ContraceptionBy Emma Brazier and Harvey Davies

Outline

Types of contraception

How each type works

The advantages and disadvantages to each type

Why do people want contraception?

Reproductive choice – when or if to have a child

Can prevent STIs

Population control

Types of Contraception

Natural

Barrier

Hormonal

Other

Surgical

IUD

Natural

Rhythm

Avoid intercourse in the fertility window – 4-5 days prior and 1-2 days after ovulation (can be predicted with watery spinnbarkeit mucus, raise in morning temperature etc.)

Pros: cheap, no side effects, nothing extra needed, Pope approved

Cons: 9% failure rate per year, no protection against STIs

Coitus interruptus

Penile withdrawal before ejaculation

Pros: cheap, no side effects, nothing extra needed

Cons: significant failure rate, no protection against STIs

Lactation

Requires REGULAR breast feeding (every 4-6 hours). Prolactin suppresses HPO axis, thus no ovulation, and works for up to 6 months)

Pros: cheap, no side effects, nothing extra needed

Cons: significant failure rate, no protection against STIs

Barrier

Condom

Pros: cheap, easily available, STI protection

Cons: some sensation loss, latex allergies

Diaphragm and Cervical Cap

Pros: don’t alter sensation, reusability

Cons: requires professional fitting first time (needs uterus orientation checking), needs to be washed and cleaned between uses

Spermicide

Good at aiding other forms of contraception

Shouldn’t really be used in isolation

All act to prevent living

sperm entering the

uterus

Hormonal

Combined Oral Contraceptive Pill

Contains oestrogen → stops ovulation and thins uterus, and progesterone → thickens cervical mucus

Pros: makes periods lighter, regular, and less painful; >99% effectiveness; lowers ovarian, uterine, and colon cancer risk

Cons: hormonal side effects (acne, breast tenderness, mood changes, weight gain etc.), not suitable for overweight or smokers, increased clotting risk

Progesterone-Only Pill (Mini Pill)

Progesterone thickens the cervical mucus, and in 20% HPO inhibition (stopping ovulation)

Pros: >99% effectiveness; can use while breast feeding, overweight, smokers, or when CI to oestrogen; reduces PMS

Cons: hormonal side effects (acne, breast tenderness, weight change and headaches), increased risk of ovarian cysts, taken same time every day

Hormonal

Injections

Depot of slow releasing progesterone injected

Pros: >99% effectiveness, no worry about compliance, lasts 12 weeks, breastfeeding friendly, may relieve some symptoms of PID/PMS

Cons: hormonal side effects

Implant

Implanted rod containing slow release progesterone

Pros: >99% effectiveness, reduces dysmenorrhoea, can cause amenorrhoea, lasts up to 3 years

Cons: hormonal side effects, minor invasive procedure, irregular bleeding

Hormonal

Patches Adhesive patch contain oestrogen and progesterone (same as COC Pill)

Pros: >99% effectiveness, lowers menstrual symptoms, can improve acne, not affected by D&V

Cons: requires weekly change, skin irritation, not suitable for overweight people or smokers, clotting risk

Rings Vaginal ring containing oestrogen and progesterone (same as COC Pill)

>99% effectiveness, lowers menstrual symptoms, can improve acne, not affected by D&V, can be left in for 21 days

Cons: need to be comfortable inserting them, not suitable for overweight people or smokers, clotting risk

Other

IUCD (Intrauterine Contraceptive Device) Two main types: copper coil, Mirena (progesterone coated coil)

Act to prevent implantation via irritation of the uterus, ± progesterone effects

Pros: long lasting (1-10 years), no compliance problems, best form of emergency contraception

Cons: can cause bleeding or more cramping, requires checking for string, no protection against STIs

Sterilisation Tubal ligation or vasectomy

Pros: ‘irreversible’ contraception

Cons: Can fail, invasive, very costly

Emergency

May be needed in times of contraceptive failure, human failure, rape etc.

Main mechanism is to prevent implantation:

High dose progesterone

IUCD

Questions?Thank you for listening