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contraception

Dr Husni Samarah

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Birth control

To have babies by choice not chance

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Birth control

Permenant

Temporary

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Birth control

Pearl index = number of failures/

total months of exposure *1200

Life Table Analysis= calculates failure to each

month of use

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Birth control

Method effectiveness Best results

Use effectiveness typical results

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Oral Contraceptive Pills

Combined oral pills

Mini pills

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Oral contraceptive pills

OCP Estrogen Progestins

Mechanism of Action

Ovulation : estrogen inhibits FSH

progestin inhibits LH

Estrogen :potentiates progestincontrols irregular shedding

Containdications : Absolute

Relative

Noncontraceptive Benefits

Use of Minipills

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Transdermal and Vaginal Steroid

contraceptionAdvantages

Avoids first pass through the liver

Safe ?? Awaiting further assesment

Improve compliance

More options provides better family planning

Use

Skin patch once weekly for 3 weeks and 1 week free

Same as OCP concerning all considerations

It delivers E2 20 mcg daily

Norelgestromin 150 mcg daily

Vaginal Steroid contraception

NuvaRing delivers E2 15mcg daily

etonogestil 120 mcg daily

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Long-Acting Methods of

Contraception

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Implants:Norplant or Implanon

Depot Provera

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Indications

Women who desire effective long term

methods

Women in whom estrogen is not accepted

Poor Compliance

Anemia or heavy vaginal bleeding

Breast feeding wanted

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Cotraindications

Absolute

ACTIVE Thrombophlebitis

Undiagnosed bleeding

Active liver disease Liver tumors

Breast cancer

Relative

Smoking heavily

Ectopic pregnancy

Diabetes Hypercholesterolemia

Hypertension

Stroke

Gallbladder disease

Sever Acne

Migraine headache

Sever Depression

Drugs : hepatic inducers

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Intrauterine DeviceHistorical Background

Types : UnmedicatedCopper IUD

The Hormone-releasing IUD

Mechanism of Action

Mainly uterine cavity

Spermicidal uterine environmentInflammatory response

Copper effect localy

effect of Progestins

Side Effects

Increased uterine bleeding by 55%Pain

Amenorhea like Mirena IUD

Patient Selection

IUD Insertion vs removal

Special Situations

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Barrier Methods Of Contraception

Historical Background

Risks and Benefits of Barrier Methods

Types

Diaphragm

Cervical Cap

Cotraceptive Sponge

Spermicides

Condoms

Female Condom

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contraception

Permenent contraception

LaparatomyLaprascopy

Hysterscopy