Presentation Transcript

1. Contraception Chapter 6

2. Contraceptives • Definition: • Conception: the fusion of an ovum and sperm creating a fertilized egg (zygote) • Contraception: preventing conception by blocking the female’s egg from uniting with the male’s sperm

3. Principles of Contraception • Based on the physiology of reproduction • Types of contraception: • Barrier • Hormonal • Natural methods • Surgical • Factors affecting choice • Advantages and disadvantages

4. Principles of Contraception • Effectiveness • Contraceptive failure rate- % of women experiencing an unintended pregnancy in the 1st yr. of contraceptive use • Continuation rate- % of people who continue to use the method after a specified period of time

5. Oral Contraceptives: The Pill • Estrogen and progesterone taken orally • Mimics the corpus luteum • Secretes progesterone & estrogen to suppress ovulation • Combination pill • Most common • Advantages : Easy to use, effective, fertility returns after use • Disadvantages : exp. symptoms of pregnancy, no protection against STD’s; stroke, blood clots in older women who smoke

6. Contraceptive Skin Patch • Thin , tiny square patch • Releases estrogen and progestin slowly into the bloodstream • Prevents the same way as OCs • Worn for 1 week, replaced on the same day for 3 consecutive weeks. 4th wk. no patch • Advantages: as effective as OCs • Disadvantages: similar to OCs

7. Vaginal Contraceptive Ring • The NuvaRing • 2 inch flexible vaginal ring molded w/ progestin and estrogen • Slowly releases hormones into bloodstream • Inserted during cycle, kept in for 3 wks., removed during 4th wk. (ring free) new ring inserted at next menstrual • Advantages : 1 month of protection, no daily/weekly action required • Disadvantages : similar to OCs and patch

8. Contraceptive Implants • Placed under skin of upper arm/leg • Delivers progesterone over a period of years • May inhibit ovulation & affect development of the uterine lining • Advantages: Highly effective, no further action required after insertion, contain no estrogen, so lower risk of estrogen related side effects • Disadvantages: no protection against STDs, menstrual irregularities, uncomfortable appearance

9. Injectable Contraceptives • Depo-Provera • Injectable progestin every 12 weeks • Provides protection like implants • Advantages Highly effective, requires little action on part of user ; No estrogen-related side effects, minor injection • Disadvantages: visit to health care facility every 3 months, side effects similar to Norplant, weight gain, infertility after stopping use

10. Emergency Contraception • “Morning-after Pill”, Plan B • Most common is the two dose regimen • May inhibit/delay ovulation or altering the transport of sperm/egg; do not affect a fertilized, implanted egg • Needs to be taken within 72 hours. Best used within 24 hours

11. The Intrauterine Device (IUD) • Small plastic device placed in the uterus • ParaGard (copper;protects 10 yrs.) • Mirena (protects 5 yrs.) • Releases small amounts of progestin • May work by preventing fertilization • Advantages: highly reliable, once inserted a simple check of string is all that’s needed; reduce risk of endometrial cancer; fertility restored after use • Disadvantages: limited to genital tract: heavy menstrual flow, uterine cramping, backache, spontaneous expulsion, may puncture uterine wall

12. Figure 6.1 An IUD properly positioned in the uterus

13. Barrier methods

14. Male Condoms • Thin latex, or polyurethane • Most widely used barrier method • Advantages: Protect against pregnancy and STD’s, easy to purchase, no prescription • Disadvantages: Most common complaints are reduced sensitivity and interfering with sexual intercourse

15. Female Condoms • Polyurethane sheath with two flexible rings • Advantages: offers potentially more protection against genital warts and herpes b/c it covers base of penis as well • Disadvantage: more expensive, more difficult to use

16. Figure 6.3 The female condom properly positioned

17. Abstinence • Abstinence • Without sexual intercourse for a chosen period of time • Benefits • More self respect and respect for others • Security that you are not being pursued for sexual reasons. • Less worry about STDs and Pregnancy.

18. The Fertility Awareness Method • Only one egg released each month • Lives for ~ 24 hrs. unless fertilized • Sperm can live in the body for 6-7 days • Only 8 days/month when conception can happen • FAM • Calendar method • A woman releases an egg 14-16 days before her next period • Temperature method • A woman’s BT drops slightly before ovulation and rises slightly after • Withdrawal • Coitus interruptus

19. Male Sterilization: Vasectomy • Severing of the vas deferens • May return to work in 2 days • Reversal varies between 80% to 50%

20. Figure 6.7 Vasectomy

21. Female Sterilization • Tubal sterilization (laparoscopy) is most commonly known as tubal ligation • Hysterectomy • Complication rate: 6-11% • Reversibility: Low

22. Figure 6.8 Tubal sterilization

23. Which Contraceptive Method is Right for You? • Key considerations include: • Health risks • Implications of unplanned pregnancy • STD risk • Convenience and comfort level • Type of relationship • Ease and cost of obtaining and maintaining each method • Religious or philosophical beliefs

24. Contraceptive Effectiveness • Most Effective (Perfect Use) • Pill, Patch, Ring, Injectiable = 0.3% • Implant =0.05% • ParaGard = 0.6% • Mirena = 0.1% • Male Condom =2.0% • Female Condom = 5.0% • Withdrawal = 4.0 % • Vasectomy = 0.1% • Tubal sterilization = 0.5%