contraception methods

1)Natural methods
  -Abstinence during fertile      phase
  -Withdrawl(coitus interruptus)

2)Barrier contraceptives
  -Condoms by male
  -Spermicidal agents
  -Diaphragm, or d cervical       cap in d vagina, use of       female condom
  -Harmones whch alter d        cervical mucus & prevent     entry of sperms into          cervical canal

3)IUCDs

4)Suppression of spermatogenesis

5)Suppression of ovulation with harmones i.e Harmonal contraceptives

6)Interceptive agents (Postcoital contraception)

7)Immunological methods

8)Surgical sterilisation


BARRIAR CONTRCPTIVES
1)Condoms- erectile penis is completely covered by a thin rubber whch is used only once. It is desirable 2 use a condom wid a spermicidal agent 2 improve efficacy.
Advantages-easily availabl, cheap, easy 2 carry, free frm sideffects, no instructions required. Also prevents transmision of STDs, Ca Cervix, AIDS.
2)Spermicidal agents- Kills sperms bfor gaining access 2 d cervical canal. Contains surfactants nonoxynol-9, octoxynol, & menfegol & enzyme inhibiting agents. Available as foam, tab, soluble pessaries, creams, jellies, films. Used in conjuction wid other barriers giv a reliable effct.
3)Occlusive diaphragms- as a barrier in d vagina against direct insemination.
 Types-
  i)Dutch cap or diaphragm
  ii)Cervical cap
  iii)Dumas cap
  iv)Femshield female condm
  v)Today
4)Altering cervical mucus
Harmones- low dose progesterone only pill minipill administered daily. Under progesterone mucus becomes viscid & prevents penetration of sperms in2 cervical canal.


HARMONAL CONTRCPTIVE
1)Combined oral pills-
Usually contains a mixture of either ethinyloestradiol or mestranol in dose of 20 to 30 microgm.
Mala-D contains 0.5mg Norgestrel.
Mala-N contains 1mg Norethisterone.
Tab r taken starting on 5th day of d cycle for 21 days. A new course of tab shud b commended 7 days aftr cesation of previous course.
Suppresses pituitary FSH & LH & thru der suppression prevents ovulation. Progesterone causes atrophic changes in d endometrium & prevents nidation & acts on cervical mucus making it thick & tenacious & inpenetrable by sperms.
Advant-
Effectivly controls fertility
Useful in menorrhagia & poly menorrhoea becoz regular & scanty menstruation.
By virtue of non ovulation can relieve dysmenorrhoea & premenstrual tension
Prevents anaemia by reducing menstrual loss
Proved 2 lower d incidence of benign breast neoplasia
Reduces d incidence of functional ovarian cyst, & ovarian, uterine malignancy
PID incidence reduced
Ectopic pregnancy incidence reduced due 2 supresion of ovulation
Protects against rheumatoid arthritis.
Side-effects-
Intermenstrual spotting
Menstrual bleeding
Genital tract monilial vaginitis
Breast cancer may occur
Pituitary adenoma
Suppression of lactation
Libido
Nausea & vomiting
Liver adenomas
Gall bladdr affection
Carbohydrate tolerance
Lipid metabolism disturbanc
Headache, depression, migraine
Thromboembolic disorders


Triphasic combined pills-
The pills contain during first 6 days of cycle 30 microgm Ethinylostradiol(EE2) + 50 microgm Levonorgestrel(LNG). For next 5 days 40microgm EE2 + 75microgm LNG. During last 10 days 30microgm EE2 + 125microgm LNG


MINIPILL
Progesterone only low dose pills
Norethisterone 350microgm
Norgestrel 75microgm
Levonorgestrel 30microgm
Started widin 5 to 7 days of menstruation


Depot injections
Depomedroxyprogesterone acetate (DMPA) 25 to 50 mg combined wid 5 mg Ostradiol deep IM


Subdermal implants
Norplant I - cotains 6 silastic casules of siloxane
Norplant II - 2 rods each containing 70mg LNG


Silastic vaginal rings
50 to 75mm in diameter and 5 to 9 mm in thickness
LNG 20microgm


Skin patches
Harmonal patch 150microgm Norelgestromin & 20microgm EE2 daily