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Презентация на тему Contraception

Содержание

IntroductionContraception is a part of Family Planning(Contraception - recurrent abortion and infertility management - genetic counseling)Regulation of family sizeWide range of methods is availableNo ideal contraception existsContraception failure ( the perfect use rate - the typical
CONTRACEPTIONDamascus UniversityAss. Pr. Saad NANO IntroductionContraception is a part of Family Planning(Contraception - recurrent abortion and infertility StratificationPhysiological - NaturalHormonalMechanical - BarrierChemicalOral - VaginalIntrauterine DeviceInjectable - ImplantTemporary - PermanentEmergency contraception Hormonal ContraceptionSynthetic female sex steroids ( estrogens - progestins )Administration (oral - Hormonal ContraceptionThe Progestins1- Affinities for estrogen, androgen, and progesterone receptors:Directly bounded ( Hormonal Contraception* Oral Contraceptive Pills ( the most widely used ) :Combined Hormonal ContraceptionOral Contraceptive Pills :Types:a- Combined oral contraceptives :   Monophasic Hormonal ContraceptionOral Contraceptive PillsAdvantages :EffectiveOther beneficial health effects- Reduce menstrual irregularities.- Reduce Hormonal ContraceptionOral Contraceptive PillsDisadvantages :Require daily useNo protection against STIs, HIVSide effects Hormonal ContraceptionOral Contraceptive PillsAdverse effects : ( Combined )Lipid (+LDL, +Cholesterol, -HDL)Glucose Hormonal ContraceptionOral Contraceptive PillsContraindications: ( Combined )History: thrombosis/ embolus/ cerebral hemorrhage/ coronary Hormonal ContraceptionInjectable Hormonal Contraceptives :Types :a- Progestin-onlyDepot-medroxyprogesterone acetate (DMPA) / 3 months Hormonal ContraceptionInjectable Hormonal ContraceptivesMechanism of action:a- Suppression of ovulation .b- Endometrium hypotrophy, Hormonal ContraceptionInjectable Hormonal ContraceptivesDisadvantages :- Menstrual changes ( Irregular bleeding/spotting , prolonged/heavy Hormonal ContraceptionSubdermal Implants :Types :Capsules placed under the skin that slowly release Hormonal ContraceptionSubdermal ImplantsAdvantages :Safe & effectiveLong-acting No effect on lactationOther beneficial health Postcoital Contraception (Emergency C):Implantation occurs on the 6th day after fertilization STERILIZATIONFemale sterilization:Surgical tubal occlusionAdvantages :Safe & highly effectivePermanent methodNo long-term adverse effectsDisadvantages STERILIZATIONMale sterilization:Vasectomy, vas deferens and tubes occlusion Advantages :SafePermanent methodNo long-term adverse effectsMinor surgeryA waiting period Non Hormonal Contraception* Lactational amenorrhea method (LAM)** Periodic abstinence *** Coitus interruptus**** Non Hormonal ContraceptionLactational amenorrhea method (LAM):Must be:Within 6 m. postpartum + Amenorrhea Non Hormonal ContraceptionPeriodic abstinence  &  Coitus interruptus :Advantages :Readily availableSafe Non Hormonal ContraceptionBarrier methods:Male, female condom / Diaphragm / Cervical cap / Intrauterine Devices IUDInert & Medicated ( Copper or Hormone releasing ) Mechanism Intrauterine Devices IUDDisadvantages :No protection against STIs, HIVRequires trained provider's help ( Intrauterine Devices IUDContraindications :History or recent STIs or PIDUterine distortionUnexplained vaginal bleedingOthers Typical rateNon Contraception« 45% women in Thank You
Слайды презентации

Слайд 2 Introduction
Contraception is a part of Family Planning
(Contraception -

IntroductionContraception is a part of Family Planning(Contraception - recurrent abortion and

recurrent abortion and infertility management - genetic counseling)
Regulation of

family size

Wide range of methods is available
No ideal contraception exists
Contraception failure ( the perfect use rate - the typical rate )

Intelligent choice of contraception :
Medical care provider (information , advice) + Couple (needs)


Слайд 3 Stratification
Physiological - Natural
Hormonal
Mechanical - Barrier
Chemical
Oral - Vaginal
Intrauterine Device
Injectable

StratificationPhysiological - NaturalHormonalMechanical - BarrierChemicalOral - VaginalIntrauterine DeviceInjectable - ImplantTemporary - PermanentEmergency contraception

