Types of Contraceptives

Barrier Methods

WHAT ARE BARRIER METHODS? Barrier methods prevent sperm from fertilizing ovum.

Types of barrier methods:

• Male condom.
• Female condom.
• diaphragm.
• spermicidal.

Male Condom

• Cheap and widely available.
• They made of latex.
• They protect against STIs including HIV.Z
• They are the only reversible male method.
• Used before sex.

The Female Condom

• Is a lubricated polyurethane condom
• Inserted into the vagina.
• It protects against STIs

Non-Contraceptive Uses of Condoms

• Condom catheter.
• In post partum haemorrhage as condom tamponade.

Condom Tamponade Technique

Diaphragm and Cap

• These are latex or non-latex devices that are
• inserted into the vagina to prevent passage of
• sperm to the cervix .
• Caps fit over the cervix.
• They are often used in with a spermicide.

Disadvantages

• women need to be taught how to insert and remove.
• High failure rate.
• May be associated with increased vaginal discharge
• Associated urinary tract infections.

OSPE

Spermicides

Spermicide alone is not recommended for prevention of pregnancy as it is of low effectiveness.

Nonoxynol 9 (N-9) is a spermicidal product sold as:

• a gel
• cream
• Foam
• sponge
• or pessary for use with diaphragms or caps.

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Long Acting Reversible Contraceptives (LARC)

Types:

• injectable
• Implant
• intrauterine device (IUD).

LARC methods are the most effective

once inserted do not require any action by the user until they need to be renewed.

Long-acting reversible contraception (LARC) is a contraceptive that lasts for a long time. ➢Types of LARC : ✓Intrauterine devices: (IUCD Mirena) which lasts for three, five or ten years ✓Implants: which lasts for five years. ➢LARCs are the most effective types of contraception.

Intrauterine Contraceptive Device (IUCD)

• Life span 10 years
• Contraindications :
  • Pregnancy.
  • DUB.
  • PID.
  • cervical cancer.
  • endometrial cancer.
• Time of insertion :
  • at menstruation time(within 10 days).
  • post partum(within 48 hs).
  • after puerperium (6 weeks after delivery)

Side Effects of IUCD

$\square$Side effects:
$✓$ Pregnancy(failure)
$✓$ Pain.
$✓$ Bleeding.
$✓$ PID.(increase vaginal discharge).
$✓$ Perforation.
$✓$ Ectopic pregnancy.
$✓$ Expulsion.
$✓$ Difficult removal.
$✓$ Actinomyces-like organisms (ALOs)
$✓$ ‘Missing’ threads may indicate
$✓$ Pregnancy
$✓$ expulsion
$✓$ or perforation.

Progestogen-Releasing Intrauterine System

• Contain 52 mg of progesterone. Release 20 ug /day. Life span 5 years.

• (Mirena®) is licensed for 5 years for contraceptive use (but if inserted in women 45 years or older, may be used for contraception until the menopause) The LNG-IUS does not prevent ovulation.

women experience unpredictable bleeding.

side-effects of the LNG-IUS include

• acne.
• tenderness.
• mood disturbance.
• and headaches.

Non-Contraceptive Benefits of LNG-IUS

• reducing HMB (reduced by 90% at 12 months).
• It is also effective for treating dysmenorrhoea,
• pain associated with endometriosis
• Adenomyosis pain
• and protecting the endometrium against hyperplasia

Mode of Action of IUDs

• IUDs stimulate an inflammatory reaction in the uterus.
• It is thought that these effects are toxic to both sperm and egg and interfere with sperm transport.
• If a healthy fertilized egg reaches the uterine cavity, implantation is inhibited.

Hormonal IUD Copper IUD #OSPE

Intrauterine Device (IUD) Illustration

The image illustrates the placement and types of Intrauterine Devices (IUDs) within the female reproductive system.

• IUD Types:
  • Copper IUD
  • LNg IUD

The diagram shows the IUD inserted into the uterus, with the Strings hanging down into the cervix and vagina.

• Key components labeled in the diagram:
  • IUD
  • Strings

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Hormonal

Hormonal Contraceptives

Hormonal contraceptives include the

• Pills
• Depo Provera injection.

There are two types of pill:

• combined oral contraceptive pill
• progestogen-only contraceptive pill
• The pill is more than 99% effective.
• Daily taking.

The Depo Provera injection is another type of hormonal contraceptive

• An injection every three months.
• Its is more than 99% effective .

COCP methods contain two hormones: an oestrogen and a progestogen.

They are available as

• oral pills
• a transdermal patch
• vaginal ring.

They are similar in terms of

• effectiveness, safety and side-effects.

These methods all work by inhibition of ovulation.

One tablet every day at the same time, without interruption.

Side-Effects of Combined Hormonal Contraception

• unexpected bleeding,.
• weight gain.
• Headaches.
• mood swings.
• loss of libido.

