Certain facts & myths about contraception Who needs contraception All the women who have not achieved menopause and are sexually active need contraception ( even the grandmothers can conceive)

Types of contraception  1.Abstinence,breast feeding,Withdrawl method  2.Barrier method-condoms, Today vaginal pessary  3.Hormonal- Oral pills, Inj Depo provera, Mirena  4.Multiload/ Cu-T 380-A  5.ligation- Tubal ligation, Vasectomy  6.Emergency contraception

Contraceptive methods and failure rate in first year with typical use  Tubal ligation %  Vasectomy 0.1%  Multiload/Cu-T380A <1%  Inj Depoprovera <1%  OCP <1%  Condom 15-25%  Fertility awareness >25%  withdrawl Method 25-35%  No contraception85%

 EXCLUSIVE BREAST FEEDING- has a failure rate of 5%  It is not effective after 6 months or earlier if the period start.  Additional contraceptive need to be used after 6 months, even if there is no period. Breast Feeding as Contraceptive

For newly married girls  1.ORAL PILLS –Very safe and very popular contraceptive in the west FOURTH GENERATION OCPS are now available in India, There is no wt. Gain and takes care of acne. BP is also not aggravated.

Contraception for young women who have not completed family  2.a) Barrier method- Condom +Today  Condom has a high failure rate in common practice. Mainly because of not knowing the correct technique of its use. It is mandatory to use it every time while having sex. This method is the only method to prevent sexually transmitted diseases. Ideally the failure should be less than 5% with correct usage. Young couples is advised to use double contraception i.e. OCP to prevent pregnancy & condom to prevent STDs 2.b)Today vaginal pessary :- failure rate 5% Few patients C/O Discharge and itching

Contraception for young women with completed family  1.Multiparous patient with youngest child 4-5 yrs old-  -Tubal ligation/ Husband undergoes vasectomy  2.Youngest child< 5yrs (spacing method)  -Cu-T 380 A -To be changed every 10 yrs  -Multiload, has to be changed every 3 or 5 yrs.  -Mirena- to be changed every 5 yrs  -Inj Depoprovera- to be taken every 3 months  -OCPs- taken 21 days in a month,followed by 7 days pill free period

Contraception for middle aged women till menopause  Menopause- cessation of periods for at least 1yr.  Options for perimenopausal women  1.Tubal ligation  2.Cu-T/Multiload/Mirena  3.Low dose Oral contraceptive pills- other health benefits include  -lower risk of endometrial &ovarian cancer  -relieves hot flushes,night sweats,vaginal dryness  -protects agaist loss of bone density  4..Condom + Today  Greatest risk of conception for perimenopausal women because of irregular cycles  40-45yrs-75% cycles are ovulatory  >46yrs-60% cycles are ovulatory  women should not stop contraceptive measures until 2 yrs after the last menstrual period

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Oral Contraceptive pills  When to start?- on the 1 st day of period  How long can be taken?-as long as required  Who shouldn’t take-H/O epilepsy,on ATT,DVT, Coronary artery disease,Thrombogenic cardiac valvular disease, cardiac arrythmias,diabetes, hypertension,active liver disease  Is there any problem in getting pregnant after using the birth control pill? - No, regular period & ovulation usually start up right away. However Girls who were very irregular before starting the pill, may be irregular after they stop the pill.  Advantages-Very safe & has only a few minor side effects.  Protects against cancer of ovaries & cancer of the lining of uterus. Most experts believe that it does not cause any increased risk of getting cancer Breast.  Other health benefits include regulation of menstrual period,decrease in cramps,treatment for acne &PCOS, lower risk of anaemia

Multiload /Cu-T 380 A  Most misunderstood contraception  It has a small T shaped body which bears a coil of copper wire on it.  Prevents pregnancy by interference with sperm transport,Ovum transport ,fertilization & implantation  Incidence of complications - Heavy periods in 10% cases, can be controlled with medicine, more common with wrong case selection  -Perforation 0.5 in 1000 cases (WHO 1987),very little chances in experienced hands  Timing of insertion-  Immediately after periods  6 weeks after normal delivery  6 weeks after caesarean section  Immediately after early abortion  Lactational Amenorrhoea after reasonably excluding pregnancy  As emergency contraception  Fertility returns immediately after discontinuation CU-T 380 A IS BEST IUCD according to W.H.O in the world. It has a failure rate like permanent method of tubal ligation. It can be kept as long as 10 years. Even those with previous caesarean can go for it.

MIRENA  Mirena is a small flexible plastic device, inserted inside the uterus,. It slowly releases progesterone hormone, which stops ovulation,alters the cervical mucus &changes the lining of uterus.  Things to know about Mirena -99.9% effective in preventing pregnancy -provides lower & steadier hormones than pills -lasts for up to 5 yrs or less if you choose -easily removed when you want it to be -won’t cause significant weight gain -May also help shorten,lighten or even eliminate periods ----.Imp safety information about Mirena- -Designed for women who have had at least one child & have no risk of ectopic pregnancy or PID -Ovarian cyst may occur & typically disappear -Complications may occur from placement -Missing periods or irregular bleeding is common in first few months, followed by shorter,lighter periods

Emergency Contraception  Levonorgestrel pill is available  Single tablet has to be used within 72 hours of unprotected coitus. It is effective to the tune of 90%.  Every women & adolescent girl should know. However emergency contraceptive can not replaced regular contraceptive for people who are sexually active.