPONGE
The sponge is a soft, round barrier device that is about two inches in diameter. It is
made of solid polyurethane foam, contains spermicide, and has a nylon loop attached to
the bottom for removal. The sponge must first be moistened with water and then the
woman inserts it into her vagina before intercourse. It covers the cervix (opening to the
uterus), and it blocks sperm from entering it. The sponge also releases a spermicide
that can immobilize sperm, thus, preventing the sperm from reaching an egg.
EFFECTIVENESS: 75 – 85%
ADVANTAGES

Fertility returns immediately upon discontinued use
 Can be inserted several hours prior to intercourse
 It provides 12-hour protection
 It contains three types of spermicide and does not appear to be allergenic nor as
irritating as previous sponges
 Does not require a prescription
 May protect against some STD's
 Does not require insertion of a new sponge for each act of intercourse
DISADVANTAGES:
 Cannot be used by women allergic to nonoxyl-9 or those who have had toxic shock
syndrome

a higher risk of vaginal yeast infections
HORMONAL CONTRACEPTIVES
COMBINED ORAL CONTRACEPTIVES
Most combination oral contraceptives are packaged as "active
pills" for 21 days followed by a seven day pill-free or "inactive" pill
interval to allow for withdrawal bleeding (menstruation). The
seven inactive pills are usually in another color.
Monophasic OCs contain the same amount of each hormone in
each active pill.
Biphasic OCs alter the progestin-estrogen ratio in two phases.
Triphasic OCs alter the progestin-estrogen ratio in three phases
by varying the amounts of progestin, estrogen, or both.
Biphasic and triphasic regimens attempt to approximate a
woman's natural hormonal fluctuations more closely by varying
the progestin-estrogen ratios. One important goal of these
formulations is to minimize the occurrence of irregular bleeding
while maintaining efficacy.
EFFECTIVENESS 96-99%
COMBINED ORAL CONTRACEPTIVES
Mechanism of action: Combination hormonal contraceptives act by suppression of gonadotropins.
Although the primary effect of this action is inhibition of ovulation, other alterations include
changes in the cervical mucus (which increase the difficulty of sperm entry into the uterus) and the
endometrium (which reduce the likelihood of implantation).
ADVANTAGES

Reduces the risk of ovarian and uterine cancer

Reduces the risk of pelvic inflammatory disease

Reduces the risk of ovarian cysts

May decrease: pre-menstrual syndrome, acne, bleeding, anemia

less breast tenderness

Does not interfere with intercourse
DISADVANTAGES

Does not protect against STD's

Must be taken daily

Cannot be used by those with a history of: breast cancer, blood clots or at risk to develop blood
clots, liver disease, kidney disease, unexplained uterine bleeding, smokers over age 35,
melanoma

Should not be used by those with: light periods, high blood pressure, diabetes, migraine
headaches, depression, sickle cell disease, fibroids

Serious side effects (rare): blood clots, liver disease, high blood pressure, migraine headaches

Common side effects include: loss of libido, nausea, breast tenderness, mid-cycle bleeding the
first few months, weight gain, increased appetite, mood swings, depression, headaches, skin
problems

Hormonal contraceptives may increase the risk of breast and cervical cancer
PROGESTIN-ONLY ORAL CONTRACEPTIVES
The Mini-Pill Progestin-Only Pills (POP), are estrogen-free
oral contraceptive pills taken daily to prevent pregnancy.
The estrogen-free mini-pill has fewer unwanted side-effects
than traditional combined oral contraceptives.
Mini-pils are less effective and can cause irregular
menstruation.
Popular brands of progestin-only pills include Micronor,
Nora-BE (0.35 mg norethindrone).
Estrogen-free oral contraceptives are available by
prescription only.
The mimi-pil always comes in 28-day packs, and all the
pills within a pack contain the same progestin.
Average Failure Rate: 1 - 13%
PROGESTIN-ONLY ORAL CONTRACEPTIVES
BENEFITS
 May be recommended to breastfeeding women
 Mini-pills are also considered safer than combined OCs,
as many of the vascular risks are greatly reduced with
the omission of the estrogen component. That means
less risk for older women, smokers, and those with heart
problems.
SIDE EFFECTS
 ectopic pregnancy
 depression
 menstrual cycle disturbances
 Oral contraceptives do not protect against STDs
 oral contraceptives increase the risk of acquiring HIV
from an infected partner
CONTRACEPTIVE PATCH
The contraceptive patch (Evra®) is a 4 cm x 4 cm beige patch that sticks to a woman's skin and
continuously releases the hormones estrogen and a progestin into the bloodstream. Each patch is
worn on the skin for seven days. One patch is worn each week for 3 weeks. The Patch should be
changed on the same day each week (called the "Patch Change Day"). The patch can be worn on
the buttocks, back or upper arms, but not on the breasts.
Mechanism of action

