Sestramita Tuah

KPJ international College Of Nursing & Health Sciences

Learning Objectives
Define contraception
List the contraception methods
State the mechanism actions of every contraception
correctly
State the advantages and disadvantages every methods
State the contraindication of each contraception
Give health education for couple to
choose the suitable contraception
Appreciate the importance
of contraception for the couple

Definition
Family planning: A program to regulate the number
& spacing of children in a family through the
practice of contraception or other methods of birth
control
Contraception ( Contra, (Con)Ception )= Preventing
conception (preventing the sperm and the egg from
uniting)
Family planning = birth control = fertility control =
conception control

Principles Of Counseling
Counseling is crucial
Treat each client well
Interact. listen, learns and response to the client
Listening to client, learn the information base on
patient needs
Avoid too much information
Provide the methods that the client wants
Help the client understand and remember

Welcome
Using this flipchart, we can help you:
Choose and use a method
Solve any problems

Greet client with warmth and respect.

Thank client for coming.
Point to this flipchart. Explain that it will help
both you and the client.

Get accurate information

Please tell me about:
Yourself

Invite client to talk and ask questions.

Make clear that you want to listen.
Explain that you need the client to speak
openly so you can help.

Your needs
Your questions
We promise you privacy &
confidentiality

Is meeting space private?

Explain that the meeting will be confidential:
What you say will not be told to others.

When client is comfortable and ready to talk, go to next page.

Do you have a method

in mind?
If you do, lets talk about how it suits
you
What do you like about it?
What have you heard about it?
If not, we can find a method that is
right for you
Important for
choosing a method:
Do you need protection
from sexually transmitted
infections (STIs) or
HIV/AIDS?

Characteristic Of Ideal Contraceptive

High efficacy (low failure rate)

Safe: No/minimal side effects
Cheap
Independent of intercourse (no interference with
coitus)
Reversible with rapid return of fertility
Acceptable to all cultures and religions
Available (widespread availability)
Easy distributed
Can be offered by non health care providers

None methods fulfill all criteria, No ideal method yet

Contraception Methods
1. Hormonal Contraception
2. Intrauterine Contraception
Intrauterine Contraceptive Devices (IUDs)
3. Barrier methods
Male barrier: Condom
Female barrier: Diaphragm, cervical cap, female condom,
spermicidal
4. Natural Family Planning (NFP)
Periodic abstinence/safe period methods
Lactation (lactation Amenorrhea Methods=LAM)
5. Surgical contraceptive: sterilization
Female sterilization : tubectomy
Male sterilization : vasectomy
6. Coitus interuptus (withdrawal)

Hormonal Contraception
A. Oral Contraceptive (OCs)
Combined Oral Contraceptive pills (COCs)
Progestogen (Progestin) Only Pills (POPs)

B. Long Acting Hormonal Contraceptives

1. Injection: Depo Provera, Noristerat, Cylcofem
2. Subdermal implants: Norplant, implanon
3. Oral Pills: A pill a- month: quinestrol (3 mg) + Lnorgestrel (12mg)
4. Progestine Releasing IUDs: hormone releasing intrauterine
system progestasert: progesterone releasing Levonorgestrel
releasing (LNG-IUD), e.g. Mirena

Hormonal Contraception
Mechanism Action
Progesterone:
Prevent ovulation
Suppress luteinizing hormone (LH) secretion an ovulation
Inhibition of sperm penetration and transport
Cervical mucus thickened the sperm can not pass through the cervix little
or no sperm entry to the uterine cavity
Produces an atrophic endometrial that is less receptive to implantation
Impairs secretion and peristalsis within fallopian tubes
Side effects breakthrough bleeding
Estrogen:
Prevent ovulation
estrogen negative feedback on the anterior pituitary Suppressing FSH inhibits
follicular development prevent ovulation
Side effect: reduce the quantity & quality of breast milk , serious complications deep
vein thrombosis

Estrogen cause pigmentation and high level of estrogen may accelerate the development of
gallbladder disease in young female but not increase the risk of acute cholelithiasis
Progestin : because they are structural related to testosterone they produce androgenic
effects like increase weight and acnes

Hormonal Contraception: Oral Contraceptive

Combined Oral Contraceptive (COCs)
Contains: Synthetic steroid hormones estrogen & progesterone
Type of Pills:
21 Pills (the most brand): One pill daily for 21 days
28 Pills ( Some brand):
One pill daily for 28 day, the 7
pill contain no hormones (remainder pills), the remainder
pill in different colour
Starting taking pills
The 1st day of menstruation (the best time) or
On the 7th day of menstruation
After stop breastfeeding or after 6 weeks for non
breastfeeding mother

