CONTRACEPTION

1. CONTRACEPTION We use our knowledge of reproductive physiology to promote or avoid pregnancy

2. Contraception is the voluntary prevention of pregnancyToday,couples choosing contraception must be informed about preventionof unintended pregnancy, as well as protection against sexually transmitted infections (STIs).

3. HISTORY • 1850 B.C. Egyptians used crocodile dung mixed with honey as vaginal pessary • China- quicksilver (mercury) was heated in oil and swallowed by women • Persia- sponges soaked in quinine, iodine, carbolic acid (phenol)and alcohol were inserted in vaginabefore intercourse

4. HISTORY • Arabs used pebbles, glass beads, buttons to put into uterus (as IUD) • 6th century Greeks scooped out the seeds from half a pomegranate and used the skin of the fruit as a cervical cap

5. HISTORY • Mid 1600’s- the Era of Condom used sheep intestine • Soranus suggested that Greek women jump backward seven times after intercourse. • European women used bees-wax to cap the cervix • Charles Goodyear developed the first rubber condom in the 19th century

6. HISTORY • 1870’s- vulcanized rubber was produced; rubber was washed and reused until it had cracks or tears • Margaret Sanger, a socialist and feminist from New York City, created the term ‘birth control’. • In 1950, Dr Gregory Pincus was asked to develop the ideal contraceptive. • He derived the steroid compounds from the roots of the wild Mexican yam.

7. History of contraceptives An oral birth control pill was tested on 6,000 women from Puerto Rico and Haiti. • In 1960, the first oral contraceptive (Enovid-10) was launched in the US market. • The ‘Pill’ heralded a revolution in birth control.

8. According to the Alan Guttmacher Institute • 64% of the more than 60 million women aged 15–44 in the United States practicecontraception. • 31% of reproductive-age women do not need a method because: • they are pregnant, postpartum, or trying to become pregnant; have never had intercourse; or are not sexually active. • Thus, only5–7% of women aged 15–44 in need of contraception are not using a method.

9. The 3 million women who use no contraceptive method account for almost: • Half of unintended pregnancies (47%), whereas the 39 million contraceptive users account for 53% • The majority of unintended pregnancies among contraceptive users result from inconsistent or incorrect use.

10. Contraception Three general strategies: Prevent ovulation; Prevent fertilization; Keep sperm & oocyte away from each other. Prevent implantation. 10

11. A multidisciplinary approach may assist a woman in choosing and correctly using an appropriate contracep­tive method • Nurses, nurse-midwives, nurse practitioners, other advanced practice nurses, physicians • have the knowledge and expertise to assist a woman in making decisions about contraception that will satisfy the woman's personal, social, cultural, and interpersonal needs

12. Using contraception depends of: • frequency of coitus • number of sexual partners • level of contraceptive involvement, • her or her partner's objections to any methods • the woman's level of comfort and willingness to touch her genitals and cervical mucus • religious and cultural factors • an individual's reproductive life plan (contraception/sterilization) • A history (menstrual, contraceptive, obstetric), • physical examination (including pelvic examination), • laboratory tests

13. BRAIDED • B—Benefits: information about advantages and suc­cess rates • R—Risks: information about disadvantages and fail­ure rates • A—Alternatives: information on other methods avail­able • I—Inquiries: opportunity to ask questions D—Decisions: opportunity to decide or change mind E— Explanations: information about method and how it is used • D—Documentation: information given and patient's understanding

14. Expected Outcomes of Care • Verbalize understanding about contraceptive methods. • Verbalize understanding of all information necessary to give informed consent • State comfort and satisfaction with the chosen method. • Use the contraceptive method correctly and consistently. • Experience no adverse sequelae as a result of the chosen method of contraception. • Prevent unplanned pregnancy or plan a pregnancy.

15. The ideal contraceptive should be safe, easily available, economical, acceptable, simple to use, and promptly reversible. • Although no method may ever achieve all these objectives, impressive progress has been made.