The Patch prevents pregnancy by stopping the ovaries from releasing an egg, and it may also
thicken the cervical mucus and make the uterine lining thin.

Effectiveness: the Patch is more than 99% effective at preventing pregnancy when used
perfectly
Benefits

a regular, lighter period

less PMS and cramping

reduces the risk of endometrial and ovarian cancers

helps to prevent benign ovarian cysts

It is completely reversible
Disadvantages

does not protect against sexually transmitted infections

side effects: breakthrough bleeding (between periods), breast tenderness, headaches, nausea
VAGINAL RING (NUVARING)
NuvaRing is a thin, transparent, flexible ring that stays in the vagina, usually around the cervix. The
ring is worn continuously for three weeks followed by a week off which triggers menstruation. Each
vaginal ring provides one month of birth control, even during the week when the ring is not worn.
The ring slowly releases on average 0.12 mg/day of etonogestrel and 0.015 mg/day of
ethinylestradiol. The walls of the vagina absorb the hormones and distribute them into the
bloodstream. These hormones work by stopping ovulation, thickening cervical mucus as a barrier to
sperm, and preventing implantation of the embryo if fertilization occurs. Average Failure Rate: 8%
Benefits:

In addition to preventing pregnancy, the ring has the added benefit of making a woman's
periods more regular, lighter, and possibly less crampy. It is thought to have similar benefits as
the birth control pill, such as treating PMS, endometriosis and acne, and preventing ovarian
and endometrial cancers but these haven't been studied. It is completely reversible.
Side Effects

Headaches, vaginal irritation, discomfort or discharge, nausea, breast tenderness,
breakthrough bleeding (bleeding between periods), especially in the first few months, yeast
infection

the vaginal ring is thought to increase the risk of heart attack and stroke, especially among
smokers

Contraindications:

heart attack, stroke or breast cancer, active liver disease,
women over 35 years old who smoke, women with a history of cancer,
diabetes, high blood pressure, high cholesterol, headaches or epilepsy,
depression, breastfeeding
DEPO-PROVERA INJECTABLE CONTRACEPTIVE
Depo Provera is a hormone (progesterone only) injection that a female takes every 12 weeks to prevent
pregnancy. Depo-Provera is estrogen-free, which means that it is safer and has fewer serious side-effects
than other hormonal methods. EFFECTIVENESS: 99%
Mechanism of action

prevents ovulation

affects the cervical mucous, making it more difficult for the sperm to penetrate the cervix

causes a thinning of the endometrium which prevents the egg from implanting.
ADVANTAGES:

One injection every 3 months

Highly effective

long-lasting

helps protect against uterine cancer

safe after childbirth and while breast-feeding

May decrease menstrual cramps

Does not interfere with intercourse
DISADVANTAGES

Does not protect against STD's

Long-acting: fertility returns 6-24 months after last injection (an average of 9 months)

Cannot be used by women with: blood clots, breast cancer, liver problems, unexplained uterine
bleeding

May not be good for women with: family history of breast cancer, abnormal mammogram, irregular or
light periods, high blood pressure, migraine headache's, asthma, epilepsy, diabetes, depression

Can cause bone density loss

Irregular bleeding

Weight gain
NORPLANT® IMPLANTS
Implanon is a type of long-term birth control that is inserted under the skin by a doctor. The implant consists of
one to six match-sized plastic rods which are surgically placed under the skin of a woman's upper arm.
Implanon contains a synthetic progestin hormone called etonogestrel. Implanon is effective for up to 3-5 years.
Average Failure Rate: less than 1%
Mechanism of action:

