Family planning. Contraception. USMF.pptx

familyplanning contraception departmentofobstetricsandgynecology corinacardaniuc stelianhodorogea mihailsurguci familyplanning contraception reasonsoffamilyplanning pregnancyplanninglimitingthenumberofchildrenavoidingmedicalrisksofpregnancycontrollingtheworldpopulation familyplanning contraception birthcontroltechniquesandmethodsinclude contraception thepreventionoffertilization contragestion thepreventionofblastocystimplantation andabortion theremovalorexpulsionofafetusorembryofromtheuterus familyplanning contraception theidealcontraceptiveshouldbesafe harmless andnotinterferewiththesexualenjoymentofeitherpartner thefailurerateofanymethodofcontraceptionisjudgedbythepearlindex pi thenumberofwomenhavingregularintercoursewhobecomepregnantwithinayearoutof100couplesusingthemethod numberofpregnanciespi x100numberofcouplesusingthemethod familyplanning contraception thereisnoperfectcontraceptive allcontraceptiveshaveadvantagesanddisadvantages whichmustbeintegratedcarefullywiththepatient sstatus therefore carefulindividualizationisnecessarytoavoidundesirablesideeffectsandtooptimizepatientacceptance methodsofcontraception behavioralalternatives coitusinterruptus interruptedsexualintercourse isthepracticeofendingsexualintercoursebeforeejaculation thisistheoldestandawidelypracticedmethod ismoderatelyeffectiveinpreventingpregnancy averagefailurerate 27 advantages requiresnodevices involvesnochemicalsorartificialhormones isavailableinanysituationatnocostdisadvantages theoccurrenceofpregnancyfromsemenescapingbeforeejaculationorsemendepositionatthevaginalintroitus maypreventcompletesatisfactiontobothpartners doesnotoffercompleteprotectionfromstds behavioralalternatives totalabstinenceabstinenceis100 effectiveinpreventingpregnancyaveragecost nocostadvantages almost100 effective protectionagainststd s free noprescriptionisneeded lactationalamenorrheamethod lam thelactationalamenorrheamethod lam isamethodofavoidingpregnancieswhichisbasedonthenaturalpostnatalinfertilitythatoccurswhenawomanisamenorrheicandfullybreastfeeding ifnotcombinedwithchemicalsordevices lammaybeconsiderednaturalfamilyplanning effectiveness 98 ifnomenseshasoccurred onlybreastfeedingisusedtofeedthebaby atleasteveryfourhoursduringthedayandeverysixhoursthroughthenight orpriortosixmonthsofageforthebaby lactationalamenorrheamethod lam advantages effectiveimmediately doesnotinterferewithintercourse nosideeffects nocost givesinfantspassiveimmunity decreasedpost partumbleedingdisadvantages offersnostdprotection highlyeffectiveonlyuntilperiodreturnsorupto6months mayneedtousealubricantbecauseofvaginaldryness mustfeedondemandandatleast6 10timesadayincludingnightfeedings notreliableifperiodhasreturned naturalfamilyplanning naturalbirthcontrolmethodsteachwomentodeterminethefertilephaseoftheirmenstrualcycle fourbasicmethods basalbodytemperature cervicalmucuschanges excretionoflh luteinizinghormone theovulationtriggeringhormone andmenstrualcalendarsthebestmethodistocombineallofthemintoonecalledthesympto thermalmethod basalbodytemperaturemethod thewomanshouldrefrainfromintercoursesevendaysbeforethetemperatureriseuntilfourdaysafter temperaturechangesdonotpredictovulationbeforeithappens tobecompletelysafe thewomanshouldconsiderunsafedaysfromthefirstdayofyourperioduntilthefourthdayafterthetemperaturerise basalbodytemperature basalbodytemperatureisthebodytemperaturemeasuredimmediatelyafterawakeningandbeforeanyphysicalactivityhasbeenundertaken inwomen ovulationcausesanincreaseofone quartertoone halfdegreecelsiusinbasalbodytemperature bbt monitoringofbbtsisonewayofestimatingthedayofovulation