Ideal contraceptive :

• Safe
• Simple to use
• Cheap
• Highly effective
• Widely acceptable
• No side effects
• Independent of coitus
• Rapidly reversible
• Easily distributed
• Can be administred by non-health care personnel

Contraceptive method

Define contraceptive method : Contraceptive methods are the preventive methods to help women avoid unwanted pregnancies.

Method of  Contraception :

A. Temporary method :

1. Barrier methods :

• . Physical method : e.g. Condom, diaphragm, vaginal sponge
• .Chemical method : e.g. Foams, creams, jelly, and pastes.
• .Combined method : e.g. Condom + Creams

2. Intrauterine contraceptive devices (IUCD) e.g. Copper T.

3. Hormonal methods e.g. Oral contraceptives pill

4. Post-conceptional methods e.g. Menstrual regulation, Menstrual induction, abortion

B. Permanent methods :

Male – Vasectomy

Female – Tubectomy

Indication of contraceptive

• Limitation of the population.
• Temporary ill health in either husband or wife
• Chronic systemic disease in wife
• Previous obstetrical complications
• Disease transmissible to foetus
• Birth spacing
• Family limitation
• Early marriage
• Late years of marriage (when family is complete)

Emergency Contraception

Define : Emergency contraception is defined as any drug or device used after unprotected intercourses to prevent pregnancy.

Objectives : To reduce unsafe abortion.

Available preparation :

• Levonorgesterel (E. Pills) : 0.75mg, 2 doses given at 12 hours interval
• Ethinyl oestradiol + Norgestrel
• Conjaugated oestrogen : 15 mg 12 hourly for 5 days
• Ethinyl oestradiol : 2.5 mg 12 hourly for 5 days
• Mifepristone : 100 mg single dose.
• Copper IUDs : Insertion within 5 days.

Complications :

1. Nausea and vomiting in case of hormone therapy
2. Failure leading pregnancy
3. Ectopic pregnancy.

Describe  condom Barrier methods of contraception :

Advantage of condom :

• Cheaper with no contraindication
• No side effects
• Easy to carry, simple to use and disposable
• Protection against sexually transmitted diseases e.g. gonorrhea, syphilis, Chlamydia, Hpv and HIV.
• Protection against pelvic inflammatory disease.
• Reduces the incidence of tubal infertility and ectopic pregnancy.
• Protection against cervical cell abnormalities
• Usual where the coital act is infrequent and irregular.
• Need no medical supervision.

Disadvantages of condom :

• May accidentally break or slip off during coitus
• Inadequate sexual pleasure.
• Allergic reaction (latex)
• To discard after one coital act.

Hormones containing contraceptives :

1. Oestrogen
2. Progesterone

Classify hormonal contraceptive :

Oral contraceptive (pills) :

Define Oral contraceptive (pills) : A contraceptive in the form of a pill containing estrogen and progestin to inhibit ovulation and so prevent conception.

Name of the Oral contraceptive pills :

Combined pill :

• Menophasic
• Biphasic
• Triphasic
• Emergency (Post-coital pill).

Single preparation :

• Sequential pill
• Mini pill
• Oestrogen only

Indication/Advantages of Oral contraceptive pills :

1. For contraceptive.
2. Treatment of endometriosis
3. Treatment of dysmenorrhea
4. Dysfunctional uterine bleeding
5. To reduce premenstrual tension
6. Functional ovarian cyst
7. Benign breast disease
8. Management of irregular menstrual bleeding

Contraindication of oral contraceptive pill :

1. Thromboembolic disorder.
2. Cardiovascular disease
3. Carcinoma of the breast and cervix
4. Previous history of jaundice
5. Diabetes mellitus.

Disadvantage/Advers effect of oral contraceptive pill (OCP) :

1. Mild adverse effect :

• Nausea
• Vomiting
• Migraine

2. Moderate adverse effect :

• .Break through bleeding.
• Weight gain
• Vaginal infection

3. Sever advers effect :

• Hypertension
• Thromboembolism
• Myocardial infarction
• Cholestatic jaundice
• Breast and cervical cancer.

Injectable Contraceptives

Define injectable contraceptives : It is form of contraception that is injected into a  muscle usually buttock or upper arm to stop pregnancy by releasing progestogen into the body.

Composition of injectable contraception :

1. Depot medroxy progesterone acetate (DMPA) 150 mg 3 monthly
2. Norethisterone oenanthate 200mg 2 monthly.

Indication of injectable contraceptives :

1. Compliance is good
2. Can be used in lactating women.
3. Alternatives to IUCD.
4. Reduced in PID, ectopic pregnancy
5. Other uses : Endometrial carcinoma, Endrometrosis

Contraindication of injectable contraceptives :

1. Suspected pregnancy
2. Women wishing to conceive in near future
3. Acute or chronic liver disease
4. Undiagnosed abnormal genital tract bleeding
5. Thromboembolic disease
6. Obesity
7. Hypertension.

Complications of injectable Contraceptives :

1. Menstrual irregularity like amenorrhoea, irregular bleeding
2. Delayed return of fertility
3. Weight gain
4. Galactorrhoea
5. Mild androgenic effect.
6. Enuresis
7. Deprission
8. Loss of libido
9. Vaginal dryness

Describe Male permanent contraceptive method Vasectomy :

Define : It is a permanent sterilization operation done in the male where a segment of vas deferens of both sides is resected and cut ends are ligated.

Different methods of vasectomy :

1. Conventional
2. Non – scalpet technique.
3. Open ended vasectomy
4. Chemical vas occlusion

Advantages of vasectomy :

1. Permanent ill health of the potential father.
2. For the purpose of family planning
3. Family limitation
4. Population control

Contraindication of vasectomy :

1. Active STD
2. Scrotal skin infection
3. Scrotal mass
4. Infection in genital tract
5. Hernia

Complications of vasectomy :

A. Immediate : 

1. Wound infection
2. Bleeding
3. Haematoma
4. Scrotal abscess
5. Epididymitis

B. Late : 

1. Sperm granuloma.

Describe female permanent contraceptive method Tubectomy :

Define : Occlusion by segment of both the fallopian tubes is called tubectomy.

Indication of tubectomy :

1. Permanent ill health of the potential mother.
2. For the purposes of family planning
3. Family limitation.
4. Population control

Contraindication of tubectomy :

1. Unexplained vaginal bleeding.
2. Pregnancy.
3. PID (pelvic inflammatory disease)
4. Current STD
5. Genital cancer
6. Deep vein thrombosis
7. Acute medical problems
8. Anaemia

Complications of tubectomy :

1. Anaesthetic problems
2. Damage of intra- abdominal organs during the procedure.
3. Ectopic pregnancy.