Dr.

Niranjan Murthy HL Associate Professor Department of Physiology SSMC, Tumkur

 Preventive methods to help woman avoid unwanted pregnancies A method or a system which allows intercourse and yet prevents conception Include temporary and permanent methods Cafeteria choice

Contraceptive methods
1. Spacing methods (a) Barrier methods (i) Physical methods (ii) Chemical methods (iii) Combined methods (b) Intra-uterine devices Hormonal methods (d) Post-conceptional methods (e) Miscellaneous 2. Terminal methods (a) Male sterilization (b) Female sterilization

Barrier Methods
(a) Physical methods: (i) Condom: Nirodh Failure rate of 2-3/100 women years Advantages: Safe, inexpensive, easy to use, prevent STD, no side effects Disadvantages: May slip off or tear, Interferes with sexual sensation

(ii) Diaphragm: Dutch cap Synthetic rubber or plastic Spermicidal jelly is used Failure rate 1.9/100 women-years Advantages: no risks and no medical contraindications, prevents STDs Disadvantages: needs practice at insertion, privacy, cant be used immediately after child birth, Toxic Shock Syndrome

(iii) Vaginal sponge: Today Polyurethane foam sponge soaked in nanoxynol-9 Less effective than diaphragm Prevents STDs Toxic Shock Syndrome

(b) Chemical methods: Spermicides were widely used in 1960s Foams, Pastes, Jellies, Creams, Suppositories, Soluble films Modern spermicides are surface active agents- inhibit oxygen uptake of sperms Disadvantages: must be applied immediately before intercourse, high failure rate, may cause irritation

(b) Intrauterine Devices: On-medicated and Medicated (i) First generation IUDs: inert Lippes loop spirals, coils, rings, bows, loops Barium sulphate Tails made of nylon

(ii) Second generation IUDs: Metallic copper was added Smaller devices which fit into nulliparous copper-7; Copper T-200; T Cu-220 C; T Cu380 A; Nova T, ML-Cu-250 low expulsion rate, easier to fit, nulliparous, post-coital, more effective

(iii) Third generation IUDs: Release of hormone Progestasert Mechanism of action of IUDs: Foreign body reaction Copper alters biochemical composition of cervical mucus Hormonal devices maintain sustained high levels of progesterone

Failure rate of 3-5/100 women-years Maintained for 2-4 years Advantages: simple, Inexpensive, no systemic sideeffects, high continuation rate Contraindications: suspected pregnancy, PID, Cancer of cervix, uterus Timing of insertion: during menstruation or 10 days within the beginning; 6-8 weeks after delivery Disadvantages: Bleeding, Pain, Pelvic infection, Uterine perforation, Pregnancy, Ectopic pregnancy

(c) Hormonal contraceptives: I. Oral pills: A. Combined pill B. Progestogen only pill C. Post-coital pill D. Once-a-month pill E. Male pill II. Depot formulations: A. Injectables B. Subcutaneous implants C. Vaginal rings

Made of gonadal steroids Synthetic estrogens : Ethinyl estradiol and Mestranol Synthetic progestogens: medroxyprogesterone, norethisterone, levonorgesterol

Combined pill: Mala- N: Levonorgesterol + Ethinyl Estradiol Mala- D: Levonorgesterol + Ethinyl estradiol Package of 28 pills
Progestogen-only pill: Minipill or micropill Norethisterone or levonorgesterol Poor cycle control May lower HDL

Post-coital contraception: IUDs Hormonal pills I pill Once-a-month pill: Failure Male pill: Gossypol a derivative of cotton-seed oil

Mechanism of OCP action: Inhibit ovulation by feedback inhibition of LH & FSH Progestogen render cervical mucus thick Progestogens inhibit tubal motility Failure rate: < 1 per 100 women-years Adverse effects: Cardiovascular side effects, cervical cancer, hypercoagulability of blood, weight gain, liver disorders, breast tenderness

(d) Postconceptional methods: (i) Menstrual regulation

(ii) Menstrual induction: prostaglandins (iii) Abortion

(e) Miscellaneous: (i) Abstinence (ii) Coitus interruptus (iii) Safe period or rhythm method (iv) Natural methods - Basal Body Temperature - Cervical mucus method (v) Breast feeding

 Rhythm method (Calendar method): Ovulation in 28 day cycle between 12-16 days Ova can survive for 1 day
Sperms can survive for 3 days Unsafe period is between 9 and 17 days in 28 day cycle Shortest cycle minus 18 days and longest cycle minus 10 days

 Basal body temperature:

Reliable for post-ovulatory period increase in BBT by 0.5 C during ovulation Billing method: Cervical mucus becomes slippery and watery clear during ovulation

Terminal methods
(a) Male sterilization: Vasectomy Simple and short duration surgery Spermatogenesis and hormonal production are not affected Sperms are phagocytosed Not sterile till 30 ejaculations Complications: operative complications; spontaneous recanalization; sperm granules; autoimmune response

(b) Female sterilization: Tubectomy Laporoscopy, minilaparotomy 6 weeks after delivery