FERTILITY CONTROL

LECTURES ON

GYNECOLOGY

DR MAGDA HELMI

Birth control, also known

as contraception and fertility control, is methods

or devices used to prevent pregnancy. Planning,

provision and use of birth control is called family

planning Safe sex, such as the use of male

or female condoms can also help prevent sexually

transmitted infections. Birth control methods have

been used since ancient times, but effective and

safe methods only became available in the 20th

century. Some cultures limit or discourage access to

birth control because they consider it to be morally

or politically undesirable.

About 222 million women who want to avoid pregnancy

in developing countries are not using a modern birth control

method. Birth control use in developing countries has decreased

the number of maternal deaths by 40% (about 270,000 deaths

prevented in 2008) and could prevent 70% if the full demand for

birth control were met. By lengthening the time between

pregnancies, birth control can improve adult women's delivery

outcomes and the survival of their children. In the developing

world women's earnings, assets, weight, and their children's

schooling and health all improve with greater access to birth

control.Birth control increases economic growth because of fewer

dependent children, more women participating in the workforce,

and less consumption of scarce resources.

Contraception is freely provided in Egypt. A

wide range of method exists and people will use

different methods or different stages of their

lives. When women no longer wish to conceive,

they may consider Sterilization method,

although long acting reversible contraception is

increasingly encouraged as an alternative to

sterilization, despite the widespread availability

of contraception, unintended pregnancy is stile

common.

Contraception choice:For thousands of years many women around the world used contraception for extremely long periods of time, in their reproductive lifespan. People will use different types of contraception at different stages in their lives and there is no one method that will suit everyone.Women tend to take most of the responsibility for contraception, but the needs and wishes of the male partners should also be considered if a method is to be used effectively.There is no perfect method of contraception and each method will have a balance of advantages and disadvantages.

Characteristics of the ideal contraceptive method would be:highly effective;no side effects or risks;cheap;independent of intercourse and requires no regular action on the part of the user;non-contraceptive benefits;acceptable to all cultures and religions;easily distributed and administrated by non healthcare personnel.

Classification of contraception

methods:

Combined hormonal contraception

The pill

Patches

The vaginal ring

Progestogen-only preparations

Progestogen-only pills

lniectables

Subdermal implants

Hormonal emergency contraception

Intrauterine contraception

Copper intrauterine device HUD)

Hormone-releasing intrauterine system (IUS)

Barrier methods

Condoms

Female barriers

Coltus interruptus

Natural family planning

Sterilization

Female sterilization

Vasectomy

The efficacy rates of the various Contraceptive methods All methods of contraception can occasionally fail and some are much more effective than others. Failure rates are traditionally expressed as the number of failures per 100 woman-years (HWY), i.e. the number of pregnancies if 100 women were to use the method for one year. The effectiveness of a method depends on two factors:I -how it works;2- how easy it is to use.Failure rates for some methods vary considerably, largely because of the potential for failure caused by poor use (user failure) rather than an intrinsic failure of the method itself Methods which prevent ovulation are usually highly effective because if there is no egg then fertilization simply cannot occur.However, if for example, pills are forgotten, then breakthrough ovulation can occur and failure rates are higher. Methods which require no regular need for the user to remember to do anything, for example an intrauterine device or Implanon®, are generally much more effective than methods which rely on the user to do something regularly.

Compliance and continuationMany people use contraception incorrectly and inconsistently. Studies looking at pill use report nearly half of all women missing at least one pill per packet and a quarter missing two pills. The contraceptive injection is highly effective, but women can forget to attend for their repeat injection. Methods which require correct use with every act of intercourse have the highest failure rates, for example condoms, natural family planning.

Failure ratesWomen are often quick to stop contraception because of perceived side effects, such as weight gain or mood change. Methods which need to be inserted or removed by health professionals tend to have better continuation rates as they cannot be easily abandoned in the heat of the moment. Increasing the uptake of implants, injectables and intrauterine contraception (long-acting reversible contraception or LARC) is a key strategy to reduce unplanned pregnancy.

Method of contraception Failure rate

Combined oral contraceptive pill

Progestogen-only pill

Depo-Pmvera

Implants

Copper IUD

Mirena

Male condom

Diaphragm

Natural family planning

Vasectomy

Female sterilization

0.1-1

1-3

0.1-2

0.1

1-2

0.5

2-3

1-15

2-3

0.02

0.13

Effectiveness of Contraceptive Methods

ContraindicationsAlthough contraception is generally extremely

safe, some methods do have very rare but

serious risks. It is important to establish any

factors in the medical history that could

contraindicate a particular method. No

method is contraindicated by age alone. The

World Health Organization (WHO) has

published clear guidelines on assessing the

criteria for contraceptive use.

category Classification of condition Use of the method in practice

1 No restriction for

the use of the

method

Use in any

circumstance

2 The advantages

of using the

method generally

outweigh the

theoretical or

proven risks

Generally use

3 The theoretical

or proven risks

` usually outweigh

f the advantages of

using the method;

requires careful t

clinical judgement

and access to

t clinical services

Not usually

recommended

unless

other, more

appropriate,

methods are

not available or

not acceptable

Represents an

unacceptable

health risk if the

5 contraceptive

l method is used

Do not use

Eligibility

criteria for

contraceptive

use:

Non-contraceptive health benefitsSome methods of contraception offer significant benefits over and above their contraceptive effect which can be important factors in contraceptive choice. Condoms prevent sexually transmitted infections.Many methods containing hormones, particularly the Mirena®, help heavy or painful periods. Some women who do not need contraception choose to use hormonal preparations for these benefits alone.The combined pill protects against both ovarian and endometrial cancer. Condoms and diaphragms both protect against cervical cancer.

The contraceptive consultationDuring the contraceptive consultation, there is often a great deal of information to discuss and not much time. The user needs to make an informed choice about which method to use. The discussion about a method needs to cover:• Mode of action;• Effectiveness;•Side effects or risks;•Benefits;

Contraceptive counseling is

multidisciplinary and specialist nurses play

an important role. Some methods of

contraception are only available on

prescription, whereas others can be used

without ever having to seek medical

advice. Counseling about sexually

transmitted infections (STI) and HIV risk

reduction and prevention is an integral part

of a comprehensive contraceptive

consultation.