1. Family planning Xiaoying Yao MD, PhD Department of family planning Obstetrics & Gynecology Hospital, Fudan University

2. Contraception Induced abortion

3. How Pregnancy (Conception) Occurs

4. Contraception mechanism Prevents ovulation Thickens mucus at the cervix so sperm cannot pass through Changes the environment of the uterus and fallopian tubes to prevent fertilization and to prevent implantation if fertilization occurs Block sperm from reaching the egg

5. Contraception mechanism

6. controception methods female – IUD – Hormonal contraception – Emergency contraceptive – External contraception femshield spermicide – Safe period contraception – Contraceptive vaccines – sterilization male – condom – sterilization

7. So many……

8. Contraceptive methods

9. Map of the use of various of contraception in China & developed countries Oral contraceptive CondomSpermicide Others Male sterilization Subcutaneous implantation IUD Female sterilization Vaginal barrier IUD Condom Injection/subcutaneous implantation Others Oral contraceptive Sterilization United Nations Department of Economic and Social Affairs Population Division: World contraceptive Use 2003

10. IUD （ intrauterine device ） Types of IUD Inertia IUD （ first generation ） Active IUD （ second generation ） – Copper-containing IUD （ include nonsupport IUD ） – Medicine-containing IUD LNG-IUD Indomethacin-IUD

11. IUD mechanism of action Killing sperm & embryo poison Interference implantation LNG mechanism

12. The active ingredient: Levonorgestrel Thickening of the cervical mucus It prevents thickening of the womb lining Prevent ovulation Mirena®

13. placement

15. Takeout

16. IUD side effect and complication Side effect – Heavy bleeding – Prolonged menstruation – Spotting – Discharge increasing – Abdominal pain Complication – Ectopic – Embedded meal – Crack – Down – Fall off – Pregnancy with IUD

17. Contraception methods – IUD – Hormonal – Others Emergency contraception External use contraceptive

18. Hormonal contraception Contraceptive mechanism – Suppression of ovulation – Changes in the cervical mucus properties – Morphologic and functional changes of endometrial – Change the function of fallopian tube

19. Hormonal contraception --Types Oral contraceptives long-acting reversible contraceptives (LARC) – Long-acting contraceptive needle (DMPA) – Sustained release contraceptives (Norplant 、 Implanol) You will be given a local anesthetic and asked to lie on your back, with your non- dominant arm slightly bent at the elbow and turned outwards. The skin is stretched and a needle containing the implant is inserted directly under, and parallel to, the skin on the inside of your upper arm. The implant will then remain under the skin when the needle is withdrawn

20. Available options for LARC Injection, effective up to 12 weeks Levonorgestrel (LNG) intrauterine system, effective for up to 5 years Copper intrauterine device (IUD), effective for up to 10 years Implants, effective for up to 3-7 years

21. Hormonal contraception –Oral contraceptives – Short-acting – long-term – combination oral contraceptive – Three-phase pills – Four-phase pills

22. Reduce the changes of coagulation system – To reduce the incidence of thrombosis To reduce the subjective side effects – nausea – Vomiting – breast tenderness Increased tolerance Development trend of OC T he lowest estrogen content of oral contraceptives  Gradually reduce the dose of estrogen

23. Contraindications to hormone contraception Cardiovascular disease, thrombosis Acute / chronic liver / nephritis Malignant neoplasms, precancerous lesions Endocrine disease Smoking Mental disease Recurrent severe migraine

24. Side effects of hormonal contraception Early pregnancy reaction Menstrual disorders Body weight change Skin problems Headache, diplopia, breast swelling

25. Safety of hormonal contraception The two panic: – In 1983 the breast cancer – In 1995 the venous thrombosis Metabolism Cardiovascular Coagulation Tumor Progeny Oral contraceptive non contraceptive benefits Treatment of bleeding and control cycle The treatment of endometriosis Improvement of premenstrual syndrome Reducing osteoporosis

26. Contraception methods – IUD – Hormonal – Others Emergency contraception External use contraceptive

27. What is emergency contraception? Emergency contraception is a way to prevent pregnancy if: – Sex without using birth control – Birth control method failed forgot to take pill or get shot the condom broke or came off diaphragm slipped – Be raped

28. What are the types of emergency contraception? Pills – work well – don't cost a lot – usually easy to get Copper intrauterine device (IUD). – works very well – but it has to be inserted by a doctor

29. How does it work? Emergency contraception pills work by –preventing ovulation –preventing fertilization –preventing implantation –96% effective The copper IUD may work by –killing sperm –preventing fertilization –preventing implantation –99% effective

30. Emergency contraception may cause some side effects – spotting or mild symptoms like those of birth control pills – nausea or vomiting – sore breasts, fatigue, headache, belly pain, or dizziness – An IUD may cause cramping and bleeding during the first few days after insertion Does it cause side effects?

31. Emergency contraception pills won't protect you for the rest of your cycle. Use your regular method of birth control, or use condoms. Unless you get an IUD, emergency contraception does not take the place of regular birth control. Find a good method of birth control you can use every time you have sex. Emergency contraception does not prevent sexually transmitted infections (STIs). What else should you think about?

32. MethodHow it prevents pregnancy Barrier methods Block sperm from reaching the egg Some are used with spermicides, which kill sperm. Fertility awareness (natural family planning) Identifies the time during a woman's cycle when she is most likely to become pregnant (fertile). An additional method or abstinence should be used during this time of fertility. Permanent birth control (sterilization) Men: Vasectomy blocks the release of sperm. Women: Tubal ligation surgery or tubal implants block the movement of an egg through the fallopian tube, preventing fertilization.

33. Tubal sterilization operation 电绝育法 Ligation method –The proximal embedding method – Madlener – Pomeroy – Falope ring – Hulka clip Madlener Pomeroy

35. Contraception Induced abortion

36. Termination of early pregnancy – Artificial abortion Vacuum aspiration<10w – Medical abortion

37. Common complications Complication Uterine perforation and visceral injury Bleeding in operation Induced Abortion syndrome Incomplete abortion Uterine hemorrhage Infection Miss-suction or leakage Cervical and intrauterine adhesions Regret syndrome (long-term) Regret syndrome (long-term)

38. Medical abortion Is a kind of non operation of artificial abortion Could reduce the fear and pain on the operation of women Long bleeding time and the potential risk of major bleeding Is the only remedy for contraception failure Not a contraceptive method vaginal bleeding Vacuum abortion <7 days Medical abortion 14-15 days 19.2% complete abortion >21 days 1.5% emergency curettage 0.16%blood transfusion

39. Medical contraindications Mifepristone: – endocrine disease – history of ICP – blood disease – history of thrombosis Prostaglandin contraindications: – cardiovascular disease – Glaucoma – Asthma – Epilepsy – colitis Other: – allergic constitution – IUD with pregnancy – ectopic pregnancy – hyperemesis gravidarum – medication (anti tuberculosis, epilepsy, anti depression, anti prostaglandin drug)

40. The choice of family planning methods The wedding Lactation After birth Menopausal transition period

41. Questions?