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Family Planning

Family Planning. Clifford dela Cruz Harmony Que Paula Valera. Contraceptive Effectiveness. Perfect Use . Describes the effectiveness of the contraceptive when used perfectly methods used at the time of coitus

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Family Planning

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  1. Family Planning Clifford dela Cruz Harmony Que Paula Valera

  2. Contraceptive Effectiveness Perfect Use • Describes the effectiveness of the contraceptive when used perfectly • methods used at the time of coitus • diaphragm, condom, spermicides, and withdrawal have much greater perfect use

  3. Contraceptive Effectiveness Typical Use Describes the effectiveness of the user, method may be used incorrectly less difference between perfect and typical use effectiveness among methods not related to the time of coitus OCs, contraceptive patches, vaginal rings, implants, injections, and intrauterine devices less motivation is required with thes

  4. Other factors Influencing Failure • Motivation • Contraceptive failure is more likely to occur in couples seeking to delay a wanted birth compared with those seeking to prevent any more births, especially for coitus-related methods • Age, Socioeconomic Status and level of education • strong negative correlation with failure of a contraceptive method

  5. Other factors Influencing Failure • Failure rates usually are lower among populations of married rather than unmarried women • Failure rates are greater during the first year of use than in subsequent years

  6. Spermicides

  7. Made of: • Carrier plus the active ingredient: SURFACTANT

  8. Surfactant • Nonoxynol 9 - Immobilizes or kills sperm by destroying the sperm cell’s membrane

  9. Spermicides • Provide mechanical barrier • Most is used in combination with barrier contraceptive to increase effectiveness

  10. Pregnancy Rate • In the first year ranges from 18% with perfect use and 29% with typical use

  11. Barrier Techniques

  12. Barrier Technique • Physically block the entry of sperm to the uterus • have the advantage of reducing the rate of transmission of sexually transmitted infections

  13. Diaphragm • Carefully fitted • Must cover the cervix • Can be used with spermicide • Left in place at least 8 hours after last coital act • Failure rate during the first year of use for the diaphragm ranged from 12.5% to 17.1% among all users and was reduced to 4.3% to 5.3% with perfect use

  14. Cervical Cap

  15. Cervical Cap • Cup-shaped plastic or rubber device that fits around the cervix • Left in place longer than diaphragm, more comfortable • 1 year pregnancy rates 17.4% for the cap and 16.7 for diaphragm

  16. Male Condom

  17. Male Condom Can be made from the ff: • Latex • Multiple sex partners • Contraception with prevention of sti • Animal Tissue • Do not prevent transmission of sexually transmitted organisms • Polyurethane • Prevent transmission of these organisms

  18. Male Condom • Should not be applied tightly • Tip should extend beyond the end of penis by about half an inch to collect ejaculate • Highly effective with strong motivated couples • Effective methods in women 30 years or older • 1st year failure rates among women wishing no more pregnancy • Women older than 30: 3% to 6% • Women younger than 25: between 8% and 10%

  19. Female Condom

  20. Female Condom • consists of a soft, loose-fitting sheath and two flexible polyurethane rings • One ring lies inside the vagina at the closed end of the sheath and serves as an insertion mechanism and internal anchor. • The outer ring forms the external edge of the device and remains outside the vagina after insertion, thus providing protection to the labia and the base of the penis during intercourse. • The condom is prelubricated and is intended for one-time use only

  21. How to use it

  22. Female Condom • Advantage of being inserted prior to beginning sexual activity and left in place after • Covers also the external genitalia therefore more protection • Cumulative pregnancy rates in U.S. centers at 6 months was 12.4% • 6-month pregnancy rate with perfect use was 2.6%, • probable 1-year pregnancy rate with perfect use would be slightly more than 5% • typical use failure rate at 1 year is estimated to be 21%

  23. PERIODIC ABSTINENCE

  24. Periodic Abstinence • Avoidance of sexual intercourse during the days of menstrual cycle when the ovum can be fertilized • Conception can only occur if coitus takes places during the 5 days preceding the ovulation or the day of ovulation

  25. Periodic Abstinence 4 Techniques • Calendar Rhythm Method • Temperature Method • Cervical Mucus Method • Sympothermal Method

