I Hate PSM

Contraceptives: A Very Quick Review

Demography and Family PlanningMaternal and Child Health

Contraceptives are Broadly Divided into Two Classes

  1. Spacing methods
  2. Terminal methods

Spacing methods

  1. Barrier methods: Physical, Chemical & Combined
  2. Intrauterine devices:
  • Non – medicated (1st gen.) & Medicated (2nd & 3rd gen)
  1. Hormonal methods:
  • Oral pills and injectable Depot formulations
  1. Post-conceptional methods:
  • Menstrual regulation
    • Menstrual induction
    • Oral abortifacient
    • MTP
  1. Miscellaneous:
  • Abstinence, Coitus interruptus, Safe period (Rhythm) method
  1. Natural family planning methods: Not very reliable
  • Basal body temperature (BBT) method:
    • Cervical mucus method: observing change in the cervical mucus
    • Symptothermic method: combination of temperature, safe period & cervical mucus method
  • Breastfeeding: Only the initial 6 months or till menstruation begins, whichever is earlier

Terminal methods

  1. Male sterilization
  2. Female sterilization

BARRIER METHODS
1. Condom Nirodh condom

Condoms

2. Female condom Female condom

  • Polyurethane pouch to be worn by the female before the intercourse

3. Diaphragm
Diaphragms

Insertion of diaphragm

  • Vaginal barrier, Also k/a ‘Dutch cap’
  • To be inserted into the vagina and fitted over the cervix using the fingers
  • A spermicidal jelly is to be filled into it before insertion.
  1. SPERMICIDAL JELLY AND VAGINAL PESSARY Spermicidal pessary

INTRAUTERINE DEVICES

  • IUCDs are of Two Types
  1. Non-medicated or inert: first-generation intrauterine devices
  2. Medicated or bioactive: second & third generation
  • Second-gen. IUDs: release copper (Cu–bearing)
  • Third-generation IUDs: release hormones
  1. LIPPES LOOPLippes loop
  • Acts by inducing local inflammation in the uterine cavity.
  1. COPPER–T & MULTILOAD copper T

Multiload

Mechanism of action of Cu-T:
a. Induces mild inflammation in the endometrium.

  • lead to incapacitation of the ovum.
    • Hence the chances of its fertilization are reduced.

b. Alteration of biochemical composition of cervical mucus

  • Inhibits the motility and survival of the sperms.
    • sperm incapacitated for fertilization

c. Changes the milieu of the endometrial lining

  • Inhospitable for the implantation
  1. Hormone Releasing IUD Hormone Progestin IUD

Releases progestin Locally

  • Thickens cervical mucus
  • Thins the lining of the uterus
  • May partially suppress ovulation

ORAL CONTRACEPTION
Hormonal

  • Combined hormonal contraceptives Oral Contraceptive pills Mala N

Oral contraceptive pills Mala D

  • Contain both an estrogen and a progestin
  • Progestin-only contraceptives progesterone Progestin only pills
    • Progestin-only pill (POP)
    • Emergency contraceptive pill (ECP) containing Levonorgestrel

Non-hormonal

  • Centchroman (Ormeloxifene) Centchroman pills

INJECTABLE CONTRACEPTIVES (DMPA) Injectable contraceptive - DMPA

Mechanism of Action

  • Inhibiting ovulation by suppressing mid cycle peaks of LH and FSH
  • Thickening of cervical mucus due to depletion of estrogen

TERMINAL METHODS OF CONTRACEPTION (STERILIZATION)

  • Vasectomy Vasectomy model
  • Tubal Ligation Tubectomy model

Some Facts regarding terminal methods:

  • One of the two surgical procedures may be used for female sterilization.
  1. Laparoscopy:
  2. Mini laparotomy (minilap):
  • Male sterilization: Vasectomy
  • Vasectomy (esp. Non-Scalpel vasectomy) is preferable over tubectomy as it is simple, safer, and cheaper than tubectomy
  • Tubectomy/Vasectomy candidate may be compensated for a failure of a sterilization surgery

References

  • Tiwari, P. (2013). Mastering Practicals in Community Medicine. India: Wolters Kluwer Health.
  • Park’s Textbook of Preventive and Social Medicine