THIS CLASSIS FOR MSc STUDENTS FOR BRIEF UNDERSTANDING

1. CONTRACEPTIVES
AND INTRA UTERINE
DEVICES

2. Birth control pills (oral contraceptives) are prescription
medications that prevent pregnancy.
Birth control (contraceptive) medications contain
hormones (estrogen and progesterone or progesterone
alone).
Birth control pills may also be prescribed to reduce
menstrual cramps or prevent anemia.
Some women experience various levels of side effects of
birth control pills.

3. Hormonal birth control medications prevent pregnancy
through the following ways:
By blocking ovulation(release of an egg from the ovaries),
thus preventing pregnancy
By altering mucus in the cervix, which makes it hard for
sperm to travel further
By changing the endometrium(lining of the uterus) so
that it cannot support a fertilized egg
By altering the fallopian tubes so that they cannot
effectively move eggs toward the uterus

5. Birth control(contraceptive) medications contain
hormones (estrogen and progesterone or progesterone
alone).
The medications are available in various forms, such as
pills, injections (into a muscle, topical (skin) patches,
and slow-release systems (vaginal rings, skin implants,
and contraceptive-infused intrauterine devices

7. Estrogens- Ethinyl estradiol-30 micro grams
Mestranol-50 micro grams
Progesterones Norethindrone- 1mg
Norethindrone acetate
Norgestimate
Desogestrel 150 micro grams
Norgestrel -0.5mg
Levonorgestrel 150 micro grams

8. Combination contraceptives, that is, contraceptive
medications containing both estrogen and progesterone,
are the most effective means for contraception with the
exception of surgical sterilization.
Several types of combination birth control pills exist,
including monophasic pills, biphasic pills, triphasic pills,
and 91-day-cycle pills.

9. Two tablets of progestin levonorgestrol containing 1500mg
Or single 1500mcg tablet taken as soon as possible after
unprotected intercourse (up to 72 hours after)
Preferably within 12 hours, no later than 72 hours
Ethinyl estradiol 50 micro gram+ levonorgestrol 250 micro
gram. Two such tablets are to be taken with in 72 hrs of
unprotected sex
Ulipristal (SPRM-Selective Progesterone Receptor
Modulator)
single dose 30mg effective with in 120hrs/5days

10. Non steroidal estrogen receptor antagonist-serm
Centchroman- 30mg twice in a week for first 3month and
once in a week subsequently as long as the contraception
is preferred
Reversible in 6 months
It is potent competitive antagonist at peripheral estrogen
receptors and supresses proliferative stage of
endometrium
It accelerates ovum transport, without affecting ovulation
No risk of teratogenesis
C/I- hepatic dysfunction, polycystic ovarian disease,
cervical hyperplasia, tuberculosis, renal disease

11. Depot medroxy progesterone acetate (Depot-Provera) -DMPA
The first injection is given within 5 days following the onset of
menstruation. After that, an injection is needed every 11-13
weeks.
Side effects: Since progesterone is the only hormonal ingredient,
estrogen-related side effects are avoided.
A side effect unique to this method of birth control is that most
women eventually stop having their periods.
Depo-Provera may last in the body for several months in women
who have used it on a long-term basis and can actually delay the
return to fertility after stopping the drug.
Other side effects include weight gain and depression.

12. Norelgestromin /ethinyl estradiol
The topical patch may be applied to clean, on the shoulders,
upper arms, buttocks or abdomen. The patch may be less
effective in women weighing more than 198 pounds (90 kg).
Use: A new patch is applied on the same day of the week, each
week for 3 weeks in a row.
The first patch is applied either on the first day of the
menstrual period or on the Sunday following menses.
On the fourth week, no patch is applied.
This 4-week period is considered 1 cycle.
Another 4-week cycle is started by applying a new patch
following the 7-day patch-free period.

13. Side effects are similar to other birth control agents
containing both estrogen and progesterone.
Effects include menstrual irregularities, weight gain,
and mood changes.
Other specific side effects include a skin reaction at
the site of application and problems with contact
use

14. Norethindrone Progesterone-only pills (POPs), also known as
mini-pills. Less than 1% of users of oral contraceptives use them
as their only method of birth control. Those who use them
include women who are breast feeding and women who cannot
take estrogen.
Use: POPs are ingested once daily, every day.
POPs may be started on any day, and there are no pill-free
days or different-colored pills to track. Since progesterone is
the only hormonal ingredient, estrogen-related side effects are
avoided. However, since POPs do not include estrogen, they
have a higher failure rate.
Users must take this pill at the same time daily for greatest
effectiveness.