  26. Calendar Rhythm Method • Periodic Abstinence determined by calculating the length of the individual woman’s previous menstrual cycle • Rationale: • Ovum is capable of being fertilized for ~24 hours • Spermatozoa has fertilizing ability for ~48 hours • Ovulation occurs 12 to 16 days (14 + 2 days) before the onset of subsequent menses

  27. Calendar Rhythm Method • This method requires abstinence for women with regular menstrual cycles • Most widely used technique but pregnancy rates are high, ranging from 14.4 to 47 per 100 woman-years

  28. Temperature Method • Relies on measuring basal body temperature daily • Woman is required to abstain from intercourse from the onset of the menses until the 3rd day of consecutive elevated basal temperature • Not commonly used

  29. Cervical Mucus Method • Requires the woman be taught to recognize and interpret cyclic changes in the presence of consistency of cervical mucus • these changes occur in response to changing estrogen and progesterone levels

  30. Cervical Mucus Method • Abstinence is required during the menses and every other day after the menses ends • Bec. of the possibility of confusing semen with ovulatory mucus, until the first day that copious, slippery mucus is observed to be present.

  31. Cervical Mucus Method • WHO Study • Failure rate during the 1st year after the completion of 3 cycles of training = 19.6 %, and • with perfect use, failure rate of 3.5 %

  32. Sympothermal Method • Use several indices to determine the fertile period • Calendar method and Cervical mucus method - To estimate the onset of the Fertile Period • Basal temperature • To estimate the end of the cycle • Success rate: 50 % • Vs Cervical Mucus Method, 26-40 %

  33. Hormonal Contraception

  34. Basic Principle • Inhibit Ovulation • Add exogenous hormone (estrogen and progesterone) • Cause a negative feedback to prevent FSH and LH production

  35. Estrogen suppresses follicle-stimulating hormone (FSH) and therefore prevents follicular emergence. • Maintains stability of endometrium.

  36. Progesterone prevents luteinizing hormone (LH) surge and therefore inhibits ovulation. • Thickens cervical mucus to pose as a barrier for sperm. • Alters motility of fallopian tube and uterus. • Causes endometrial atrophy.

  37. These contraceptives are currently available in a wide variety. • oral • injectable • transdermal(patch)and • transvaginal(ring) forms

  38. Oral Contraceptives

  39. Oral contraceptives are a combination of • estrogen and progestin or • progestin only (mini-pill) • The other forms contain progestins alone or a combination of estrogen and progestin.

  40. Mechanisms of Action • The contraceptive actions of combination oral contraceptives are multiple. • The most important effect is to prevent ovulation

  41. Progestin prevents ovulation by suppressing luteinizing hormone. • Progestins also thicken cervical mucus, thereby retarding sperm passage.

  42. Estrogen prevents ovulation by suppressing the release of follicle-stimulating hormone. • A second effect is to stabilize the endometrium, which prevents breakthrough bleeding.

  43. The net effect of estrogen and progestin is • extremely effective ovulation suppression, • inhibition of sperm migration through thickening of cervical mucus, and • creation of an unfavorable endometriumfor implantation.

  44. Thus, estrogen plus progestin containing combined oral contraceptives provide virtually absolute protection against conception when taken daily for 3 out of every 4 weeks.

  45. Pharmacology Estrogen Progestin 19-nortestosterone derivatives • Ethinyl Estradiol • Mestranol (less commonly)

  46. Dosage • Over time, the estrogen and progestin contents of COCs have been reduced remarkably to minimize hormone-related adverse effects. • Daily estrogen content varies from 20 to 50 g of ethinylestradiol, most contain 35 g or less.

  47. Phasic Pills • The amount of progestin varies. • Monophasic – formulation where the progestin dose remains constant during the cycle. • Biphasic and Triphasic - the progestin and in some, the estrogen dose varies during the cycle.

  48. Administration • With the exception of one preparation, COCs are taken daily for a specified time (21 to 81 days) and then omitted for a specified time (4 to 7 days) called the "pill-free interval.” • During these pill-free days, withdrawal bleeding is expected.

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