thetendencyofawomantohavelowertemperaturesbeforeovulation andhighertemperaturesafterwards isknownasabiphasicpattern cervicalmucusmethod checkingthecervicalmucusforconsistencymayassistindeterminationofovulation aftertheperiod thereareafewdayswhenthereisnomucus thesearecalleddrydaysandaresafe thenthemucuschangestotheslippery clearpatternafewdaysbeforeovulation thisisthebeginningofanunsafe themostunsafe time theamountofmucusbecomesthegreatestjustbeforeovulation cervicalmucusmethod fingertestingafinger tipisusedtotestthecapacityofthecervicalmucustostretch itmayfeelstickyandbreakeasily oritmayfeelsmootherandslipperylikeraweggwhiteandstretchbetweenthethumbandfirstfinger fromalittleuptoseveralinchesbeforeitbreaks fingertesting thecalendarmethod thecalendarmethodisbasedonworkingoutthefertileperiodfrompreviouscycles bycarefuldocumentationofthewoman smenstrualcycle thismethodisalsoknownasthe rhythmmethod averagefailurerate 13 20 forawomanwithveryregularcycles itmaybepossibletopredictthedayofovulation theunsafeperiodlastsfrom7daysbeforethedayofovulationto4daysafterovulation determinationoflhsurge thelaboratorydeterminationofabruptsurgeoflhandprogesteronewithovulationisthemostreliablemethodofdeterminingovulation ovulationpredictorkitscanbeusedwiththetemperaturechartstomoreaccuratelypinpointyourdayofovulation theyworkbydetectingthesmallamountsoflhthatispresentintheurinebeforeovulation thereisariseintheamountoflhinthebodyapproximately24hoursbeforeovulation thisincreaseisregisteredbyacolorchange naturalfamilyplanning effectiveness95 98 effectivewithperfectuse75 88 fortypicalusebenefitshasnonegativehealthsideeffectsanalternativeforwomenwhocannotordonotwanttousehormonalmethodsconsistentwithmanyreligiousbeliefsandlifestylesencouragesmaleinvolvementdisadvantagesprovidesnoprotectionfromsexuallytransmittedinfectionsrequirestimetolearn usually3to6cycles requiresdisciplinetochartfertilitysignsandfollowtherulestoavoidpregnancydifficulttousewithirregularperiods illnesscanaltertemperature vaginalinfectionscanaltercervicalmucuschanges barriercontraceptionmechanical barriermethodsplaceaphysicalimpedimenttothemovementofspermintothefemalereproductivetract malecondom malecondomispenilesheathmadeoflatexorpolyurethaneoranimalmembranethatservesasabarrier mechanismofaction preventsspermfromreachingthecervix theadditionofavaginalspermicidemakesthemethodveryeffective effectiveness 80 90 increasesifusedwithspermacide advantages widespreadavailabilitylowcostprotectionagainststdnoprescriptionneededsafefertilityreturnsupondiscontinuedusedisadvantages manufacturingdefects ifwithdrawalofthepenisoccursafterdetumescence semenmayleakintothevaginabothpartnersmaycomplainofdecreasedsensationduringintercoursewomanmaybeallergictospermacidalorlatex canbeusedonlyoncemayinterferewithspontaneity femalecondom femalecondomisalatexorpolyurethanemembrane bag thatcanbeinsertedintothevagina ithasahigherrateofpregnancythanthemalecondom effectiveness 75 85 averageadvantages protectsagainstsomesexuallytransmitteddiseasesnoprescriptionneededfertilityreturnsimmediatelyupondiscontinuedusecanbeinsertedanytime uptoeighthoursbeforeintercoursemedicallysafedisadvantagesdecreasedvaginalsensationmaybedifficulttoinsert thecervicalcap thecervicalcapisabarrierdevicecoveringthecervicalportion thecervicalcapisthesmallestcervicalbarrier itismadeofrubberorplastic dependingonthetypeofcap itstaysinplacebysuctiontothecervixortothevaginalwalls cervicalcapsshouldnotbeleftinplacefor 48 72hourstoavoidinfection thecapmustbeusedwithaspermicide whichdestroyssperm effectiveness 85 forwomenwhohaveneveraababy70 