KAEDAH KAEDAH PERANCANG KELUARGA
Contraceptives Hormonal Non-Hormonal
Contraceptives Hormonal Combined (Estrogen & Progestogen) •Oral (COC) •Injectable •Patch •Vaginal ring Non-Hormonal Emergency Progestogen only •Oral (POP) •Injectable •Implant •Intrauterine system (IUS) •Yuzpe regime • Progestogen
Contraceptives Hormonal Intrauterine Devices (IUCD) •Copper •Non-copper Non-Hormonal Natural methods Barrier •Rhythm method •Coitus interruptus •Billing’s cervical mucous •Lactational amenorrheic method (LAM) •Male condom •Female condom •Diaphragm •Spermicides •Cervical cap Surgical •Sterilization •Vasectomy
COMPONENTS: Male condom Female condom Cervical cap Diaphragm Spermicides BARRIER METHODS
BARRIER METHODS • Contraceptives that prevent the sperms from entering the vagina and the os • Can be mechanical, chemical or combination
7 MECHANICAL CHEMICAL Male condom Female condom Cervical cap Diaphragm Sponge Spermicide BARRIER METHODS
1. Male Condoms • What? • Sheaths or coverings, that fit over a man’s erect penis. • Action: • Forming a barrier that keeps sperm out of the vagina • Keep infections in semen, penis, or in the vagina from infecting the other partner.
How Effective? • Protection against pregnancy: • When used correctly and consistently, only 2 of every 100 women whose partners use condoms become pregnant over the first year • Return of fertility after use is stopped: No delay Male Condoms • Protection against HIV: • When used consistently and correctly, prevents 80-95% transmission
Guna kondom baru. Lihat tarikh luput. Buka sampul dengan teliti. Picit hujung kondom untuk keluarkan udara. Letakkan kondom (gulungan di luar) di ataszakar yang tegang sebelum zakar memasuki vagina. Lurutkan kondom ke bawah zakar hingga pangkalzakar Sapukan pelincir- mengurangkan risiko kondom terkoyak Male Condoms
Sesudah ejakulasi, pegang kondomdan keluarkan zakar dari vagina semasa ia masih tegang Pegang pada hujung bukaan kondom untuk mengelakkan cecair semen terkeluar Periksa kondom. Pastikan tiada kebocoran. Buangkan kondom di tempat yang sepatutnya. Male Condoms
2. Female Condoms • What? • Sheaths or linings, that fit loosely inside a woman’s vagina, made of thin, transparent, soft film. • Action: • Forming a barrier that keeps sperm out of the vagina. • Keep infections in semen, penis, or in the vagina from infecting the other partner. • Protection against pregnancy: • When used correctly and consistently, only 5 of every 100 women whose partners use condoms become pregnant over the first year of use • Return of fertility after use is stopped: No delay • Protection against HIV and other STIs: • Reduce the risk of infection with STIs, including HIV, when used correctly with every act of sex.
• Some are pre-lubricated, and others come with a separately packaged lubricant. • Clean water, saliva, or a lubricant made of water, glycol, or silicone can also be used. • Oil-based products such as coconut oil or butter – can be used with nitrile or polyurethane condoms, but not with latex condom. Female Condoms
Female Condoms
4. Diaphragm • What? • A soft latex cup that covers the cervix. • Action: • Work by blocking sperm from entering the cervix; spermicide kills or disables sperm. • Protection against pregnancy: • When used correctly and consistently, about 16 of every 100 women using the diaphragm with spermicide over the first year of use • Return of fertility after use is stopped: No delay • Protection against HIV and other STIs: • May provide some protection against certain STI but should not be relied on
5. Cervical Caps • What? • A soft, deep, latex or plastic rubber cup that snugly covers the cervix. • Comes in different sizes; requires fitting by a trained provider. • Action: • Work by covering the cervix and blocking sperm from entering the cervix
Cervical Caps
COMPONENTS: COPPER IUD NON COPPER IUD INTRA UTERINE CONTRACEPTIVE DEVICES
DEFINITION • A small, often T-shaped birth control device that is inserted into the uterus to prevent pregnancy. • 2 main types: • Non Hormonal: • Copper containing IUDs • Inert IUDs • Hormonal: Progestogen-releasing
Gambar wiki • A type of long-acting contraception • Duration of use: • Copper: depending on content of copper • Multiload Cu-250 : 3 years • Multiload Cu-375 : 5 years • Cu-380 : 10 years • Mirena: 5 years IUDs
Copper-Bearing Intrauterine Device
Copper-Bearing Intrauterine Device • What? • A small, flexible plastic frame with copper sleeves or wire around it. • Inserted into a woman’s uterus through her vagina and cervix. • Action: • Works by causing a chemical change that damages sperm and egg before they can meet and inhibits sperm’s motility • Protection against pregnancy: • <1 pregnancy per 100 women using an IUD over the first year • One of the most effective and long-lasting methods. • Return of fertility after use is stopped: No delay • Protection against STIs: None
THE INSERTION PROCEDURE Step 1: Perform bimanual examination then insert a speculum into the vagina to inspect the cervix. Step 3: Cleans the cervix and vagina with appropriate antiseptic. Copper-Bearing IUD Step 2: Insert a speculum into the vagina to inspect the cervix.