16. Plan of Care and Interventions • fundamental to initiating and maintaining any form of contraception. • The nurse counters myths with facts, clarifies misinformation, and fills in gaps of knowledge • Contraceptive failure depends on both the properties of the method and the characteristics of the user • Safety of a method depends on the patient's medical history, tobacco use, and age. (Barrier methods offer some protection from STIs, and oral contraceptives may lower the incidence of ovarian and endometrial cancer, but increase the risk of thromboembolic problems)

17. Natural family planning methods And Fertility Awareness Methods Coitus interruptus Calendar metods Basal body temperature Ovulation-detection method Symptothermal method (cervical mucus+BBT) Predictor test for ovulation Barrier Methods Chemical male (condom) Mechanical female (condom, cervical diaphragm, cervical cap) Hormonal Methods Combined (oral, injection, transdermal, vaginal ring) Pogestin only (oral, injection, implantable) Intrauterine Device Emergency Contraception Methods of Contraception

18. Natural family planning methods And Fertility Awareness Methods Calendar metods Basal body temperature Ovulation-detection method Symptothermal method (cervical mucus+BBT) Predictor test for ovulation Coitus interruptus Barrier Methods Hormonal Methods Intrauterine Device Emergency Contraception Methods of Contraception

19. Natural family planning methods (NFPM) provides contraception by using methods that rely on avoidance of intercourse during fertile periods • And Fertility Awareness Methods combine the charting signs and symptoms of the menstrual cycle with the use of abstinence or other contraceptive methods during fertile periods

20. Natural family planning methods Fertility determine techniques include • Calendar metod • Basal body temperature (BBT) • Cervical mucus Ovulation-detection method • Postovulation method • Symptothermal method (cervical mucus+BBT) • Predictor test for ovulation

21. Natural family planning methods NFPM main principles • The ovum can be fertilized no later than 16-24 hours after ovulation • Motile sperm have been recovered from the uterus and the oviducts as long as 7 days after coitus. • However, their ability to fertilize the ovum probably lasts no longer than 24 to 48 hours. • Pregnancy is unlikely to occur if a couple abstains from intercourse for 4 days before and for 3 or 4 days after ovulation (fertile period). • Work only in woman with regular menstrual periods • Depends of length pf menstrual period • The typical failure rate is 25% during the first year of use

22. Natural family planning methodsThe fertile period can be anticipated by the following: • Calculating the time at which ovulation is likely to occur based on lengths of previous menstrual cycle • Recording the increase in basal body temperature, a result of thermogenic effect of progesterone • Recognizing the changes in cervical mucus at different phases of menstrual cycle • Using combination of several method • Using predictor test for ovulation

23. Natural family planning methodsCalendar (rhythm) method • is based on the number of days in each cycle counting from the first day of menses • The beginning of the fertile period is estimated by subtracting 18 days from the length of the shortest cycle. • The end of the fertile period is determined by subtracting 11 days from the length of the longest cycle. • shortest cycle is 21 days and longest is 35 days, • 21 - 18 = 3 , 35 - 11 =24 • Fertile period from 3 to 24 days

24. Natural family planning methodsCalendar (rhythm) method • Effectiveness. • Pregnancy rate of 9–25 per 100 women in first year of use. • Advantages. • No physical side effects, economical, immediate return to fertility on cessation of use, no method-related health risks. • Disadvantages. • High failure rate, no protection against STDs, inhibits spontaneity, requires regular menstrual cycles.

25. Natural family planning methodsBasal Body Temperature Method (BBT) • is the lowest body temperature of a healthy person that is taken immediately after waking and before getting out of bed. • usually varies from 36.2° to 36.3° C during menses and for about 5 to 7 days afterward • About the time of ovulation a slight drop in temperature (approximately 0.05° C) may be seen; after ovulation, in concert with the increasing progesterone levels of the early luteal phase of the cycle, the BBT rises slightly (approximately 0.2° to 0.4° C) • The temperature remains on an elevated plateau until 2 to 4 days before menstruation.