forwomenwhohavehadababyadvantagessafefertilityreturnsimmediatelywithdiscontinuedusedisposablecapdoesnotneedtobefittednorneedsaprescriptioncanbeinsertedseveralhoursbeforeintercourse thecervicalcap disadvantagesmustbeindividuallymoldedforeverypatientbecausecervicalanatomyvariesgreatlylimitedsizesavailablemustbeleftinplace6 8hoursafterintercoursemustbeusedeachtimemaybecomedislodgedsomewomenmaybeallergictospermicides latexneedmorefrequentpapsmearsthefirst1 2yearsofusebecauseitmaycausechangesinthecellsofthecervixitdoesn tprotectagainststis andthecapitselfisn tprotectivemuststayinplaceatleast8hoursafterthelastsexact vaginaldiaphragm vaginaldiaphragmisasoft rubberdomethatformsabarriertopreventspermfromreachingthecervix itcoversthecervixandisheldsecurelyinplacebehindthepubicboneandrearwallofthevagina theyaremadeinvarioussizesandformaximumsafetymustbeusedwithaspermicidejellyorcream effectiveness 85 advantagessafefertilityreturnsimmediatelywithdiscontinuedusecanbeinserted2 3hoursbeforelovemakingmayreducetheriskofcervicalcancersomestdprotection vaginaldiaphragm disadvantagesmustbefittedbyahealthcareprofessionalneedsprescriptionmustbeleftinplace6 8hoursafterintercoursebutnomorethan24hoursmustbeusedeachtimemaybecomedislodgedsomewomenmaybeallergictospermicides latexmustbereplacedperiodicallymustapplyspermicidewitheachnewactofintercoursemayhaveanincreaseinurinarytractinfectionsmaydecreasespontaneity chemicalcontraceptives douchingaftercoitusdouchingimmediatelyafterintercourseisatimehonouredbutineffectivemethod theintentofthemethodistowashsemenoutofthevaginabeforespermcanenterthecervix itdoesnotaffectthosespermwhichhavealreadypassedupthecervicalcanal spermicides spermicidescontainachemicalcallednonoxynol 9 itcomesintheformofcream onlyforusewithdiaphragms gel foam film orsuppository alloftheseagentsrequireinsertionintothevaginabeforeeachcoitus byinsertingspermicideinthevagina infrontofthecervix itdestroysspermoncontact effectiveness 80 advantagesavailablewithoutaprescriptionnoknownrisktogeneralhealthfertilityreturnsimmediatelyupondiscontinuedusesomeprotectionfrombacterialinfectionsandpelvicinflammatorydiseasedisadvantages lesseffectivethanothermethodsmustwait8hoursbeforetakingabathordoucheusuallylastonlyonehoursideeffects vvginalirritation somewomenareallergictospermicidesneedinsertionatleasttenminutesbeforeintercoursenonoxynol 9doesnotprotectagainststis contraceptivesponge thespongeisasoft roundbarrierdevicethatisabouttwoinchesindiameter itismadeofsolidpolyurethanefoam containsspermicide andhasanylonloopattachedtothebottomforremoval thespongemustfirstbemoistenedwithwaterandthenthewomaninsertsitintohervaginabeforeintercourse itcoversthecervix openingtotheuterus anditblocksspermfromenteringit thespongealsoreleasesaspermicidethatcanimmobilizesperm thus preventingthespermfromreachinganegg effectiveness 75 85 advantagesfertilityreturnsimmediatelyupondiscontinuedusecanbeinsertedseveralhourspriortointercourseitprovides12 hourprotectionitcontainsthreetypesofspermicideanddoesnotappeartobeallergenicnorasirritatingaspreviousspongesdoesnotrequireaprescriptionmayprotectagainstsomestd sdoesnotrequireinsertionofanewspongeforeachactofintercoursedisadvantages cannotbeusedbywomenallergictononoxyl 9orthosewhohavehadtoxicshocksyndromeahigherriskofvaginalyeastinfections hormonalcontraceptivescombinedoralcontraceptives mostcombinationoralcontraceptivesarepackagedas activepills for21daysfollowedbyasevendaypill freeor inactive pillintervaltoallowforwithdrawalbleeding menstruation theseveninactivepillsareusuallyinanothercolor monophasicocscontainthesameamountofeachhormoneineachactivepill