Birth Control (Contraception)

Prepared by : Dr. Latifa Mari’e

Objective: • Review of reproductive systems

• To learn about the various methods of contraception or birth control to prevent pregnancy and STIs

Reproductive system: female

Fallopian tube: connects ovaries to the uterus, creating

passageway for the egg to be transported from the ovaries to the

uterus

Ovary: main reproductive organ. They produce hormones and

eggs

Uterus: connects all the organs. This is where a baby develops.

Cervix: neck of the vagina

Vagina: muscular tube leading from external genitals to the cervix.

Menstrual blood leaves the body through this passageway. A

penis is inserted in to the vagina during vaginal sex. A baby is

delivered from the uterus through the cervix and vaginal opening.

Reproductive system: female

Menstrual cycle

Review menstrual cycle.

- Girls are born with hundreds of thousands of

tiny eggs, called ova – one is called an ovum.

- These egg cells are only half formed.

- At puberty, hormones tell the ovaries it is time

to start releasing ova.

- Usually one egg at a time matures (develops)

and is released from an ovary.

At the same time, the uterus starts to grow a thick lining on the

inside wall.

•The lining has lots of tiny blood vessels.

•The lining is there to protect and feed an egg that has

combined with a sperm to form a fertilized egg.

If an egg does not meet a sperm, the lining is not needed.

•It breaks up.

•Mixed with some blood it comes out the uterus into the vagina and then out the vaginal opening.

This is called menstruation.

• If a woman is not pregnant then her ovary will release

another egg, the lining build up and, if the egg is not

fertilized, she has another period.

• This is called the menstrual cycle.

Reproductive system: male

Reproductive system: male

STIs and Pregnancy Prevention

• Hormonal Methods

• Non-hormonal Methods

What is the most effective method of preventing pregnancy and STIs?

Abstinence

Hormonal methods of birth control

The pill

• A hormonal method that contains: a. Combined : estrogen and progesterone or

b. Mini pill :progesterone only pills

cocp

• .It includes a combination of an estrogen (usually ethinylestradiol) and a progestogen (specifically a progestin). When taken correctly, it alters the menstrual cycle to eliminate ovulation and prevent pregnancy.

• Combined oral contraceptive pills are a type of oral medication that is designed to be taken every day, at the same time of day, in order to prevent pregnancy.

• When taken correctly, the pill is over 99% effective at preventing pregnancy.

Benefits • The hormones in the pill have also been used to

treat other medical conditions, such as polycystic ovary syndrome (PCOS), endometriosis, adenomyosis, acne, hirsutism, amenorrhea, menstrual cramps, menstrual migraines, menorrhagia (excessive menstrual bleeding), menstruation-related or fibroid-related anemia and dysmenorrhea (painful menstruation).Besides acne, no oral contraceptives have been approved by the U.S. FDA for the previously mentioned uses despite extensive use for these conditions.

contraindications

• Thrombophlebitis or thromboembolic disorders

• Cerebro-vascular or coronary artery disease

• Carcinoma of the breast or other estrogen-dependent neoplasia

• Undiagnosed abnormal genital bleeding

• Known or suspected pregnancy

• Benign or malignant liver tumor

Cocp and cancer

• Combined oral contraceptive use reduces the risk of ovarian cancer by 40% and the risk of endometrialcancer by 50% compared with never users

• But they increase a woman's risk of breast and cervical cancer

pop

• The "traditional" progestogen-only pill (POP) prevents pregnancy by thickening the mucus in the cervix to stop sperm reaching an egg.

• The desogestrel progestogen-only pill can also stop ovulation.

• You need to take the progestogen-only pill reliably every day.

• If you take the minipills on time, they are 99% effective.

Benefits • It may be suitable for women who cannot take the

combined pill because of the oestrogen it contains. For example, those with heart disease, high blood pressure, a history of stroke, those at risk of blood clots, and women who experience certain types of migraine headaches.

• It can be used when you are breast feeding.

• It doesn’t interfere with sexual spontaneity.