26. Natural family planning methodsBasal Body Temperature Method (BBT)

27. Natural family planning methodsBasal Body Temperature Method (BBT)

28. Natural family planning methodsCervical mucus Ovulation-Detection Method • requires that the woman recognize and interpret the cyclic changes in the amount and consistency of cervical mucus that characterize her own unique pattern of changes • cervical mucus should be free from semen, contraceptive gels or foams, and blood or discharge from vaginal infections, douches and vaginal deodorants, medications such as antihistamines for at least one full cycle

29. Natural family planning methodsCervical mucus Ovulation-Detection Method

30. Natural family planning methodsCervical mucus Ovulation-Detection Method

31. Natural family planning methodsCervical mucus Ovulation-Detection Method

32. Natural family planning methodsSymptothermal method(BBT+cervical mucos) • The woman is taught to palpate the cervix to assess for changes indicating ovulation; that is, the os dilates slightly, the cervix softens and rises in the vagina, and cervical mucus is copious and slippery • The woman notes days on which coitus, changes in routine, illness, and so on have occurred • Calendar calculations and cervical mucus changes are used to estimate the onset of the fertile period; changes in cervical mucus or the BBT are used to estimate its end

33. Natural family planning methodsPredictor test for ovulation • detects the sudden surge of luteinizing hormone (LH) that occurs approximately 12 to 24 hours before ovulation. Unlike BBT, the test is not affected by illness, emotional upset, or physical activity

34. Natural family planning methods Coitus interruptus • male partner withdrawing the penis from the woman's vagina before he ejaculates. • It is a good choice for couples who do not have another contraceptive available • Effectiveness depends on the man's ability to withdraw his penis before ejaculation • The failure rate is 19% • Does not protect against STIs or human immunodeficiency virus (HIV) infection

35. Natural family planning methods And Fertility Awareness Methods Barrier Methods Chemical male (condom) Mechanical female (condom, cervical diaphragm, cervical cap) Hormonal Methods Intrauterine Device Emergency Contraception Methods of Contraception

36. Barrier Methods • Provide barrier for sperm • AND • Mechanical condoms provide a mechanical barrier to STIs • Chemical barriers slightly reduce the risk of gonorrhea and chlamydia but may increase the transmission of HIV

37. Barrier Methods • Exposure to multiple partners is defined as having had more than one partner in the past year or having had a partner who had other partners around the same time.

38. Barrier MethodsSpermicides • Nonoxynol-9 is a surfactant that destroy the sperm sell membrane, • Mode of action • Provide a physical and chemical barrier that prevent viable sperm from entering the cervix • frequent using increase the transmission of HIV, • can cause genital lesion • aerosol foams, foaming tablets, suppositories, creams, films, gels, and sponges • Should be inserted no longer than 1 hour before intercose • Effectiveness depends on consistent and accurate use • Typical failure rate in the first year of use is 29%

39. Barrier MethodsSpermicides • Advantages • Easy to apply • Safe • Low cost • Available without a prescription or previous medical examination • Aids in lumbricate of the vagina • Alternative to lacting woman and premenopausal, foget oral contraceptive • Disadvantages • Maximall effectiveness lasts no longer 1 hour • Repeated intercourse need additional spermicides • Alergic reaction and irritation of vaginal and penile tissue • Decrease sensation • Increase STI

40. Barrier MethodsSpermicides

41. Barrier Methodsmale condom • prevent sperm from entering the cervix • FAILURE RATE • Typical users, 14% • Correct and consistent users, 3% • ADVANTAGES • Safe • No side effects Readily available • Premalignant changes in cervix can be prevented or ame­liorated in women whose partners use condoms Method of male nonsurgical contraception • DISADVANTAGES • Must interrupt lovemaking to apply sheath. Sensation may be altered. • If used improperly, spillage of sperm can result in preg­nancy. Occasionally, condoms may tear during intercourse. • STI PROTECTION • If a condom is used throughout the act of intercourse and there is no unprotected contact with female genitals, a latex rubber condom, which is impermeable to viruses, can act as a protective measure against STIs. The addi­tion of nonoxynol-9 increases protection against trans­mission of STIs.