28 Pills

21 Pills

Combined Oral Contraceptive (COCs)

Advantages
Very effective when used correctly (Reliability almost 100%)
Not intervier need to do anything at time of sexual
intercourse
Monthly regular period, Easy to use
No rest period needed (user can stop taking pills at any time,
the fertility return soon)
Can regulate menstrual flow and decrease cramps and other
symptoms of menses
Taken long time will Help to:
Prevent iron deficiency anemia
Prevent the reproductive disorder : Endomentrial cancer,
Ovarian cancer, Ovarian cysts, Benign breast disease,
ectopic pregnancy, Pelvic inflammatory disease

Combined Oral Contraceptive (COCs)

Disadvantages
Just highly effective if taken everyday
Common side effect:
Nausea spotting or bleeding between menstrual period
Slight weight gain, amenorrhea
Depression and loss of libido.
Estrogen may cause water retention elevated BP, weight gain ,
breast tension, mild headaches
In few women , may cause mood changes including depression,
less interest in sex
Not recommended to hypertension women, age >35 yrs, smoker
Do not protect against sexual transmitted disease (STDs)
not recommended for breastfeeding, effect to milk quality & quantity

Hormonal Contraception: Oral Contraceptive

Progestogen (Progestin)Only Pills (POPs)
POPs = Mini-pills = Depot medroxyprogesterone
Contains: Synthetic steroid hormones progesterone
POP characteristic:
No estrogen side effect
Effective for breast feeding mother do not affect
the quality & increase the volume of milk very
slightly contraceptives for breast feeding women
Should use the same time each day, few hours late
increase the risk of pregnancy

Oral Contraceptive Contraindications

Heart disease
Kidney disease
Asthma
High blood pressure
Diabetes
Epilepsy
Gall bladder disease
Sickle-cell anemia
Migraine headaches
Depression
Smoker

Hormonal Contraception:
Injectable Contraceptive
Contains: Depo-Provera (DMPA) Progesterone
Dose: 150 mg, intramusular in deltoid (upper
arm), gluteal muscle (buttock)
Timing of injection:
Anytime if confirm the women not
pregnant
6 weeks after delivery for
breastfeeding mother or until she has a
menstruation, whichever come first.
For the next injection should on time,
if late not more than 4 weeks late

Injectable Contraceptive
Advantages

Disadvantages

Does not interfere with

sex
No daily pill taking
Used by any age
Quality and quantity
of breast milk not
harmed
No estrogen effect
Long-term pregnancy
prevention but
reversible. 1 injection
for 3 months

Common side effect: Side

effects similar to the pill in
all aspects
Changes in menstrual
cycles: light spotting or
bleeding, Heavy bleeding
(in 1st time), Amenorrhea
(especially after 1st year of
use)
Headache, breast
tenderness, nausea, acne
May cause weight gain
Delayed return of fertility (4
months longer than others)

Hormonal Contraception: Implant

Implant system is a set of 1 or 6 small plastic capsules.
Which placed under the skin of a womans upper arm
Contain : progestin (continuous release)
Prevent pregnancy at least 3 5
years
Contraindications: Liver
disease, Breast cancer,
Cardiovascular disease,
Unexplained vaginal bleeding,
Pregnant, Smokers

Implant
Advantages

Disadvantages

More effective than the Pill

Long term protection but
reversible
Not interfere of sexual
intercourse
Eliminate the uses error
No menses or light menses
Quality and quantity of breast
milk do not seem harmed.
Not painful if anesthetic is
given properly

Inserting & removing by

special health care provider
can not with woman desire
Removal more difficult &
painful
Do not protect STD
Side effects = Similar to the
pill

Implanon Applicator

The IntraUterine Device (IUD)

IUD is a small, flexible plastic frame. has copper wire or copper
sleeves. inserted into a womans uterus thought vagina

Mechanism:
Preventing sperm and ovum from
meeting/ preventing implantation
Inhibition of ovulation: the mirena is
intended to initially release a daily dose
of 20 micrograms levonorgestral (a
progestin).
Cervical mucus is changed to obstruct
passage of sperm through the cervix.
Endometrial thinning which inhibits
implantation of embryos

The IntraUterine Device (IUD)

Type
Copper bearing IUDs (plastic with copper sleeves or copper wire
on the plastic).ex: TCu-380A & MLCu-375 almost 10 yrs
Hormone releasing IUDs (plastic, plus hormone progesterone
release) ex:LNG-20 1 yr
Inert or unmedicated IUDs (made of plastic or stainless steel only).
Example: Lippes Loop

