Lecture on contraceptive methods applied to women

2021-01-30 12:00 AM

In addition to the high effectiveness of contraception, contraceptive methods must not affect the user and be widely accepted for use.

Contraceptive methods are measures aimed at preventing fertilization and implantation. It can be a mechanical or chemical barrier that inhibits the formation of gametes, or prevents the implantation of eggs.

The prevention of unplanned contraception and birth spacing have profound effects on health protection, reducing morbidity and mortality of mothers and children. However, the application of contraceptive methods must be a voluntary decision based on the client's choice of an appropriate method after fully receiving information about each method. The role of the medical staff is to provide the client with all the advantages and disadvantages as well as how to use each method.

The effectiveness of contraceptive methods is calculated according to the Pearl Index (P):

P = (Number of failures x 1000) / (Total number of cycles observed)

P: Number of pregnancy failures / 100 women using contraceptive / 1 year.

In addition to the high effectiveness of contraception, contraceptive methods must not affect the user and be widely accepted for use.

Intrauterine device

The intrauterine device has been confirmed as a highly recognized method of contraception for wide use. The intrauterine device is by far one of the most highly effective and widely used contraception.

Types of intrauterine devices

The intrauterine device is divided into two types: closed loop and open loop.

Open uterine devices: (TCu, Multiload).

Closed intrauterine device: (Ota, Dana).

Contains copper.

Contains medications.

The intrauterine device is made of Polyethylene with Barium Sulfate for contrast.

Shape: the intrauterine device has many different shapes such as circles (Ota), spiral (Margulies), S-shaped (lippes, Dana), T-ring (T, Tcu).

Size: Some intrauterine devices come in many different sizes.

There are two basic types of intrauterine devices: copper-free or drug-impregnated (inert) and copper- or medicated. an intrauterine device with copper or medicine, to give the substance or the copper release a higher contraceptive effect. The area of ​​the copper face around the uterine device can be more or less 120 - 380 mm. The more copper area, the higher the contraceptive effect. Levonorgestrel (Mirela) impregnated type contains 52 mg of Levonorgestrel slow release 20 mcg / day.

In Vietnam, the widely used type is Multiload 375 (MLCu 375) with 2 foldable wings, 375mm copper wire and TCu 380A. T-shape with a 314 mm copper wire wrapped around the T body, 2 horizontal wings with 2 33mm copper pieces, T leg with a colorless wire tied to create a double wire.

Mechanism of action

Basic mechanism of action of intrauterine devices: 

Causes a secondary inflammatory reaction in the uterine lining, destroys sperm, prevents the implantation of a fertilized ovule.

Thickens mucus in the cervix, impeding sperm movement (for hormonal-containing devices).

Advantages

The intrauterine device is highly effective in preventing pregnancy, especially the Tcu 380A with a failure rate of less than 1%.

Easy to use, economical, does not affect health, long-term contraceptive period, only 1 time of contraception from 10-12 years (Tcu 380 A), easy to get pregnant after removing uterine device.

Point

Indicated for all subjects who want to avoid temporary or long-term contraception in childbearing age (including during lactation).

An intrauterine device (copper-containing type) is also used as an emergency contraceptive.

Contraindicated

Gynecology: Menstrual disorders (menorrhagia, bleeding, dysmenorrhea), infections of the upper genital tract, bacterial vaginosis - cervix; postpartum infection or infection caused by abortion, benign or malignant tumors of the genitals, uterine malformation.

About obstetrics: pregnant or suspected to be pregnant.

Other conditions: deep thrombophlebitis or pulmonary embolism, severe liver failure or liver tumors (for intrauterine devices containing levonorgestrel).

The timing of the intrauterine device

The best time to place the intrauterine device is 3 days after the period is clear because it is less likely to become pregnant. However, an intrauterine device can be inserted any day during the period, when the person is certain that the person is not pregnant.

Postpartum: Can be booked after 6 weeks (end of the postpartum period). It must be noted that at this time the uterine muscle is very soft, easily punctured. It is also possible to place an intrauterine device after menstrual regulation suction or an abortion, but provided that there is no residue of vegetables and infection.

Intrauterine device (copper-containing type) for emergency contraception: Insertion should be done as soon as possible within 5 days after unprotected sex.

After placing the intrauterine device, the woman should abstain from intercourse for 1 week. According to the re-examination appointment of medical staff, usually again at the following times:

1 month, 3 months after booking.

1 year to check again.

When there are unusual signs such as: woman does not feel the cord of her uterine device in her vagina, delayed period (suspected pregnancy), bleeding or unusual bleeding, abdominal pain or pain during intercourse If there is a lot of damaged gas, accompanied by a fever, they must be examined immediately at medical establishments.

Side effects and complications

Possible side effects:

Abdominal pain: Woman may feel cramping for several days after the intrauterine device is placed. With copper, more women experience menstrual cramps more. 

Bleeding: Bleeding right after a uterine device is placed or bleeding is occurring more often than usual. Bleeding usually occurs in the first 2 - 3 months after insertion. If more than 3 months, bleeding symptoms do not decrease, need to be examined again.