• It allows fertility to return without delay after you stop taking it

• Menstrual bleeding may be reduced or stopped

Side effects

• breast tenderness;

• possible mood changes;

• headaches;

• bloating;

• acne;

• decreased or increased libido (sex drive); and

• nausea.

• contraindicated in suspected pregnancy, breast cancer and undiagnosed vaginal bleeding. Relative contraindications are active viral hepatitis and severe chronic liver disease.

Implanon

• implanon NXT is a contraceptive implant preloaded in a disposable applicator. The implant contains 68 mg of the active substance etonogestrel. Etonogestrel is a synthetic female hormone resembling progesterone. A small amount of the hormone etonogestrel is continuously released into the bloodstream for three years. The rod itself is made of ethylene vinylacetate copolymer, a plastic that will not dissolve in the body. It also contains small amounts of barium sulfate (which renders it visible under X-ray) and magnesium stearate.

• Although the implant may be removed at any time, it must be removed no later than three years after insertion.

• It prevents the release of an egg cell from the ovaries (ovulation)

• It causes changes to cervical mucus that makes it difficult for sperm to enter the womb

advantages

• High effectiveness of up to 99 percent within seven days of implant insertion

• Safe in the majority of women

• Efficacy for three years without further intervention

• Easily removed in most cases to allow pregnancy to occur naturally

• Independent of user memory or schedule, and of sexual intercourse, as it provides continuous contraception

• Safe for use during lactation

• Relieves menorrhagia and dysmenorrhea in many cases

• Amenorrhea in one of every five women on the implant, which is often perceived to be a benefit

• Reduces the risk of pelvic inflammatory disease

• Suitable in conditions which preclude the use of combined hormonal contraception

• Quick return of fertility within 21 days of implant removal

Side effects

• changes in your menstrual periods;

• vaginal itching or discharge;

• acne, mood changes, weight gain;

• breakthrough bleeding, menstrual cramps;

• nausea, stomach pain;

• breast tenderness;

• dizziness

• flu-like symptoms, sore throat.

contraindications

• Pregnancy.

• Liver disease, including severe cirrhosis or liver tumors.

• Personal history of breast cancer.

• Undiagnosed abnormal vaginal bleeding.

• Allergy or hypersensitivity to any of the implant materials.

Transdermal patch

• A patch that releases hormones through the skin

• Thin, smooth and beige patch

• Prevents the release of a mature egg

• Thickens cervical mucous

• Changes the lining of the uterus

• Typical effectiveness rate is 91%

What are the advantages?

1. A reversible and highly effective birth control

method

2. Once-a-week regimen; no daily contraceptive

routine required,used for 3 weeks/ m

3. Simple and easy to use

4. Regulates menstrual cycle and reduces

cramps

5. Does not interfere with intercourse

6. Expected to provide other benefits similar to

oral contraceptives; research is needed

What are the disadvantages?

1. May cause irregular bleeding or spotting

2. May cause breast sensitivity or headache

3. Does not protect against STIs

4. Patch may detach from skin (less than 2%)

5. Possible skin irritation at the application site

Nuva Ring (vaginal ring)

• Soft and flexible ring, inserted into the vagina

• The ring slowly releases hormones while in the vagina for 3 weeks

• Prevents the release of a mature egg

• Thickens cervical mucous

• Changes the lining of the uterus

• Typical effectiveness rate is 91%

What are the advantages?

1. A reversible and highly effective birth

control method

2. Once-a-month regimen; no daily

contraceptive routine required

3. Regulates menstrual cycles

4. Does not interfere with intercourse

5. Does not require daily attention

What are the disadvantages?

1. Does not protect against STIs

2. May cause irregular bleeding or spotting

3. May cause side effects such as

headache, nausea, or breast tenderness

4. May cause vaginal discomfort

5. The ring may be expelled from the

vagina but this is uncommon

Depo Provera – Injectable contraceptive

• An injection of progestin administered every 12 to 13 weeks

• Prevents the release of a mature egg

• Thickens cervical mucous

• Changes the lining of the uterus

• Typical effectiveness rate is 94%

What are the disadvantages?

1. Initially, irregular bleeding is the most common

side effect

2. Decrease in bone mineral density which may be

reversible when a woman stops taking the injection.