15. Women with the following conditions should not use estrogen-
containing birth control medications:
to any component of the product
History of blood clotting disorders
History of stroke or heart attack
heart valve disease with complications
Severe hypertension
Poorly controlled diabetes
Recent major surgery with prolonged bed rest
Breast cancer, Liver cancer (or liver disease)
Uterine cancer or other known or suspected estrogen-dependent
cancers
jaundice during pregnancy or jaundice with prior hormonal
contraceptive use

16. The effectiveness of oral contraceptives, Progesterone
Only Pill and post coital pill will be reduced by
interaction with drugs that are enzyme inducers
Drugs that may cause this effect include: many
antibiotics (e.g., cephalosporins, chloramphenicol,
macrolides, penicillins, tetracyclines, sulfas),
aprepitant, bexarotene,
Broad spectrum antibiotics may reduce effectiveness
of OCPs by altering the bacterial flora of the bowel

17. Nausea, breast tenderness, fluid retention, weight gain,
acne, breakthrough bleeding, missed periods, headaches,
depression, change in vision, other mood changes, and
lower sexual desire.
Additionally, the following more serious side effects may
occur: thromboembolism(blood clots)
Breast cancer, cervical cancer
Benign liver tumors
Diabetes

18. Smoking cigarettes while using this medication increases
your chance of having heart problems.
Do not smoke while using this medication.
The risk of heart problems increases with age (especially
in women greater than 35 years of age) and with
frequent smoking (15 cigarettes per day or greater)
May experience vaginal bleeding.

19. 1. Menstrual Bleeding Disorders
2. Dysmenorrhea
3. Symptoms of Androgenisation (Seborrhea, Acne, Hirsutism,
Alopecia)
4. Premenstrual Syndrome (PMS) and Premenstrual Disphoric
Disorder (PMDD )
5. Ovarian Cysts
6. Endometriosis/Adenomyosis
7. Pelvic Inflammatory Disease (PID)
8. Multiple Sclerosis
9. Menstrual Migraine
10. Endometrial Hyperplasia
11. Benign Breast Disease
12. Prevention of Ovarian Cancer
13. Endometrial Cancer
14. Colon Cancer

20. • IUD’s are medicated or non-medicated devices
which exerts it’s contraceptive action in the uterine
cavity continuously for a prolonged period of time
without requiring patients motivation.
• An IUD prevents sperm from meeting an egg.
An IUD may stop a fertilized egg from growing inside
the uterus.
INTRA UTERINE DEVICES-IUDs

21. 1. Non-medicated IUD’s:
Contraceptive action by producing sterile
inflammatory response in Endometrium. These are
available in ring shaped IUD’s made up of s.s and
plastic fabricated form polyethylene, polypropylene.
2. Medicated IUD’s:
- Copper IUD’s
- Progesterone releasing IUD’s
INTRA UTERINE DEVICES-IUDs

23. Most common:
T-shaped, copper bands on plastic stem/arms
Inserted in uterus through vagina and cervical opening
Strings: assure IUD is in place; facilitate removal
Most common copper IUD: TCu-380A
Less common: hormonal IUDs

24. Primary mechanism is prevention of fertilization
Reduce motility and viability of sperm
Approved for 10 years of use but can be removed any
time
Prevents fertilization by:
Impairing the viability of the sperm
Interfering with sperm movement

25. Copper is known to be cytotoxic in high concentration
it enhances the spermatocidal and spermato
depressive action of an IUD.
The copper concentration in endometrial epithelium
and superficial stromata inhibits the binding of steroids
of their receptors.
Cupric ion inhibits the binding of 17-β- estradiol to
human endometrial cytosol.
Cupric ions shows only little effect on sperm motility.
Copper wire was also “Blastocystocidal”.