In case of using a levonorgestrel intrauterine device, you may experience mild and irregular drip bleeding in 4-6 months, then return to normal and your menstrual volume may be less.

Possible complications include:

Some possible complications are perforation of the uterus, infection, heavy bleeding, pelvic pain, menstrual periods, an intrauterine device entering the abdomen and possible pregnancy.

Birth control pills

Since 1950, the emergence of oral contraceptive (Pincus) is a great invention. This is a temporary, highly effective method of contraception. Along with the intrauterine method, it significantly contributes to reducing the rate of global population growth, and thereby reducing the morbidity and mortality rates of mothers, couples have been able to take control of the distance. childbirth.

Contraceptive pills

Combination oral contraceptive (VKH):

Ingredients: Combination oral contraceptive pill consists of 2 components:

Synthetic estrogens: Ethinyl-estradiol (EE).

Synthetic progestins: 17 hydroxyprogesterone’s or 19-nortestosterones. The current trend is to use generation 3 progestatif with little undesirable effects.

Progestin is the main contraceptive, but in the contraceptive mechanism, estrogen and progestin both have a synergistic effect on the pituitary. Estrogen is the ingredient to deal with the drip bleeding caused by the progestin alone, but the side effects and complications of oral contraceptives are often caused by estrogen.

The dose of EE is 50mcg for the classic tablet, 20-35 mcg for the low dose tablet. The failure rate of VKH ranges from 0.1% to 5% mainly due to incorrect use.

Presentation of the drug:

In family planning programs, a single-phase combined oral contraceptive is now commonly used: a combined dose of progestin throughout the cycle:

Type 1 stage:

Microgynon, New choice, Ideal (Levonorgestrel 0.15mg, EE 0.03mg).

Rigevidon (desonorgestrel 0.15mg, EE 0.03mg).

Marvelon (desogestrel 0.15mg, EE 0.03mg).

Mercilon (desogestrel 0.15mg, EE 0.02mg).

Phase 2: Prgestatif dose increased at 10 days after menstrual cycle (Gynophase, Adepal, miniphase)

3-phase type: 3-phase tablets allow to reduce the total steroid dose but the contraceptive effectiveness has not changed (Tri-Regol, Tri-Mihulet, Tri-nordiol).

The drug is packed in blister packs of 21 tablets or blister packs of 28 tablets (including 21 tablets with medicinal ingredients and 7 pill-free buffers).

Contraceptive mechanism:

Suppression of oocyte release by inhibiting the release of FSH, LH from the hypothalamus - pituitary axis.

Interferes with implantation of the egg due to inappropriate endometrial alteration.

Preventing sperm movement due to thickening of cervical mucus.

Indications: All women who want to use a highly effective temporary contraceptive and have no contraindications.

Contraindications:

Pregnant or suspected pregnancy.

Are breastfeeding and less than 6 weeks after birth

Unexplained vaginal bleeding of unknown cause.

Tracking types of tumors.

Women over 35 years of age smoke cigarettes.

Medical conditions such as high blood pressure, diabetes, liver disease, kidney disease ...

Treatment with anticonvulsants such as Phenytoin, Carbamazepine, Barbiturate or antibiotics such as Griseofulvin, Rifampicin.

Side effects:

Drip bleeding is common in the first 2-3 menstrual cycles immediately after taking the drug.

Breast erection, pelvic pain (fake pregnancy).

Headache, psychological changes, libido.

Light weight gains due to salt retention, water retention.

These side effects usually appear only in the early days of taking the drug.

Using:

Start taking the first pill from day 1 to day 5 of the cycle, taking one pill each day at a certain time following the arrow on the pack. With a pack of 28 pills, when the blister runs out, take the first tablet of the next pack the next day even though you are still having periods. With a blister of 21 tablets, when the blister runs out, rest for 7 days and then use the next blister pack.

Postpartum do not breastfeed: drink from the fourth week after birth.

After curettage, after a miscarriage, it can be started as early as the first 5 days after curettage.

Management of forgetting pills: If you forget a pill, take it as soon as you remember and continue as usual. If you forget the pill for 2 consecutive pills, you must take 2 pills a day for two days after that. At the same time, use additional supportive contraception until the pack is gone. If you forget 3 or more pills, discard the pack and start using a new pack. Take supportive measures for the first 7 days. Every year, women need to go for checkups once or when there are signs of abnormalities

Pure oral contraceptive:

Progestin-only contraceptive pill, no Estrogen. In addition to its contraceptive effect, it is often used for therapeutic purposes. 2 types:

Microprogestatif, low-dose continuous progestin:

Composition and presentation of the drug:

The most commonly used low-dose progestin contraceptive is EXLUTON (lynestrenol 0.5mg), blister pack of 28 tablets. Also, can be found in the market: Microval (Levonorgestrel 0.03mg), Milligynon (Norethisterone Acetate, 0.6mg). Ogyline (norgestrienone).

Contraceptive mechanism:

Thickening cervical mucus, preventing sperm from entering the genital tract. Atrophy of the endometrium, reducing the ability to nest.

The contraceptive efficiency is high at 97%.

