Family Planning Methods Hormonal Contraceptives AN OVERVIEW OF

Family Planning Methods Hormonal Contraceptives

AN OVERVIEW OF CONTRACEPTIVE METHODS What is Contraception? Contraception means preventing pregnancy. What is contraceptive? A contraceptive is a drug, device, or a method used to prevent pregnancy or reduce the chances of getting pregnant without avoiding sexual intercourse.

Categories of Family Planning Short term – Condoms, Pills, Depo-Provera Long-term family methods – Implants and IUDs Permanent vasectomy – Tubal ligation and

Types of contraceptive methods � Hormonal and Non-Hormonal contraceptives 1) Hormonal Contraceptives: These are contraceptives methods with hormones. � � Combine oral contraceptives (COCs) – These contain two hormones; estrogen and progesterone similar to the natural ones in a woman’s body. eg of COC – Microgynon, Lofeminal, Eugynon.

MECHANISM OF ACTION � Suppresses � It ovulation. prevents implantation.

Advantage • • � � � Highly effective when taken correctly; 92 - 99. 9%. Reversible, easy to use and safe for most women Client controlled Does not interfere with sexual intercourse Widely available and accessible Non contraceptive Benefits � Reduce the risk of: � - benign breast disease � - ovarian & endometrial � cancer

DISADVANTAGES Client dependant – must be taken every day Requires regular supply Minor side effects in some clients May cause rare but serious circulatory system complications especially in women > 35. No protection from STIs/HIV

Family planning methods a. COCs are safe and can be used by most women including: Women requesting an effective reversible Women who have not been pregnant before method Irregular menstrual cycles

Family planning methods Anemia due to heavy menstrual bleeding History of ectopic pregnancy Family history of ovarian cancer, history of benign, functional ovarian cysts

WHEN TO INITIATE METHOD COCs can be started at anytime of the menstrual cycle when provider is reasonably certain client is not pregnant. Postpartum after 3 weeks if not breastfeeding or after 6 months if breastfeeding or when weaning foods are introduced.

Tell client what to do if she forgets to take pills � If you forget to take one or two pills, take the missed pill as soon as you remember and continue taking the pill as usual. � If client misses three or more pills she should take active pill as soon as she remembers but should use a backup method for the next 7 days. If she had unprotected sex within the last 5 days emergency contraception should be considered.

Progestin-only pills (POPs) These are oral contraceptive pills containing only one hormone (progestin). They are also known as mini pills. They do not contain oestrogen and also contains less progestin than combined pills. Examples – Microlut, Ovrette,

Progestin-only pills (POPs) MECHANISMS OF ACTION Suppresses ovulation Thickens cervical mucus preventing sperm penetration Thins endometrial lining making implantation less likely Reduces sperm movement in fallopian tubes

ADVANTAGES Highly effective when taken correctly; 92% - 99. 9%. Reversible, easy to use and safe for most women. It is widely available and accessible Non contraceptive Benefits Reduce the risk of: benign breast disease ovarian & endometrial

ADVANTAGES cancer functional ovarian cysts ectopic pregnancy symptomatic PID Menstrual improvements (regularity and flow) Reduces menstrual cramps and bleeding problems Reduces the risk of iron deficiency anaemia

DISADVANTAGES Changes in menstrual bleeding pattern; irregular bleeding, spotting in some women. Has to be taken orally daily. Some weight gain or loss may occur.

DISADVANTAGES Requires continuous supply. Effectiveness may be lowered when client is on certain drugs such as phenytoin and barbiturates for epilepsy or rifampicin for tuberculosis. Does not protect against STIs including HIV.

WHEN TO INITIATE METHOD POPs Can be started at anytime during the menstrual cycle when provider is reasonably certain the client is not pregnant (first day of menstrual cycle is preferred). If within 5 days of menses no need for a backup method but if after day 5 use a backup method or abstain from sexual intercourse for 2 days.

WHEN TO INITIATE METHOD In the Postpartum: 6 wks after delivery if breastfeeding. Immediately or within 3 weeks if not breastfeeding. Post abortion within 7 days.

INSTRUCTIONS ON HOW TO USE POPs • • • Explain type of pack supplied Explain to client that all pills on pack are active pill and that she should take one pill each day until pack is empty. Start a new pack immediately after finishing the previous pack.

INSTRUCTIONS ON HOW TO USE POPs • Show her how to take the first pill from the pack and follow the arrows for the rest of the pills. • Discuss with client how she can remember taking pills everyday such as linking taking of pills with a routine daily activity.