42. Barrier Methodsfemale condom • is made of polyure-thane and has flexible rings at both ends • The closed end of the pouch is inserted into the vagina and is anchored around the cervix, and the open ring covers the labia. • The female condom can be inserted up to 8 hours be­fore intercourse and is intended for one-time use. • Typical failure rate is 21% in the first year of use

43. Barrier Methodsdiaphragm • is a shallow, dome-shaped rubber device with a flexible wire rim that covers the cervix • The diaphragm is a mechanical barrier preventing the meeting of the sperm with the ovum. • The diaphragm holds the spermicide in place against the cervix for the 6 hours it takes to destroy the sperm. • Typical failure rate of the diaphragm alone is 20% in the first year of use. • Effectiveness of the diaphragm can be increased when combined with a spermicide

44. Barrier Methodsdiaphragm • Disadvantages • reluctance to insert and remove the diaphragm. A cold diaphragm • a cold gel temporarily reduce vaginal response to sexual stimulation if insertion of the diaphragm occurs immediately before intercourse. • Side effects • irritation of tissues related to contact with spermicides and urethritis and recurrent cystitis caused by upward pressure of the diaphragm rim against the urethra • Contraindication • woman with relaxation of her pelvic support (uterine prolapse) or a large cystocele. • Women who have a latex allergy should not use diaphragms made of latex.

45. Barrier Methodscervical cap • soft, natural rubber dome with a firm but pliable rim. It fits snugly around the base of the cervix close to the junction of the cervix and vaginal fornices. • It is recommended that the cap remain in place no less than 8 hours and not more than 48 hours at a time. • It is left in place at least 6 hours after the last act of intercourse. • The seal provides a physical barrier to sperm: spermicide in­side the cap adds a chemical barrier. • The extended period of wear may be an added convenience for women. • Contindication • abnormal Papanicolaou (Pap) test results, • those who cannot be fitted properly with the existing cap sizes, • those who find the insertion and removal of the device too difficult, • those with a history of Toxic Shock syndrome, • those with vaginal or cervical infections, • those who experience allergic responses to the latex cap or spermicide.

46. Barrier MethodsSponges • is a small, round, polyurethane sponge that contains nonoxynol-9 spermicide. It is designed to fit over the cervix (one size fits all). The side that is placed next to the cervix is concave for better fit. The opposite side has a woven polyester loop to be used for removal of the sponge. • The sponge must be moistened with water before it is inserted. It provides protection for up to 24 hours and for repeated instances of sexual intercourse. The sponges hould be left in place for at least 6 hours after the last act of intercourse. Wearing longer than 24 to 30 hours may put the woman at risk for TSS

47. Barrier MethodsSponges

48. Natural family planning methods And Fertility Awareness Methods Barrier Methods Hormonal Methods Combined (oral, injection, transdermal, vaginal ring) Pogestin only (oral, injection, implantable) Intrauterine Device Emergency Contraception Methods of Contraception

49. Natural family planning methods And Fertility Awareness Methods Barrier Methods Hormonal Methods Combined (oral, injection, transdermal, vaginal ring) Pogestin only (oral, injection, implantable) Intrauterine Device Emergency Contraception Methods of Contraception

50. Hormonal MethodsCombined oral contraceptives (COCs) • Consist of synthetic estrogen and progestin preparations • suppresses the action of the hypothalamus and anterior pituitary, leading to inappropriate secretion of follicle-stimulating hormone (FSH) and LH; ovulation is inhibited because ovarian follicles do not mature. • maturation of the endometrium is altered, making it a less favorable site for implantation should ovulation and fertilization occur; • the cervical mucus remains thick as a result of the effect of the progestin and reduces the chance for sperm penetration • Decrease tubal motility