- Implant
Temporary - Permanent
Emergency contraception


Слайд 4 Hormonal Contraception
Synthetic female sex steroids ( estrogens -

Hormonal ContraceptionSynthetic female sex steroids ( estrogens - progestins )Administration (oral

progestins )
Administration (oral - implant - injectable - IUDs

- vaginal)

Estrogens :
Ethinyl Estradiol (EE)
Mestranol (ME) - bioactivation in liver to EE
Progestins:
- Estrane / 19-norprogestins ( = testosterone + C 19 ), oral :
norethynodrel, norethinodrone acetate, lynestrenol, norgestrel
norgestimate, desogestrel, gestodene (newer)
- Pregnane / 17-acetoxy progestin ( = progesterone ), injectable :
medroxy-progesterone acetate ( Provera )

Слайд 5 Hormonal Contraception
The Progestins
1- Affinities for estrogen, androgen, and

Hormonal ContraceptionThe Progestins1- Affinities for estrogen, androgen, and progesterone receptors:Directly bounded

progesterone receptors:
Directly bounded ( norethinodrone, levonorgestrel )
Require bioactivation (

newer : norgestimate, desogestrel, gestodene )
Progesterone receptors (medroxy-progesterone acetate,17-acetoxy progestin)
2- Ovulation inhibition:
newer are more selective
little dose ( = little or no androgenic effect + inhibit ovulation )
3- Substitute for progesterone, and antagonize estrogen:
androgenic potency on lipid and glucose metabolism
+LDL , -HDL / effect glucose tolerance

Слайд 6 Hormonal Contraception
* Oral Contraceptive Pills ( the most

Hormonal Contraception* Oral Contraceptive Pills ( the most widely used )

widely used ) :
Combined oral contraceptives (COCs)
Progestin-only formulations (POPs)

**

Injectable Hormonal Contraceptives:
Progestin-only injectables
Combined injectables
*** Subdermal implants:
Norplant
Implanon
**** Postcoital Contraception (emergency contraception):
Estrogens - Combined
Copper IUDs
Danazol - Mifepristone

Слайд 7 Hormonal Contraception
Oral Contraceptive Pills :
Types:
a- Combined oral contraceptives

Hormonal ContraceptionOral Contraceptive Pills :Types:a- Combined oral contraceptives :  Monophasic

:
Monophasic / Multiphasic, (+21 days, -7days

).
b- Progestin-only formulations : ( Every day without interruption ).
Mechanism of action:
a- Suppression of ovulation :
Suppress FSH and LH
b- Endometrium hypotrophy :
Not suitable to implantation
c- Thickening of cervical mucus :
Difficult for sperm

Слайд 8 Hormonal Contraception
Oral Contraceptive Pills
Advantages :
Effective
Other beneficial health effects
-

Hormonal ContraceptionOral Contraceptive PillsAdvantages :EffectiveOther beneficial health effects- Reduce menstrual irregularities.-

Reduce menstrual irregularities.
- Reduce hpermenorrhea / anemia / dysmenorrhea

/ premenstrual syndrome / PID / Functional ovarian cyst.
- Reduce ovarian and endometrial cancer.
- Reduce ectopic pregnancy.
- Reduce benign breast disease.


Слайд 9 Hormonal Contraception
Oral Contraceptive Pills
Disadvantages :
Require daily use
No protection

Hormonal ContraceptionOral Contraceptive PillsDisadvantages :Require daily useNo protection against STIs, HIVSide

against STIs, HIV
Side effects are common :

Combined Nausea, Dizziness, breast tenderness, headaches, mood changes, weight gain, breakthrough bleeding.
Progestins Irregular bleeding, amenorrhea, and similar but less common.
May pose health risks ( Combined )


Слайд 10 Hormonal Contraception
Oral Contraceptive Pills
Adverse effects : ( Combined

Hormonal ContraceptionOral Contraceptive PillsAdverse effects : ( Combined )Lipid (+LDL, +Cholesterol,

)

Lipid (+LDL, +Cholesterol, -HDL)
Glucose metabolism (effect glucose tolerance)
Hypertension (A-Rennin

/ H2O + Na) + weight gain
Thrombosis ( ? Coagulation factors ? Platelet ?)
Hepatic (biliary stone)



Слайд 11 Hormonal Contraception
Oral Contraceptive Pills
Contraindications: ( Combined )
History: thrombosis/

Hormonal ContraceptionOral Contraceptive PillsContraindications: ( Combined )History: thrombosis/ embolus/ cerebral hemorrhage/

embolus/ cerebral hemorrhage/ coronary disease.
Estrogen-dependent malignancy
History: gestational cholestasis/

impaired liver function/ hepatic adenoma.