26. • A copper bearing IUD was reported to produce
significant effects like:
• Increased alkaline phosphate activity in uterine
fluids and endometrium tissue.
• No change of acid phosphate activity in uterine
fluid but its concentration in endometrium tissue
increases.
Copper T IUD

27. Highly effective and very safe
Does not interfere with intercourse
Easy to use
Long lasting
Easily reversible
Quick return to fertility
No systemic effects
Complications are rare

28. The contraceptive ring can be left in for 4 weeks and
replaced immediately with another ring.
The patch can be used for more than 3 consecutive
weeks. (“apply new patch each week x 9 weeks…”)

29. T-shaped piece of plastic that releases
Small amounts of levonorgestrel each day
Primary mechanisms: inhibits sperm
movement, progestin thins the endometrial
lining, thickens cervical mucus
Typically does not prevent ovulation
(low systemic levels
of progesterone )
Approved for 5 years
of use: remove any time, immediate
return to fertility
Levonorgestrel IUD

30. Side effects, including cramping and increased or
prolonged bleeding
Rare complications include perforation and pelvic
inflammatory disease
Method failure can lead to ectopic pregnancy
(extremely rare)
Insertion and removal require trained provider
No STI/HIV protection
Side effects are most common during the first 3
months.

31. Risk of PID in IUD users:
Low overall
risk of PID attributable to IUD is 0.15% to 0.30%
Higher during first 20 days after insertion
Due mostly to presence of gonorrhea or chlamydia at
time of insertion
Similar to risk of PID in women with gonorrhea and
chlamydia who are not using IUD

32. Do not insert IUD if:
at high individual risk of STIs, or
clinical symptoms and signs of an STI are present
Follow infection prevention procedures during
insertion
Recommend follow-up visit at 3 to 6 weeks to check
for infection
Return immediately if any symptoms of PID develop
Source:WHO, 2004; updated 2008.

33. IUDs:
Are not abortificients
Do not cause infertility
Do not cause discomfort for the male partner
Do not travel to distant parts of the body
Are not too large for small women

35. • Very effective with nothing to remember for up to 7 years.
“Are you looking for a method that is easy to use effectively?”
• Side-effects: see page IM3.
• For STI/HIV/AIDS protection, also use condoms.
Norplant Implants
• 6 small plastic tubes placed
under skin of upper arm
• Heavy women may need them removed after 4 or 5 years (see
page IM4). Another set of capsules can be inserted if client wants
to continue using implants.
• Can get pregnant soon after capsules are taken out.
• Very effective
• Last up to 7 years, depending on your weight
• Very safe
• Usually change monthly bleeding
• No protection against STIs or HIV/AIDS
Implants
• Implants are not harmful for health. They do not bother her or affect
strength. For breastfeeding women, they do not affect the quality of
breastmilk.
• Check for concerns, rumours:
“What have you heard about implants?”
• Explain common myths. Capsules do not break
inside the body. They are bendable. (Also see Appendix 10.)
About Norplant implants:
• Contain progestogen but not estrogen hormones.
• Work mainly by thickening the cervical mucus and by stopping
ovulation (see Appendices 4 & 5).
• Soft capsules that are just visible under the skin. Do not leave
noticeable scar if inserted and removed correctly.
• Inserted and removed by trained personnel in simple surgical
procedure.

36. One 4cm x 2mm rod
Contains progestin and no estrogen
Suppresses ovulation and thickens cervical mucus
Highly effective for 3 years
Not user dependent and only 1 visit
Very discreet and rapidly reversible
Can be used during lactation

37. Effectiveness of methods
Oral contraceptives
Percentage of women pregnant in first year of use
Rate during typical use
Rate during perfect use
Female condom
Female sterilization
Implants
DMPA
Spermicides
Standard Days Method
Male condom
IUD (TCu-380A)
0 10 15 20 255 30

38. Sperm-killing substances inserted deep in the vagina, near the
cervix, before sex. − Nonoxynol-9 is most widely used. −
Others include benzalkonium chloride, chlorhexidine,
menfegol, octoxynol-9, and sodium docusate.
Available in foaming tablets, melting or foaming suppositories,
cans of pressurized foam, melting film, jelly, and cream. −
Jellies, creams, and foam from cans can be used alone, with a
diaphragm, or with condoms. − Films, suppositories, foaming
tablets, or foaming suppositories can be used alone or with
condoms.
Work by causing the membrane of sperm cells to break, killing
them or slowing their movement. This keeps sperm from
meeting an egg.

39. Do not reduce vaginal secretions or make women
bleed during sex.
Do not cause cervical cancer or birth defects.
Do not protect against STIs.
Do not change men’s or women’s sex drive or reduce
sexual pleasure for most men.
Do not stop women’s monthly bleeding