The primary way is by stopping release of an egg from the ovaries. Implanon also changes the mucus in
the cervix and this may keep sperm from reaching the egg. Implanon also has post-fertilization
mechanisms, whereby the hormone changes the lining of the uterus, making it harder for a fertilized egg to
implant and develop.
ADVANTAGES

The birth control effect is immediate

Works up to five years or until removed

Capsules can be removed anytime

Fertility returns immediately upon removal of implants

Helps protect against uterine cancer

Can be safely used after childbirth and while breast-feeding

Does not interfere with intercourse
DISADVANTAGES

Cannot be used by women with liver disease, breast cancer, unexplained uterine bleeding, blood clots

May not be good for women with high blood pressure, gall bladder disease, elevated cholesterol, irregular
periods, light periods, headaches, heart disease, seizure disorders.

Cannot be used by women who have a history of certain types of high blood pressure, breast cancer,
unexplained vaginal bleeding, liver growths, blood clots in veins, possible pregnancy

increased risk of ectopic pregnancy

implant does not offer any protection from STDs
Side effects: irregular bleeding, prolonged periods, light periods, hair loss, decreased interest in sex, acne,
depression, prolonged time between periods, weight gain, breast pain, headache
INTRAUTERINE DEVICE
The intrauterine device, or IUD, is a small plastic
or metal birth control device that is placed inside
the uterus for long term pregnancy protectionan.
Types of IUD
 Mirena Intrauterine System (hormonal)
 Copper T IUD (hormone-free)
COPPER T IUD
This IUD is a non-hormonal birth control and contains copper. The IUD may prevent pregnancy by
interfering with: sperm movement (the ability of the sperm to fertilize the egg) or implantation
(nesting of a fertilized egg into the lining of the uterus).
EFFECTIVENESS: Copper-T IUD - 99%
ADVANTAGES

Requires no attention except for monthly checks for the string

Fertility returns immediately upon removal

Does not interfere with lovemaking

Can be used while breast-feeding
DISADVANTAGES

Does not protect against STD's

Should not be used by women who have: never had children or still want children; an allergy to
copper

Should not be used by women who have a history of decreased immune problems; multiple sex
partners; a history of pelvic inflammatory disease (PID) or tubal pregnancy

Have an increase risk for tubal pregnancy, PID, infertility

Side effects possible: cramps, backache, spotting, heavy periods

May be expelled
IUD's can be inserted by a qualified physician:

Days 1 to 7 of the menstrual cycle

Postpartum - Copper T 380A immediately to up to 48 hours after delivery, or 4-6 weeks.

Post abortion - immediately to 7 days if no infection is present
HORMONAL IUD: MIRENA INTRAUTERINE SYSTEM
This IUD is hormonal and releases small and balanced amounts of progestin, called levonorgestrel,
working similarly to most hormonal birth control pills, keeping you from releasing eggs during
ovulation and thickening your cervical mucus, creating an impenetrable barrier.
Effectiveness of Mirena IUS : less than a 1% failure rate for perfect users
Benefits

The IUS does not contain estrogen so it can be used in women who cannot take or have a
sensitivity to estrogen.

The IUS is effective for up to five years

Mirena IUS decreases the amount of menstrual bleeding and may decrease menstrual cramping
Disadvantages

The hormonal IUS does not protect against sexually transmitted infections (STIs) or HIV

Possible complications of inserting an IUS include irregular bleeding or spotting, perforating the
uterus, infection, or expulsion

Risk for ectopic pregnancy

It cannot be used by women with irregularly shaped uteruses or who have a condition of the
uterus that distorts the uterine cavity
Side-Effects

cramps, dizziness,

Irregular bleeding or spotting between periods, especially during the first few months

No periods (amenorrhea). Twenty percent of women completely stop having periods after using
Mirena for a year.
EMERGENCY CONTRACEPTION
Emergency contraception refers to back-up methods for contraceptive
emergencies which women can use within the first few days after
unprotected intercourse to prevent an unwanted pregnancy. Emergency
contraceptives are not suitable for regular use.
Forms of EC include:
 Emergency contraceptive pills (ECPs)—or the "morning-after pill"—are
drugs that act both to prevent ovulation or fertilization and possibly
post-fertilization implantation of a blastocyst (embryo).
 Intrauterine devices (IUDs)—usually used as a primary contraception
method, but sometimes used as emergency contraception.
EMERGENCY CONTRACEPTIVE PILLS