Step 5: Slowly and gently pass the uterine sound through the cervix to measure the depth and position of the uterus. Step 4: Slowly insert the tenaculum through the speculum and close the tenaculum just enough to hold the cervix and uterus steady. Copper-Bearing IUD
Step 7: Cut the strings on the IUD, leaving about 3 cm hanging out of the cervix. Copper-Bearing IUD Step 6: Slowly and gently insert the IUD into the uterus until the stopper is on the cervix, then remove the inserter tube.
• Can be done any time of the month, may be easier during monthly bleeding (cervix is naturally softened). • Explain the procedure to the client • Insert a speculum to see the cervix and IUD strings, clean the cervix and vagina. • Ask the client to take slow, deep breaths and to relax and ask her to tell if she feels pain during the procedure. • Use the tenaculum to hold the cervix • Using narrow forceps, pull the IUD strings slowly and gently until the IUD comes completely out of the cervix. Copper-Bearing IUD REMOVAL PROCEDURE
RISKS ASSOCIATED WITH USE • Infection • Small risk (highest -first 20 days after insertion) • Expulsion • A slight chance that IUD could shift out of place. (increased risk if using a menstrual cup, being under the age of 20, and never having been pregnant) • Perforation • Very low risk (1 to 2 in 1,000), during insertion. • IUD come through uterine wall into the abdominal cavity. • If discovered within 6 weeks after insertion or causing symptoms at any time, removal by laparoscopic or laparotomic surgery is required Copper-Bearing IUD
TIMING FOR INSERTION Copper-Bearing IUD Woman’s situation When to start Having menstrual cycles Any time of the month • If within 12 days after the monthly bleeding, no need for a backup method. • If it is more than 12 days, insert if confirmed not pregnant. No need for a backup method. Switching from another method • Immediately, if using the method consistently or if confirmed not pregnant. No need to wait for her next monthly bleeding. No need for a backup method. • If switching from an injectable, insert when the next injection is due. No need backup method. Soon after childbirth (regardless of breastfeeding status) • Any time within 48 hours after giving birth, including by caesarean delivery. (Provider needs specific training in postpartum insertion by hand or using a ring forceps.) • If it is more than 48 hours after giving birth, delay until 4 weeks or more. After miscarriage • Immediately, if within 12 days after first- or second-trimester miscarriage and if no infection is present. No need for a backup method. • If more than 12 days and no infection, any time if not pregnant. No need a backup method. • If infection is present, treat or refer, discuss another method. If still wants the IUD, it can be inserted after the infection has completely cleared. Need back up method. • Insertion after second-trimester abortion or miscarriage requires specific training. If not, delay insertion until at least 4 weeks after miscarriage or abortion.
AS EMERGENCY CONTRACEPTION Copper-Bearing IUD • Within 5 days after unprotected sex. • When the time of ovulation can be estimated, she can have an IUD inserted up to 5 days after ovulation. Sometimes this may be more than 5 days after unprotected sex.
COMPONENTS: FEMALE STERILIZATION VASECTOMY SURGICAL METHODS
1. Female Sterilization • What? • Permanent surgical contraception for women who will not want more children. • Action: • Works because the fallopian tubes are blocked or cut. Eggs released from the ovaries cannot move down the tubes, and so they do not meet sperm. • One of the most effective contraceptive, a small risk of failure • Protection against pregnancy: • Less than 1 pregnancy per 100 women over the first year (5 per 1,000) • Return of fertility: Fertility does not return because cannot be reversed. • Protection against STIs: None
SURGICAL APPROACHES • Tubal ligation via abdominal wall • Mini laparotomy – 5cm incision • Laparoscopic – 1cm incision • During Caesarean section • Through cervix Female Sterilization
COMPLICATIONS • During procedure ➢Injury and bleeding from other organs i.e bowel, bladder, uterus ➢Anaesthesia related effects ➢Excessive bleeding Female Sterilization • Immediately post procedure ➢ Bleeding ➢ Infection • Long term complications ➢ Adhesion ➢ Ectopic pregnancy
2. Vasectomy • What? • Permanent contraception for men who will not want more children. • Also called male sterilization and male surgical contraception • How? • Through a puncture or small incision in the scrotum • Involves locating the 2 tubes that carries sperm to the penis (vas deferens) and cuts or blocks them by cutting and tying them closed or by applying heat or electricity (cautery). • Action: • Works by closing off each vas deferens, keeping sperm out of semen. Semen is ejaculated, but it cannot cause pregnancy.