biphasicocsaltertheprogestin estrogenratiointwophases triphasicocsaltertheprogestin estrogenratiointhreephasesbyvaryingtheamountsofprogestin estrogen orboth biphasicandtriphasicregimensattempttoapproximateawoman snaturalhormonalfluctuationsmorecloselybyvaryingtheprogestin estrogenratios oneimportantgoaloftheseformulationsistominimizetheoccurrenceofirregularbleedingwhilemaintainingefficacy effectiveness96 99 combinedoralcontraceptives mechanismofaction combinationhormonalcontraceptivesactbysuppressionofgonadotropins althoughtheprimaryeffectofthisactionisinhibitionofovulation otheralterationsincludechangesinthecervicalmucus whichincreasethedifficultyofspermentryintotheuterus andtheendometrium whichreducethelikelihoodofimplantation advantagesreducestheriskofovariananduterinecancerreducestheriskofpelvicinflammatorydiseasereducestheriskofovariancystsmaydecrease pre menstrualsyndrome acne bleeding anemialessbreasttendernessdoesnotinterferewithintercoursedisadvantagesdoesnotprotectagainststd smustbetakendailycannotbeusedbythosewithahistoryof breastcancer bloodclotsoratrisktodevelopbloodclots liverdisease kidneydisease unexplaineduterinebleeding smokersoverage35 melanomashouldnotbeusedbythosewith lightperiods highbloodpressure diabetes migraineheadaches depression sicklecelldisease fibroidsserioussideeffects rare bloodclots liverdisease highbloodpressure migraineheadachescommonsideeffectsinclude lossoflibido nausea breasttenderness mid cyclebleedingthefirstfewmonths weightgain increasedappetite moodswings depression headaches skinproblemshormonalcontraceptivesmayincreasetheriskofbreastandcervicalcancer progestin onlyoralcontraceptives themini pillprogestin onlypills pop areestrogen freeoralcontraceptivepillstakendailytopreventpregnancy theestrogen freemini pillhasfewerunwantedside effectsthantraditionalcombinedoralcontraceptives mini pilsarelesseffectiveandcancauseirregularmenstruation popularbrandsofprogestin onlypillsincludemicronor nora be 0 35mgnorethindrone estrogen freeoralcontraceptivesareavailablebyprescriptiononly themimi pilalwayscomesin28 daypacks andallthepillswithinapackcontainthesameprogestin averagefailurerate 1 13 progestin onlyoralcontraceptives benefitsmayberecommendedtobreastfeedingwomenmini pillsarealsoconsideredsaferthancombinedocs asmanyofthevascularrisksaregreatlyreducedwiththeomissionoftheestrogencomponent thatmeanslessriskforolderwomen smokers andthosewithheartproblems sideeffectsectopicpregnancydepressionmenstrualcycledisturbancesoralcontraceptivesdonotprotectagainststdsoralcontraceptivesincreasetheriskofacquiringhivfromaninfectedpartner contraceptivepatch thecontraceptivepatch evra isa4cmx4cmbeigepatchthatstickstoawoman sskinandcontinuouslyreleasesthehormonesestrogenandaprogestinintothebloodstream eachpatchiswornontheskinforsevendays onepatchisworneachweekfor3weeks thepatchshouldbechangedonthesamedayeachweek calledthe patchchangeday thepatchcanbewornonthebuttocks backorupperarms butnotonthebreasts mechanismofactionthepatchpreventspregnancybystoppingtheovariesfromreleasinganegg anditmayalsothickenthecervicalmucusandmaketheuterineliningthin effectiveness thepatchismorethan99 effectiveatpreventingpregnancywhenusedperfectlybenefitsaregular lighterperiodlesspmsandcrampingreducestheriskofendometrialandovariancancershelpstopreventbenignovariancystsitiscompletelyreversibledisadvantagesdoesnotprotectagainstsexuallytransmittedinfectionssideeffects breakthroughbleeding betweenperiods breasttenderness headaches nausea vaginalring nuvaring nuvaringisathin transparent flexibleringthatstaysinthevagina usuallyaroundthecervix