INSTRUCTIONS ON HOW TO USE POPs cont: • • • If you vomit within 2 hours of taking a pill, take another pill or use a backup method if you have sex during the next 48 hours. If you forget to take one or more pills, you should take the missed pill when you remember, then continue on normal pill schedule. Use a backup method if you have sex during the next 48 hours Explain that for breastfeeding women effectiveness of the method reduces with the cassation of breastfeeding

Dispelling Myth and Misconception regarding POP Cause birth defects Cause infertility Require a rest period Generally decrease sex drive Build up in woman’s body

EMERGENCY CONTRACEPTIVES PILLS (MORNING AFTER OR POST – COITAL PILL) � Emergency contraceptive pills help to prevent pregnancy when taken up to 5 days after unprotected sex. The sooner they are taken after unprotected sex the better the protection. NOTE: they do not disrupt an existing pregnancy. � They are safe and suitable for all women including even women not on ongoing regular hormonal contraceptives. � Pill Formulations and dosing for emergency contraception varies with type so provider should follow manufacturer’s instructions

MECHANISM OF ACTION Works mainly by preventing or delaying ovulation and is not effective if a woman is already pregnant. When to take It should be taken as soon as possible after unprotected sex, though it can prevent pregnancy up to five days after unprotected sex. Effectiveness 98% effective with progestin only emergency contraceptives and 99% effective for combined emergency contraceptives.

Advantages Prevents pregnancy with 5 days of unprotected sex. Immediate return to fertility. Can be taken at any time after unprotected sex. No routine test or examination required before use. Can be used when client misses her pill. It is controlled by client. Risk of abortion is reduced

Disadvantages Does not protect against pregnancy after taking i. e. does not act as ongoing contraceptive. Does not protect against sexually transmitted infections Side effects Changes in the bleeding pattern; irregular bleeding, early or late bleeding. Nausea and sometimes vomiting. Headaches, Fatigue, Breast tenderness, abdominal pain, fatigue and dizziness.

PROGESTIN-ONLY INJECTABLE CONTRACEPTIVE (PIC) These are contraceptive injections containing female hormone (progesterone). - Examples of Progesterone only injectables – Depo. Provera, Noristerat.

PROGESTIN-ONLY INJECTABLE CONTRACEPTIVE (PIC)

PROGESTIN-ONLY INJECTABLE CONTRACEPTIVE (PIC) They are long acting and protect women against pregnancy. It can be used by breastfeeding women and those who cannot take oestrogen.

TYPES � Depot -medroxyprogesterone acetate 150 mg (Depo-Provera, DMPA) – this is administered every three months. � Norethisterone enanthate 200 mg (NET-EN) – administered every two months)

ADVANTAGES OF PROGESTIN ONLY INJECTABLES � It is highly effective; 97%. When used regularly and on time less than one pregnancy per 100 women, over the first yr 3/1000 women. � It is safe, easy to use and reversible. � Does not interfere with sexual activity.

ADVANTAGES OF PROGESTIN ONLY INJECTABLES � Suitable � Non � Can for lactating mothers. contraceptive benefits. be started without pelvic or other routine laboratory tests.

ADVANTAGES OF PROGESTIN ONLY INJECTABLES Clients on net-en experience fewer days of bleeding and are less likely to have amenorrhea by the end of the first year. Protects against iron deficiency anaemia, endometrial cancer and symptomatic PID. It reduces the frequency of sickle cell crisis in clients with sickle cell

DISADVANTAGES weight gain (especially with DMPA), headache, dizziness and mood changes Cannot be stopped immediately Abdominal bloating and discomfort

DISADVANTAGES Does Has not protect against STIs. to be taken every 3/2 months. Delay in return to fertility; on average 4 months longer than other methods (DMPA only).

WHEN TO START Progestin only injectables can be started at any time of the menstrual cycle when provider is reasonably certain client is not pregnant. If within 7 days of start of menstruation no back up is needed, if after 7 days she should use a backup method for the first seven days after injection. Postpartum 6 weeks after delivery if breastfeeding, and within 4 weeks if not breastfeeding. Post abortion or miscarriage if starting within 7 days no need for a back up but if after 7 days a back up is needed for the first 7 days

MODE OF ACTION � Thickens cervical mucus, preventing sperm penetration. � Changes endometrial lining making implantation less likely. � Reduces sperm movement in fallopian tubes. � Suppresses ovulation.