Hypertension / Diabetes / Heavy smoking + >35years /
Hyperlipidemia

Migraine / Sickle cell disease / Epilepsy

Planned major surgery / Active gallbladder disease / Undiagnosed genital bleeding

Слайд 12 Hormonal Contraception
Injectable Hormonal Contraceptives :

Types :

a- Progestin-only
Depot-medroxyprogesterone acetate

Hormonal ContraceptionInjectable Hormonal Contraceptives :Types :a- Progestin-onlyDepot-medroxyprogesterone acetate (DMPA) / 3

(DMPA) / 3 months Norethisterone enamthate / 2 months



b- Combined / 1 month
Mesygyna (50mg DMPA+5mg estradiol valerate)
Cyclofem (25mg DMPA+5mg estradiol cypionate)

Слайд 13 Hormonal Contraception
Injectable Hormonal Contraceptives
Mechanism of action:
a- Suppression of

Hormonal ContraceptionInjectable Hormonal ContraceptivesMechanism of action:a- Suppression of ovulation .b- Endometrium

ovulation .
b- Endometrium hypotrophy, not suitable to implantation
c-

Thickening of cervical mucus, making it difficult for sperm

Advantages :
Safe & effective
Long-acting (but combined 1 month)
No effect on lactation
Other beneficial health effects


Слайд 14 Hormonal Contraception
Injectable Hormonal Contraceptives
Disadvantages :
- Menstrual changes (

Hormonal ContraceptionInjectable Hormonal ContraceptivesDisadvantages :- Menstrual changes ( Irregular bleeding/spotting ,

Irregular bleeding/spotting , prolonged/heavy bleeding , amenorrhea ) (

less in combined )
- No protection against STIs, HIV
- Side effects ( headache ,dizziness ,breast tenderness , mood changes , Weight gain) (more in combined)
- Effects cannot be stopped immediately
- Return to fertility is usually delayed ( 9 months )
Long term adverse effects :
DMPA : possible effect on bone density ( <21y)
Combined : based on safety information for COCs.

Слайд 15 Hormonal Contraception
Subdermal Implants :
Types :
Capsules placed under the

Hormonal ContraceptionSubdermal Implants :Types :Capsules placed under the skin that slowly

skin that slowly release a progestin
a- Norplant:
Levonorgestrel / 6

match-sized / 5 years
b- Implanon:
Etonogestrel / single rod / 3 years

Mechanism of action:
a- Thickening of cervical mucus, making it difficult for sperm
b- Suppression of ovulation in 1/2 of a women's cycles

Слайд 16 Hormonal Contraception
Subdermal Implants
Advantages :
Safe & effective
Long-acting
No effect

Hormonal ContraceptionSubdermal ImplantsAdvantages :Safe & effectiveLong-acting No effect on lactationOther beneficial

on lactation
Other beneficial health effects
Can be reversed anytime +

Rapidly restoring fertility
Disadvantages :
- Menstrual changes ( Irregular bleeding/spotting , prolonged/heavy bleeding , amenorrhea )
- No protection against STIs, HIV
- Requires provider's help + minor surgical procedure (twice)

Слайд 17
Postcoital Contraception (Emergency C):
Implantation occurs on the

Postcoital Contraception (Emergency C):Implantation occurs on the 6th day after

6th day after fertilization / Within 72hrs
Estrogens :
Tubal

mobility and endometrium alteration - Interference with corpus luteum function.
Combined :
The most used regimen ( EE 200mcg+norgestrel 2mg ) (Overal 2+2tab/12h )
Copper IUDs :
More effective than sex steroids.
Mifepristone : Anti progesterone (RU486).
Danazol : Weak androgen - pregnancy rate 2%.