theringisworncontinuouslyforthreeweeksfollowedbyaweekoffwhichtriggersmenstruation eachvaginalringprovidesonemonthofbirthcontrol evenduringtheweekwhentheringisnotworn theringslowlyreleasesonaverage0 12mg dayofetonogestreland0 015mg dayofethinylestradiol thewallsofthevaginaabsorbthehormonesanddistributethemintothebloodstream thesehormonesworkbystoppingovulation thickeningcervicalmucusasabarriertosperm andpreventingimplantationoftheembryoiffertilizationoccurs averagefailurerate 8 benefits inadditiontopreventingpregnancy theringhastheaddedbenefitofmakingawoman speriodsmoreregular lighter andpossiblylesscrampy itisthoughttohavesimilarbenefitsasthebirthcontrolpill suchastreatingpms endometriosisandacne andpreventingovarianandendometrialcancersbutthesehaven tbeenstudied itiscompletelyreversible sideeffectsheadaches vaginalirritation discomfortordischarge nausea breasttenderness breakthroughbleeding bleedingbetweenperiods especiallyinthefirstfewmonths yeastinfectionthevaginalringisthoughttoincreasetheriskofheartattackandstroke especiallyamongsmokerscontraindications heartattack strokeorbreastcancer activeliverdisease womenover35yearsoldwhosmoke womenwithahistoryofcancer diabetes highbloodpressure highcholesterol headachesorepilepsy depression breastfeeding depo proverainjectablecontraceptive depoproveraisahormone progesteroneonly injectionthatafemaletakesevery12weekstopreventpregnancy depo proveraisestrogen free whichmeansthatitissaferandhasfewerseriousside effectsthanotherhormonalmethods effectiveness 99 mechanismofactionpreventsovulationaffectsthecervicalmucous makingitmoredifficultforthespermtopenetratethecervixcausesathinningoftheendometriumwhichpreventstheeggfromimplanting advantages oneinjectionevery3monthshighlyeffectivelong lastinghelpsprotectagainstuterinecancersafeafterchildbirthandwhilebreast feedingmaydecreasemenstrualcrampsdoesnotinterferewithintercoursedisadvantagesdoesnotprotectagainststd slong acting fertilityreturns6 24monthsafterlastinjection anaverageof9months cannotbeusedbywomenwith bloodclots breastcancer liverproblems unexplaineduterinebleedingmaynotbegoodforwomenwith familyhistoryofbreastcancer abnormalmammogram irregularorlightperiods highbloodpressure migraineheadache s asthma epilepsy diabetes depressioncancausebonedensitylossirregularbleedingweightgain norplant implants implanonisatypeoflong termbirthcontrolthatisinsertedundertheskinbyadoctor theimplantconsistsofonetosixmatch sizedplasticrodswhicharesurgicallyplacedundertheskinofawoman supperarm implanoncontainsasyntheticprogestinhormonecalledetonogestrel implanoniseffectiveforupto3 5years averagefailurerate lessthan1 mechanismofaction theprimarywayisbystoppingreleaseofaneggfromtheovaries implanonalsochangesthemucusinthecervixandthismaykeepspermfromreachingtheegg implanonalsohaspost fertilizationmechanisms wherebythehormonechangestheliningoftheuterus makingitharderforafertilizedeggtoimplantanddevelop advantagesthebirthcontroleffectisimmediateworksuptofiveyearsoruntilremovedcapsulescanberemovedanytimefertilityreturnsimmediatelyuponremovalofimplantshelpsprotectagainstuterinecancercanbesafelyusedafterchildbirthandwhilebreast feedingdoesnotinterferewithintercoursedisadvantagescannotbeusedbywomenwithliverdisease breastcancer unexplaineduterinebleeding bloodclotsmaynotbegoodforwomenwithhighbloodpressure gallbladderdisease elevatedcholesterol irregularperiods lightperiods headaches heartdisease seizuredisorders cannotbeusedbywomenwhohaveahistoryofcertaintypesofhighbloodpressure breastcancer unexplainedvaginalbleeding livergrowths bloodclotsinveins possiblepregnancyincreasedriskofectopicpregn