WHO CAN USE PICs � Almost all women can safely and effectively use progestin only injectables including

How to administer the injection � Wash hands with soap and water. � Use a disposable autodestruct syringe and needle, check expiration date. � Prepare DMPA – gently shake vial. � Shaking not required for NET-EN. � Pierce top of vial and withdraw

How to administer the injection � Insert needle deep into the muscles in the upper arm or in the buttocks and inject the entire content of syringe. � Do not massage injection site. � Drop needle into a safety box. � Inform client to come back any time she has problems or concerns or wants to switch method. � Agree on a date for next injection encourage her to come on time for her next injection.

Client instructions Do not rub the injection site. Return to the health clinic for an injection every 3 months (DMPA), every 2 months (NET-EN) and every month. PICs do not provide protection against STIs, including HIV, and HBV. Encourage woman to return at any time if she has problems or concerns.

Client instructions Dispelling Myth and Misconception regarding PICs does not: Cause birth defects Cause infertility Cause cancer

Implants These are hormonal devices which are inserted into the upper arm by a trained person. Eg of Progesterone only Implant – Jadelle

Implants A thin, flexible capsule made of a soft rubber-like material and filled with a synthetic progestin hormone that are inserted just under the skin of a woman’s upper arm by means of a minor surgical procedure. Implants provide protection from pregnancy for up to five years.

Implants

MODE OF ACTION � Suppresses ovulation. � Thickens cervical mucus preventing sperm penetration. � Thins out the endometrial lining making implantation less likely. � Decreases tubal motility.

ADVANTAGES � Implants � Rapidly are 99% effective (< 24 hours). � Long-term � Do method (up to 5 years protection). not interfere with intercourse

ADVANTAGES � Immediate � Less � No return of fertility on removal. side effects than POPs and COCs. supplies needed by client. � Can be provided by trained non-physician (nurse or clinical officer).

DISADVANTAGES May cause changes in menstrual bleeding pattern Weight gain or loss may occur Require trained provider for insertion and removal Requires minor surgical procedure observing infection prevention practices. It is provider-dependent. Effectiveness may be lowered when client is on drugs like phenytoin and barbiturates for epilepsy or rifampicin for tuberculosis Do not protect against STIs, including HIV/AIDS

When to initiate method Anytime as long as the client is not pregnant. Preferably within the first 7 days of the menstrual cycle. If starting after day 7, use a backup method or abstain from sexual intercourse for 48 hours.

When to initiate method Postpartum: After 6 weeks if breastfeeding Immediately or within 3 weeks if not breastfeeding Post abortion (immediately or within the first 7 days)

When to remove When clients develop unbearable side effects. When infection occur at the insertion site. When client wants a baby At 5 years after insertion of the implants When the client wants it removed

Dispelling Myth and Misconception regarding Implant does not: Build up blood in the woman’s body. Cause Move infertility. to other part of the body.

Non-Hormonal Contraceptives

Non-Hormonal Contraceptives � Barrier Methods: - e. g. male and female condoms � IUD – Copper T � Male and Female sterilisation � Can anything make condoms less effective?

Non-hormonal cont General information on condoms. Sperm can get into the vagina during sex, even if condom is been used. This may happen if: - The penis touches the area around the vagina before a condom is put on. - The male condom splits/breaks - The condom is not the right type or size - The is condom not used correctly - The male condom slips off or female condom gets pushed too far into the vagina - Use too much or too little lubricant

Non-Hormonal Cont Advantages of condoms - It is highly effective (MC-98%, FC-95%) - Is only use during sex. - It helps protect users from some STIs including HIV. - They have no serious side-effects. - Male condoms are easily available. - Female condom can be put in any time before sex.

Non-hormonal cont � - Disadvantages of condoms it can interrupt sex. MC can sometimes slip off or split. It can sometimes cause some side effect.

CONDOM - Male: Are Male Condom (MC)? What This is a sheath, or covering, that fits over a man’s erect penis. It is mostly made of thin latex rubber. It is commonly called rubbers, “raincoats, ” “umbrellas, ” skins, and also known by many different brand names eg protector plus.

How to use a male condom? � Use a new condom each time to have sex. � Check the ‘use by’ date on the packet. � Open the packet with care to avoid breakage/puncture � Squeeze teat or close end to get rid of air. � Ensure it is not inside out � Put the condom on when the penis is fully erect. � Still holding the end, roll the condom all the way down the base of penis.

Remove condom immediately after ejaculation. Wrap it and put it in a bin. Do not put it down the toilet.