How Effective? • One of the most effective contraceptive, a small risk of failure • Protection against pregnancy: • Far less than 1 pregnancy per 100 women over the first year (less than 2 women in every 1,000). • Means that 998 or 999 of 1,000 women whose partners have had vasectomy will not become pregnant • A small risk of pregnancy remains beyond the first year after the vasectomy and until the man’s partner reaches menopause. • Over 3 years of use: About 4 pregnancies per 1,000 women • Return of fertility: Fertility does not return because cannot be reversed. • Protection against STIs: None Vasectomy
Hormonal contraception
contraception Hormonal combined Progestogen only Emergency pills Non hormonal
Combined •Oral (COC) •Injectable •Patch •Vaginal ring
Kaedah Kontraseptif Hormonal PIL
Contoh : Pil Kombinasi (COC) ❑Diane 35 ❑Marvelon ❑Regulon ❑Microgynon ❑Nordette ❑Oralcon ❑Loette ❑Gynera ❑Yasmin
How OCP acts?
COCP- combined oral contraceptive • Progestin and an estrogen—like the natural hormones progesterone and estrogen in a woman’s body. • Preparation: • Ethinyl oestradiol • Current low dose COCP (35,30,25 and 20mcg EE) contain much lower levels compared to 150mcg doses first used in the 1960s • Lower EE doses = lower side effects including VTE, nausea, breast tenderness and bloating but 20mcg formulation associated with more break-through bleeding
Mode of Action COCP • Suppression of ovulation • By prevention of ovarian follicular maturation • By interrupting the oestrogen-mediated positive feedback on the hypothalamic-pituitary axis thus preventing LH surge • Thicken the cervical mucus • reduce sperm penetrability • Alteration of the endometrium • reducing likelihood of implantation
Combined oral contraceptive Pills. •High dose Pill - 50mcg Oestrogen •Low dose Pills – 30 mcg Oestrogen •Very low dose Pills – 20 mcg Oestrogen
Known Health Benefits Help protect against: • Risks of pregnancy • Cancer of the lining of the uterus (endometrial cancer) - protection continues for 15 or more years after stopping use • Cancer of the ovary • Symptomatic pelvic inflammatory disease • Due to progesterone effect on cervical mucus- increase viscosity impedes ascent of pathogens and may confer protective effect. • Lower menstrual flow also reduces bacterial growth
Disadvantages • Cardiovascular effect • VTE - Women with one major risk factor or multiple minor risk factors for VTE should not be given COCs • Myocardial infarction • Cerebrovascular accidents • Raised blood pressure • Breast cancer -BUT women who develop breast cancer while on COCP tend to have better prognosis tumours • Cervical cancer • Compared with never users of oral contraceptives, the relative risks of cervical cancer increased with increasing duration of use, advice for regular pap smear screening to detect precancerous lesion • Liver adenoma or carcinoma • Cholestasis • Gallstones
Who Can Use Combined Oral Contraceptives Safe and Suitable for Nearly All Women , including: • Have or have not had children • Are not married • Are of any age, including adolescents and women over 40 years old • Have just had an abortion or miscarriage • Smoke cigarettes—if under 35 years old • Have anemia now or had in the past • Have varicose veins • Are infected with HIV, whether or not on antiretroviral therapy, unless that therapy includes ritonavir
Absolute contraindication • Breastfeeding and less than 6 weeks post-partum • Non-breastfeeding and < 21 days postpartum with additional venous thromboembolism (VTE) risk factors • Age ≥35 years and smoking ≥15 cigarettes/day • Current or history of ischaemic heart disease, stroke,(including transient ischaemic attack), and complicated valvular or congenital heart disease • Uncontrolled Hypertension, Migraine with an aura , Past or present evidence of VTE, liver tumour, Current breast cancer, Diabetes with complication • Multiple risk factors for cardiovascular disease (e.g. smoking, obesity, older age, diabetes, hypertension)