Contraception & family planning

1. CONTRACEPTION Practical view of the contraception Dr Elhadi Miskeen, MBBS, MD, FAIMER, TUFH Dr. Suaad Elnour, MBBS, MD, MPHE, MSc Department of obstetrics and gynecology College of Medicine, University of Bisha This Photo by Unknown author is licensed under CC BY-ND.

2. Contraception & family planning 1. Demonstrate knowledge and understanding of family planning and contraception. LEARNING OBJECTIVES 2. Identify different methods of contraception, their efficacy, side effects and failure rate. 3. Counsel lactating and none lactating ladies about different modalities of contraception 4. Demonstrate an appropriate approach in dealing with emergency contraception.

3. FACTS-WHO • Among the 1.9 billion Women of Reproductive Age group (15-49 years) worldwide in 2019, 1.1 billion have a need for family planning; of these, 842 million are using contraceptive methods, and 270 million have an unmet need for contraception. • The proportion of the need for family planning satisfied by modern methods, Sustainable Development Goals (SDG) indicator 3.7.1, has stagnated globally at around 77% from 2015 to 2020 but increased from 55% to 58% in the Africa region. • Only one contraceptive method, condoms, can prevent both a pregnancy and the transmission of sexually transmitted infections, including HIV. • Use of contraception advances the human right of people to determine the number and spacing of their children.

4. Safe Effective Acceptable WHAT IS THE IDEAL CONTRACEPTION Inexpensive Reversible Simple to administer Independent of coitus Long lasting to avoid frequent administration Requiring minimal or no medical supervision

5. 100% EFFECTIVE WAY TO PREVENT PREGNANCY AND STD IS TO BE SEXUALLY ABSTINENT OR TO POSTPONE SEXUAL INVOLVEMENT This Photo by Unknown author is licensed under CC BY-SA-NC.

6. CONTRACEPTION MALE /FEMALE TEMPORARY PERMANENT Hormonal Methods Vasectomy Barrier methods Bilateral tubal ligation Behavioral Methods

7. TEMPORARY METHODS • Condom • Diaphragm • Cervical cap BARRIER • OCP (Combined-progesterone based) • Implants • Patch Hormonal IUD • Copper T • Lavenogestral containg device (Mirena)

8. HORMONAL CONTRACEPTION All hormonal contraception mechanism • Stop ovulation • Prevent the uterine lining from building up • Making cervical mucous thick to prevent penetration of sperm This Photo by Unknown author is licensed under CC BY-SA-NC.

9. Combined methods

10. This Photo by Unknown author is licensed under CC BY-ND. Male condom

11. • Oral contraceptive made from synthetic hormones • 97%-99% effective • Contains estrogen and progestin • 21-day or 28-day form • Monophasic or multiphasic (fewer side effects) • Take pills daily at the same time Birth Control Pills Combined pill ? ? ? Women must have a pap smear to get a prescription for birth control pills Pills DO NOT prevent STD?s

12. • Contain only progesterone • Used continuously for 28 days • It thickens the cervical mucous and makes the lining of the uterus less receptive to implantation • Indicated in breast feeding women MINI PILLS

13. COMBINED PILLS ADVANTAGES ↓Acne • ↓ ABNORMAL Hair growth • ↓Breast cysts • ↓ Ovarian cysts • ↓ Ovarian carcinoma • ↓ Dysmenorrhea • ↓ Endometrial carcinoma • ↓PID • ↓ Risk of ectopic • pregnancy • ↓ Anemia • ↓ Osteoporos •

14. DISADVANTAGE OF COMBINE PILLS • ↑ Risk of CV disease • ↑ Risk of breast cancer • ↑ Risk of cervical cancer • ↑ Risk of thromboembolic episodes • ↑ Risk of liver adenoma • Lipid metabolism disorders • Nausea • Depression • Post-pill amenorrhea • Weight gain • Breast tenderness

15. CONTRAINDICATION • Absolute: CV diseases, liver damage, hormone-dependent tumors • • Relative: age >35 + another risk factor (smoking, DM etc.)

16. INJECTABLE 1. DEPO PROVERA 2. NORESTERAT • Women get shots of the hormone progestin in the buttocks or arm every three months from their doctor. I:e Depo provera while 2 monthly is Noresterat • It is 97–99% effective at preventing pregnancy. This Photo by Unknown author is licensed under CC BY.

17. Side effects of injectables Extremely irregular menstrual bleeding and spotting for 3-6 months! NO PERIOD or after 3-6 months Weight change Breast tenderness Mood change

18. IMPLANT eg: Implanon Contains 68 mg etonogestrel Single rod implanted sub dermally on day 1-5 of cycle Last for 3 years. Works by thickening cervical mucus and also inhibits ovulation Extremely effective in pregnancy prevention > 99% Irregular bleeding common side effect

19. IUDS • IUD is the world's most widely used method of reversible birth control • 3 TYPES: • Inert ( no longer recommended because of painful and heavy periods). Eg: lippes loop • Copper Releasing IUD • Mirena (levonorgestrel).

20. IUDs • Banded device containing 380mm2 copper • Until no longer required > 40s • Emergency contraception

21. Clinical Use of IUD • Long-term contraception Women with contraindications to COC • Emergency contraceptive(1:1000) • menorrhagia , endometriosis, chronic pelvic pain, dysmenorrhea, anaemia Mirena can be used This Photo by Unknown author is licensed under CC BY.

22. Pregnancy Post partum puerperal sepsis Immediately post-septic abortion Undiagnosed abnormal vaginal bleeding. ABSOLUTE CONTRAINDICATION Suspected gynecological malignancy. (Cervical cancer, Endometrial cancer) Current STDs. -Current PID anatomical abnormalities

23. NATURAL METHODS Relies upon the fact that there are certain days during the menstrual cycle when conception can occur following ovulation, the ovum is viable within reproductive tract for a maximum of 24 hrs. The life spam of sperm is longer 3 days. Calendar Method (Safe period) During 28 day menstrual cycle, ovulation occur around day 14. This means that coitus must be avoided from 8th to 17th day. Failure rate is high so many couples find it difficult to adher to this method. This Photo by Unknown author is licensed under CC BY-NC-ND.

24. Male condom Female condom Diaphragm Cervical Cap BARRIER METHOD

25. Diaphragm

26. TUBAL LIGATION SURGERY •This involve mechanically blockage of both fallopian tube to prevent the sperm reaching and fertilizing the oocyte •Sterilization performed by laparoscopically(under GA) or through a suprapubic “mini-laparotomy” •Failurerate:0.5% VASECTOMY

27. Advantages: intended to be permanent • highly effective • safe • quick recovery TUBAL LIGATION lack of significant long-term side effects cost effective

28. TUBAL LIGATION Disadvantage: Possibility Of Patient Regret Difficult To Reverse Future Pregnancy Could Require Assisted Reproductive Technology (Such As IVF) More Expensive Than Vasectomy

29. After intercourse and before implantation Indication: failure of condoms Unprotected intercourse EMERGENCY CONTRACETION Within 72 hours after unprotected intercourse • Levonorgestrel Combined Prescription • Single dose, the earlier the better • Prevented 75% of unplanned pregnancies IUD Emergency Contraception • Within 5 days after unprotected intercourse • Copper IUD

30. Contraception in lactating woman • Breastfeeding women have many birth control options. • Many contraceptives can be started immediately after birth • Including intrauterine (IUDs), arm Provera® shots, and progestin-only pills devices Depo- implants,

31. THANKS hadimiskeen19@gmail.com