Calcium supplementation is advised.

3. May be associated with weight gain in some

women

4. Takes an average of nine months after the last

injection for the ovaries to start releasing eggs

again

5. Does not protect against STIs

6. The lack of a monthly period may be bothersome

for some women

• Not given for more than 2 years ,risk of osteoporosis.

Intrauterine Contraception -IUC

• T-Shaped device that is inserted in the uterus by a Doctor or Nurse Practitioner

• Two types of IUC: • the Copper intrauterine device (no hormone)

• the levonorgestrel-releasing intrauterine system (contains a progestin)

• Typical effectiveness rate is 99.8%

• IUD prevent pregnancy by preventing fertilization

• IUD also decreases the risk of ectopic pregnancy.

LNG-IUS

Advantages

-Very low dose of hormone

-May make periods lighter with less cramping

-Many women won’t get a period ~6 months after

insertion

-Improves symptoms of endometriosis

Disadvantages

-Risk of hormonal side effects: acne, headaches,

breast tenderness, changes in mood

-Irregular bleeding, light or no periods

Hormonal methods of birth control • Side effects that may occur during the first few

months on hormonal contraception include : irregular bleeding, spotting

nausea

mood swings

bloating

breast tenderness

headaches

Emergency contraception • Can be taken up to 5 days after intercourse • The sooner it is taken, the better it works • Delays or prevents the release of an egg • May prevent implementation of a fertilized egg • 95 % effective if taken within 24 hours after

intercourse • 85% effective if taken 25-48 hours after intercourse • 58% effective if taken 49-72 hours after intercourse

• Two options:

1.Plan B : Plan B is a safe form of emergency contraception that only contains progestin. It is used to prevent pregnancy up to 72 hours (3 days) after a single act of unprotected intercourse,, but that it may not be as effective.

• 2. Ella: The active ingredient of Ella is ulipristal acetate. It works by blocking the effects of the hormone progesterone. Ella is used to prevent pregnancy up to 120 hours (5 days) after unprotected intercourse.

Insertion of a copper IUD up to five days after unprotected sex can also be used an emergency contraception

1.Plan B : Plan B is a safe form of emergency contraception that

only contains progestin. It is used to prevent pregnancy up to 72

hours (3 days) after a single act of unprotected intercourse

2.Insertion of a copper IUD up to five days after unprotected

sex

3.Ella: Ella is a type of emergency contraceptive pill (prevent

pregnancy up to 120 hours (5 days) after unprotected

intercourse

Barrier methods (non-hormonal)

Condom

• Thin latex or polyurethane that fits over an erect penis

• Catches sperm during ejaculation to prevent it from entering the vaginal/cervical canal

• Typical effectiveness is 82%

• Reduces but does not eliminate the spread of STIs and HIV

Condom (female)

• Polyurethane sheath inserted into the vagina

• Provides a physical barrier to prevent sperm from entering cervical canal

• Sperm is trapped in the condom, which is thrown away after use

• Typical effectiveness rate is 79%

Sponge and Spermicides

• The sponge is a soft, disposable, device with a spermicide

• Typical effectiveness is 76%-88% • Fits over the cervix • Traps and absorbs sperm to increase effect of

spermicide • Spermicide in the sponge disables the sperm • Effective for up to 12 hours

• Spermicides disable sperm • Typical effectiveness is 88%onge

spermicides can cause vaginal irritation which can increase

the risk of STI transmission

Surgical Methods

Sterilization

• Tubal ligation - a surgical procedure to close or block the fallopian tubes ensuring sperm and egg do not meet

• Female sterilization = tubal ligation

•Permanent; only for couples who are absolutely sure their family is complete

•Abdominal surgery

Sterilization

• Vasectomy - A surgical procedure to close or block the vas deferens

Comparing Birth Control Effectiveness

Abstinence 100%

Implanon 99.9%

IUC 99.8%

Depo Provera 94%

The Pill 91%

The Patch 91%

The Ring 91%

Male Condom 82%

Female Condom 79%

Sponge and Spermicides 76-88%

•Thank you