The IntraUterine Device (IUD)

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

The IntraUterine Device (IUD)

Advantages

Disadvantages

Effective long term preventing Menstrual changes (common in 1st 3

months, lessen after 3 months)
of pregnancy
Longer & heavier menstrual
90-96 % effective in use
Bleeding or spotting between
No interfere with sex
period
No hormonal side effect
More cramps/pain during period
Immediately reversible
Common problem:
Spontaneous expulsion of device
Copper-bearing and inert IUDs
especially inserted soon after
have no effect on breastmilk
childbirth (IUD induce
Can inserted immediately after
contraction)
childbirth
Perforation of uterus (not common)
Do not protect STDs
Cannot stop or use by her own. Need
medical staff in IUD insertion or
removal

Barrier Methods
Type Barrier methods
Male barrier: Condom
Female barrier: Diaphragm, cervical cap, female condom,
spermicidal
Mechanism of action :
A barrier / preventing the passage of semen into the cervix
Prevents passage of infections into the vagina (protection
against STDs)
Disposable use

Barrier Methods
Advantages

Disadvantages

Prevent STD
Use soon after childbirth
Safe. No hormonal side effects
Can stop any time
Sold many place without
prescription, no need health
care services
Easy to kept
easily available, reversible,
effective and acceptable if used
consistently and correctly.

Latex may cause itching for

allergic.
May decrease sensation
Take a time to put the condom
Supply must ready
Small possibility the condom
will slip or break during sex
Poor reputation embarrass
some people to buy

Condom
A condom is a sheath or covering made to fit over
an erect penis or inside vagina
Type:
Male condom: Made of thin polyurethane or
latex rubber, with different sizes, shapes, color
& textures
Female condom: Made of soft plastic
(polyurethane) with a closed end. Each end has
a ring or rim.
Additional of spermicidal lubricant to the
condom
Effectiveness rate: 97% (male), 95% (female)

Diaphragm
The diaphragm is a shallow latex cup with a spring
mechanism in its rim to hold it in place in the vagina
Spermicidal cream is applied to the inside of the dome,
which fits against the vaginal wall.
After intercourse, the diaphragm must be left in place
for at least 6 hours. effective contraception for 6 hours.
Effectiveness depends on the age of the user, continuity
of use, and the use of spermicide along with the
diaphragm. Failure rate is estimated to be 20%
Relative Contraindications : Latex allergy, Uterine
prolapse , Repeated UTIs
Disadvantages :Prolonged use increase the risk of UTI,
Might cause vaginal erosions if not placed properly .

Cervical Cap

A cup-shaped latex device that fits over the base of the cervix.
The cap must be filled 1/3 with spermicide prior to insertion
Inserted 8 hours before coitus & can be left in place for 48 hours.
Acts as both mechanical barrier to sperm and a chemical agent
with the use of spermicide .
Pregnancy rates range between 4 and 36 per 100 women / year
Effectiveness depends on the parity of women due to the shape of
the cervical os.
Disadvantages : cervical erosions and vaginal spotting, requires
professional fitting and training for use, high failure rate , and
candidates must have a history of normal results of pap smears.

Natural Family Planning (NFP)

Fertility Awareness Methods
Fertility awareness is a woman learn identify the fertile
time of her menstrual cycle
Natural Family Planning method:
Periodic abstinence/safe period methods
Calendar or rhythm method: Midway in cycle
Basal Body Temperature (BBT) method: Increase in
body temperature
Cervical Mucous Method: Clear slippery mucous
Lactation (lactation Amenorrhea Methods=LAM)

Natural Family Planning (NFP)

Fertility Awareness Methods
A woman use one of these or a combination of the method.
Identify the fertile time start and end. avoids pregnancy by
changing sexual behavior during fertile time, such as by:
Abstain from vaginal intercourse: avoiding sexual during fertile
time
Use barrier methods: condoms. Diaphragm and spermicidal
Use withdrawal/coitus interruptus: ejaculation outside of vagina

Fertility Awareness Methods

Calendar or Rhythm method
Record the menstrual cycle for 6 months
Formula to calculate the fertile time =
First day of fertile time: The shortest cycle subtract 18
The last day of fertile time: The longest cycle subtract 11
Example: woman recorded her 6 months menstrual cycle are :
26, 24, 30,32,30,26 (longest cycles is 32, shortest cycles is 26)
The fertile time for the woman is:
26 18 = 8
32 11 = 21
she must avoid unprotected sex from day 8 through day 21
of her cycle (14 days avoiding unprotected sex)