Слайд 18 STERILIZATION
Female sterilization:
Surgical tubal occlusion
Advantages :
Safe & highly effective
Permanent

STERILIZATIONFemale sterilization:Surgical tubal occlusionAdvantages :Safe & highly effectivePermanent methodNo long-term adverse

method
No long-term adverse effects
Disadvantages :
Small risk of surgical complications


High initial cost
No protection against STIs, HIV
Cannot be reversed
Post-sterilization syndrome

Слайд 19 STERILIZATION
Male sterilization:
Vasectomy, vas deferens and tubes occlusion
Advantages

STERILIZATIONMale sterilization:Vasectomy, vas deferens and tubes occlusion Advantages :SafePermanent methodNo long-term adverse effectsMinor surgeryA waiting period

:
Safe
Permanent method
No long-term adverse effects

Minor surgery
A waiting period


Слайд 20 Non Hormonal Contraception
* Lactational amenorrhea method (LAM)

** Periodic

Non Hormonal Contraception* Lactational amenorrhea method (LAM)** Periodic abstinence *** Coitus

abstinence
*** Coitus interruptus

**** Barrier methods
Male, female condom

/ Diaphragm / Cervical cap
Vaginal spermicides

Слайд 21 Non Hormonal Contraception
Lactational amenorrhea method (LAM):
Must be:
Within 6

Non Hormonal ContraceptionLactational amenorrhea method (LAM):Must be:Within 6 m. postpartum +

m. postpartum + Amenorrhea + Fully breastfeeding
Mechanism of action:
Suckling

nipples >> Hypothalamus , Prolactin + >> GnRH - >> FSH - LH - >> Follicular development 0 >> No ovulation.
Advantages :
Effective (for all breastfeeding women) (no preparations )
Begins immediately postpartum (be used while women decide)
Disadvantages :
Requires conditions
No protection against STIs, HIV

Слайд 22 Non Hormonal Contraception
Periodic abstinence & Coitus

Non Hormonal ContraceptionPeriodic abstinence & Coitus interruptus :Advantages :Readily availableSafe and

interruptus :

Advantages :
Readily available
Safe and side effects free

Disadvantages :
Requires

skills and motivation (partner's cooperation)
No protection against STIs, HIV
High failure rate

Слайд 23 Non Hormonal Contraception
Barrier methods:
Male, female condom / Diaphragm

Non Hormonal ContraceptionBarrier methods:Male, female condom / Diaphragm / Cervical cap

/ Cervical cap / Vaginal spermicides
Mechanism of action:
Work by

physically or chemically blocking.
Advantages :
Effective if used consistently and correctly
Safe and no systemic side effects
Immediate initiate, discontinue and return to fertility
Some protects against STIs, HIV
Disadvantages :
Requires motivation + partner's cooperation consistently
High failure rate

Слайд 24 Intrauterine Devices IUD
Inert & Medicated ( Copper or

Intrauterine Devices IUDInert & Medicated ( Copper or Hormone releasing )

Hormone releasing )
Mechanism of action:
Causing endometrium reaction (making

it hostile to sperm and possibly to egg).
Timing of insertion :
During menstruation - Anytime if no pregnancy
Postpartum >6w - post abortion (if no infection or hemorrhage)
Advantages :
Highly effective
Long acting but easily reversible with return to fertility
No effect on lactation

Слайд 25 Intrauterine Devices IUD
Disadvantages :
No protection against STIs, HIV
Requires

Intrauterine Devices IUDDisadvantages :No protection against STIs, HIVRequires trained provider's help

trained provider's help ( twice )
Can cause side effects

:
Cramping & Increased, prolonged menstrual ( inter. ) bleeding
Can have complications :
PID ( sequels )
Perforation ( serious )
Expulsion
Ectopic pregnancy ( more than other methods )
Intrauterine pregnancy ( septic abortion - PROM - premature )


Слайд 26 Intrauterine Devices IUD
Contraindications :
History or recent STIs or

Intrauterine Devices IUDContraindications :History or recent STIs or PIDUterine distortionUnexplained vaginal

PID
Uterine distortion
Unexplained vaginal bleeding
Others :Allergic to Cu /// Previous

EP /// Nulliparity
Hormone releasing intrauterine system (IUS)
Progestins released directly into the uterus
Thickening of cervical mucus + Partial ovulation suppression + Tubal motility
Reduces quantity and duration of menstruation + pain
Expensive

Слайд 27 Typical
rate
Non

Typical rateNon

85% 85%
COC 0.001% 2-3%
POP 0.005% 2-3%
IUD 2-3%
Sterilization ( F ) 0.004
Sterilization ( M ) 0.001
Periodic abstinence 9% 20%
Male condom 2% 12%
Diaphragm 6% 18%
Vaginal spermicides 9% 28%

Typical
rate

Perfect
rate

Method


Слайд 28

Contraception« 45% women in genital activity»


Contraception
« 45% women in genital activity»


Asia >60% ---- Africa < 20%



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