There are two types of emergency contraceptive pill:
Levonelle (levonorgestrel 750 mcg) is the most commonly
used. It can be taken up to three days (72 hours) after
having unprotected sex
ellaOne (30 mg of ulipristal acetat) is a newer type of
emergency contraceptive pill that can be taken up to five
days (120 hours) after having unprotected sex
The effectiveness of the emergency contraceptive pill
decreases over time. If it is taken within 24 hours of having
unprotected sex, it prevents 95% of pregnancies.
The WHO-recommended regimen for emergency
contraception is: 1.5 mg of levonorgestrel as a single dose.
The drug mifepristone (RU486, Mifeprex) may be used either
as an ECP or as an abortifacient, depeding on whether it is
used before or after implantation.
EMERGENCY CONTRACEPTIVE PILLS
Side effects
 nausea
 vomiting
 abdominal pain
 headache
 dizziness
 breast tenderness
 The high doses of progestogen in levonorgestrel
treatments may induce progestogen withdrawal
bleeding a few days after the pills are taken. If
levonorgestrel is taken after ovulation, it may
increase the length of the luteal phase, thus
delaying menstruation by a few days.
INTRAUTERINE DEVICE (IUD) FOR EMERGENCY
CONTRACEPTION.
An alternative to emergency contraceptive pills is
the copper-T intrauterine device (IUD) which can
be used up to 5 days after unprotected
intercourse to prevent pregnancy. Insertion of an
IUD is more effective than use of Emergency
Contraceptive Pills. ONLY THE COPPER T CAN BE
USED FOR EMERGENCY CONTRACEPTION
PERMANENT CONTRACEPTION
TUBAL LIGATION
In tubal ligation the two fallopian tubes which transport the eggs from the
ovaries to the uterus are disconnected either by cutting or by applying
cautery, clips or silastic rings. A tubal ligation is generally considered
permanent. EFFECTIVENESS: 99%
Benefits
 It's the most effective method of contraception that is controlled by
women. It is ideal for women who don't want to have any more kids.
Disadvantages
 Surgical procedure required
 Permanent
There are two main methods of Tubal Ligation used today
 A laparoscopic tubal ligation can be done anytime when a woman is
not pregnant There are three ways to block the tube: Cautery
(Burning); Applying Clips (Hulka Clips); Applying Silastic Rings
 Postpartum Tubal Ligations are done within two days of delivery
because the top of the uterus is at the level of the belly button at that
time.
PERMANENT CONTRACEPTION
MALE STERILIZATION (VASECTOMY)
A Vasectomy interrupts the travel through the Vas Deferens by blocking
it. Thus, if sperm cannot reach the egg, there is no
pregnancy. Sterilization is considered to be an irreversible, permanent
method of contraception. Rejoining the vas deferens is very difficult,
specialized surgery and moderately successful at best.
Vasectomy can prevent pregnancy it cannot protect against Sexually
Transmitted Diseases.
EFFECTIVENESS: 99%+
ADVANTAGES:
 doesn't interfere with erection or ejaculation
 no known side effects
 doesn't interfere with spontaneity
DISADVANTAGES:
 permanent
 surgical procedure required
 some discomfort at the time of procedure
REFERENCES
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WHO. Medical eligibility criteria for contraceptive use. Third
edition. Geneva, 2004.
WHO. Selected practice recommendations for contraceptive
use. Second edition. Geneva, 2005.
Trussell, J., and E. J. Raymond. 2011. Emergency
Contraception. (A more recent summary of findings by the
same Dr. Trussell whose earlier work is cited above.)
"Mechanisms of the Contraceptive Action of Hormonal
Methods and Intrauterine Devices (IUDs)". Family Health
International. 2006. Retrieved 2006-07-05.
"Contraception: past, present and future". UK Family
Planning Association. April 2006. Archived from the original
on 2006-09-28. Retrieved 2006-11-09.