Calendar Method

Fertility Awareness Methods

Basal body Temperature & Cervical Mucus
Assessment of ovulation sign:
Basal Body Temperature (BBT): Estrogen drop temperature,
Progesterone increase temperature
Take body temperature in same way (Orally/rectally) at same
time each morning before gets out of bed.
Ovulation time: temperature drop then rise 0.2-0.5C
Avoid unproductive sexual from menstruation until 3 days of
temperature increasing
Cervical Mucus evaluation: Estrogen ferning pattern mucus
Check the secretion everyday. the secretions have a peak day
of mucus most slippery, stretchy and wet then become sticky,
pasty and crumbly until no secretion at all.
The couple can have unprotected sex until menstrual begins

Cervical Mucus evaluation

Natural Family Planning (NFP)

Advantages and Disadvantages
Free
Safe. No side effect
Acceptable to many whose
religious beliefs prohibit
other methods
Provide an increased
awareness of the body
Involve no artificial
substances or devices
Encourage communication
Useful in planning a
pregnancy.
No effect to breast milk
Involves men in family
planning

Require extensive initial counseling to

be effective. 1 pregnancy in 5 woman
May interfere with sexual spontaneity
Require a couple to keep records for
several cycles before beginning to use
them
May be difficult or impossible for
women with irregular cycles
May not be reliable in preventing
pregnancy
Need cooperation and commitment of
both woman & man
Unreliable if woman had fever, vaginal
infection, breastfeeding, changes body
temperature, cervical mucus or
menstrual cycle length
Calendar methods may not effective for
woman with irregular menstrual cycles
Doesnt protect from STD

Natural Family Planning (NFP)

Lactation Amenorrhea Methods
The Lactation Amenorrhea Methods is use of breastfeeding
as a temporary family planning method.
LAM provides natural protection against pregnancy and
encourage starting another methods at the proper time.
Naturally protected against pregnancy when:
Breastfeeds often, day and night. at least 8 10 x in day
and at least once at night
Menstrual periods have not return
Baby less than 6 months. baby start to eat and
breastfeeding is not effective any longer

Use of the lactation amenorrhea method for contraception

Lactation Amenorrhea Methods

Advantages & Disadvantages
Advantages
Encourages the breastfeeding
Can used immediately after
childbirth
Not interfere of sexual
intercourse
No cost
No hormonal side effect
Benefits for baby and mother

Disadvantages
Effective 6 months is
not certain
Frequent breastfeeding
may difficult for
working mother
Not protective from
STD

Surgical Contraceptive Sterilization

Sterilization is surgical procedure for permanent method
of contraception and highly effective
Sterilization methods:
Female sterilization : Tubectomy/ Tubal Ligation (Cut
and seal the fallopian tubes)
Mechanically blockage of both fallopian tube to
prevent the sperm reaching and fertilizing the oocyte
Male sterilization : vasectomy (Vas deferens are cut &
sealed)
Incision of vas deferens on both sides of the scrotum
to prevent the release of sperm during ejaculation

Vasectomy

Tuba Ligation

Surgical Contraceptive Sterilization

Tubectomy /Tubal Ligation
Sterilization performed by laparoscopically (under General
Anesthesia) or through a suprapubic mini-laparotomy (one day care)
Failure rate: 0.5%
Complication: may experienced anesthetic problem or may be damage
to intra-abdominal during the procedure.
Advantages
Intended to be permanent

Highly effective
Safe
Quick recovery
Lack of significant long-term side
effects (normal menstruation)
Cost effective
No need waiting for coitus after
operation

Disadvantage
Possibility of patient regret
Difficult to reverse ( Future
pregnancy could require assisted
reproductive technology (IVF)
More expensive than vasectomy
Ectopic pregnancy can be a late
complications

Surgical Contraceptive Sterilization

Vasectomy
Usually under local anesthesia.
Takes 4-6 weeks or 6-36 ejaculations to clear remaining sperm, Must
be rechecked at 6 to 12 months to insure fertility has not been
restored.
Failure rate:0.1%
Complication: Immediately bleeding, wound infection & hematoma.
Advantages
Disadvantage
Permanent
Highly effective
Safe
Quick recovery
Lack of significant long-term side
effects
Cost effective: less expensive and
easier than tubal ligation

Reversal is difficult, expensive, often

unsuccessful
Not effective until all sperm cleared
from the Reproductive tract (may take
up to 12 w)
No protection from STDs