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Below are examples of WHO medical eligibility criteria Category 4 conditions for use of combined hormonal contraception (CHC). These represent situations in which CHC is not recommended because the risks clearly outweigh any potential benefits:

• Age > 35 years and smoking
• Uncontrolled high blood pressure (systolic >160 mmHg and/or diastolic >100 mmHg)
• Hypertension with vascular disease
• Current or past venous thromboembolism (e.g., deep vein thrombosis)
• Current or past arterial thrombotic events (e.g., myocardial infarction, cerebrovascular accident/stroke)
• Multiple serious cardiovascular risk factors (combined risk profile that substantially increases thrombotic/cardiovascular risk)
• Known thrombogenic mutation (inherited or acquired thrombophilia)
• Current breast cancer

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Safety of Combined Hormonal Contraception

• Cancer
• Cancer risks among users of COCPs
• A 12% reduction in the risk of any cancer.
• Reduced risk of colorectal cancer.
• Reduced risk of endometrial cancer.
• Reduced risk of ovarian cancer.
• Increased risk of breast cancer during use (decreases on stopping and similar risk to never used by 10 years after stopping).
• Increased risk of cervical cancer (but early changes detected by cervical cytology and human papillomavirus [HPV] vaccination).

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Drugs that Decrease Efficacy of Hormonal Contraception

Type of drugZ	Liver enzyme inductionY
Anticonvulsant	- Carbamazepine - Eslicarbaz - Oxcarbazepine - Phenobarbital - Phenytoin - Primidone - Topiramate
AntibioticZ	Rifampicin Rifabutin
Antifungal	Griseofulvin
	- Protease inhibitors - Amprenavir - Atazanavir - Nelfinavir - Lopinavir
Antiretroviral	- Saquinavir Ritonavir - Non-nucleoside reverse transcriptase inhibitors - Efavirenz - Nevirapine

3 Missed Pill Guideline

If one pill has been missed >24 hs and <48hs

• Continue contraceptive cover
• Missed pill should be taken as soon as possible
• Then continue pills as usual

Minimizing risk of pregnancy

• EC if missed pill in the early packet or last week of previous packet

If one pill has been missed >48 hs

• Continue contraceptive cover
• Missed pill should be taken as soon as possible
• Remaining should continue at usual time
• Pack up for 7 pills

Minimizing risk of pregnancy

• If missed pill in the 1st week EC
• If pill missed in the 2nd week (8-14 d)
• If missed pill in the 3rd week (15-21 d) omit the pill free period

Progestogen-Only Contraceptive Methods

Progestogen-only methods are available as

• Oral
• Injectable
• Implant
• and intrauterine system.

The mechanism of action All progestogen-only contraceptive methods by thicken cervical mucus Z so reducing sperm penetrability and transport.

The progestogens that are used are referred to as second-generation (levonorgestrel, norethisterone)

Progestogen-only Injectable Contraception

Description and Administration

• One injection every 13 weeks.
• There are 2 forms:
  • DMPA-IM administered by IM. Depo-Provera (150 mg)
  • DMPA-SC by SC route. Sayana press (104 mg)

Protection and Advantages/Disadvantages

• Protection: 3 months.
• Advantages & disadvantages:
  • No daily administration.
  • Self-administration possible.
  • Long delay in return to fertility ..on average 5 months after stopping injections, sometimes up to 1 year
  • Bleeding may occur at any time (irregular) or there may be no monthly bleeding (amenorrhoea).

Side Effects of Progestogen-only Contraception

Common Side Effects

• Cause weight gain in a minority of women
• Loss of bone mineral density (BMD)
• Other progesterone side effects.
• Irregularity of cycle
• Difficulties in resuming fertility after stopping.

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Implant Contraception

Description and Administration

• Containing the progestogen etonorgestrel (Implanon & Nexplanon) 68 mg
• Providing contraception for 3 years.
• One (or two) rods inserted under the skin of the upper arm, under local anaesthesia.

Protection and PRO & CON

• Protection: 3 years.
• PRO & CON
  • Effectiveness does not depend on compliance.
  • Bleeding may occur at any time (irregular)
  • There may be no monthly bleeding (amenorrhoea).
  • The implant is discreet but palpable under the skin.

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Permanent Contraception Methods

Female Sterilization

• This is a permanent method of contraception that prevents sperm reaching the oocyte in the Fallopian tube.
• Tubal ligation.
• Effectiveness 99%.
• It can be performed by
  • (1) Laparoscopy
  • (2) Hysteroscopy or
  • (3) Laparotomy (e.g., at caesarean section).

Vasectomy

• This is the technique of interrupting the vas deferens to provide permanent occlusion.
• There is a small risk of a scrotal haematoma and infection with the procedure.
• Post-vasectomy semen analysis should be conducted at 12 weeks to confirm the absence of spermatozoa.
• Alternative contraception should be used until azoospermia is confirmed.

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Emergency Contraception

Effective Methods

• The most effective method of EC is an IUD (about 99% effective).
• An IUD can be inserted up to 5 days after ovulation for EC.
• Ulipristal acetate (UPA) or levonorgestrel (LNG) are available as oral methods of EC.
• UPA can be given within 120 hours of unprotected intercourse.
• LNG can be used within 96 hours of unprotected intercourse.
• Effective ongoing contraception should be started after EC.