High-dose Progestin (macroprogestatif) tablets:

Possible preparations are: Norluten (Norethisterone 5mg), Orgametril (Lynestrenol 5mg). Some drugs derived from progesterone such as Lutenyl (No megestrol 5mg), Luteran (Chlormadinone 5mg), Surge stone (Promegeston 0.125mg) are less masculine when used for a long time. High-dose progestin pills are of little use for contraceptive purposes and are often used therapeutically.

Emergency contraceptive pills:

The emergency contraceptive pill is also called the morning after pill.

Mechanism of action: making the uterine lining unfavorable for implantation.

Indications: In case of unprotected sexual intercourse, sexual assault.

Usage: Progestin-only emergency contraceptive pills: The commonly used type is Postinor (Levorgestrel 0.75mg) The first pill to be taken as soon as possible within 72 hours after unprotected intercourse, the second pill two drink 12 hours after the first.

Combined oral contraceptive pill (Ideal, Choice, New choice, Tetragynon): Take 4 combined oral contraceptive pills within 72 hours of sex, 12 hours, then take 4 more.

Common side effects include dizziness, nausea, and vomiting after taking emergency contraceptive pills.

Contraceptive injection

The injectable contraceptive DMPA is a hormone progestin that works to prevent pregnancy for 1 month or 3 months.

Depo-provera (medroxyprogesterone acetate) is a natural progesterone preparation that is prepared in a small crystalline emulsion and is therefore slowly absorbed.

Noristerat (noréthisterone) 200mg.

Mechanism of action: DMPA injection continuously inhibits oocyte release, thinning the uterine lining and thickens cervical mucus.

Indicated for women who want to use a long-term, reversible, highly effective contraceptive without having to take daily pills. Advantages: High efficiency, long-lasting effect, just injected once for 4 weeks, 12 weeks.

It is possible to restore fertility. Does not affect much the heart, suitable for women over 35 years old to be careful with estrogen. Can be used for lactating women, does not affect intercourse, easy to use.

Side effects: drip bleeding, mid-period menorrhagia, amenorrhea, mild weight gain. Prolonged use is usually associated with a decrease in bone mineral density and will return to normal after discontinuation of the drug.

Contraindications: less than 6 weeks after birth; Many risk factors for cardiovascular disease; Uncontrolled high blood pressure; Vascular disease; are suffering from deep thrombophlebitis; have a history of or have heart disease caused by anemia; history of stroke; have a history or history of breast cancer; insulin-dependent diabetes with vascular changes or disease course over 20 years; are suffering from viral hepatitis, severe cirrhosis, and liver tumors.

Cons: Because the drug has a long-lasting effect, it is not possible to stop working immediately or take it out of the body when an accident occurs or want to get pregnant again.

The failure rate is 0.3%.

Time of injection, dose: The shot can be taken at any time during the menstrual cycle as long as there is definitely no pregnancy. Best within the first 7 days of your period or after curettage. If breastfeeding, the injection is 6 weeks after giving birth.

The standard regimen is a dose of 150mg DMPA every 12 weeks, intramuscularly. Maybe 2 weeks early or later still works.

Contraceptive implants

Current contraceptive implants have 2 types:

Norplant: This type has 6 soft, bioplastic shells, each containing 36mg Levonorgestrel. This hormone seeps through the follicle wall into the bloodstream continuously, ensuring a contraceptive effect lasting 5 years. The failure rate is 0.2%.

Implanon: Only one capsule contains 68mg Etonogestrel and lasts for 3 years.

Place of implantation: the inside of the non-dominant arm (usually the left hand), the implant is shallow under the skin.

Noplant implanted 6 fan-shaped capsules.

The implanon is implanted in the middle of the inside of the arm. The main side effect is dripping vaginal bleeding.

Spermicide

Are substances with chemical effect to kill or lose the ability of sperm to move. In addition, it acts as a solvent to create a barrier, or to create a foam to push sperm away from the cervix.

Commonly used substances: lactic acid, nicoceptin, nonoxynol 9, Chlorure benzalkonium (Pharmatex). Medicines must ensure sperm kill fast, not cause discomfort, not reduce pleasure. The drug is produced in the form of a cream, emulsion, suppository, effervescent tablet, a type of effervescent nebulizer to reach the vagina.

5 minutes before intercourse put or pump drugs into the vagina, the drug only works within 1 hour. The downside is that it causes vaginal heating, and every time you have sex, the drug must be re-placed.

The failure rate is about 10%. Should combine spermicide with one of the other birth control contraceptive results will be higher.

Traditional methods of contraception. As simple contraceptive methods, easy to apply, with short-term contraceptive effects. These are methods that have been used for a long time and have certain effects in limiting population growth.

The Ogino-Knauss method

The Ogino-Knauss method is a classical contraceptive and remains one of the most popular today.

Mechanism of action:

Ovulation-based methods always occur at a fixed time 12-16 days before the next menstrual period. It is estimated that the fertilization time of the ovule is about 10 - 24 hours, the time for fertilization of the sperm in the female genital tract is 48 hours. So if you want to avoid pregnancy, you should avoid intercourse 2 days before the expected ovulation and 1 day after ovulation.

Ogino-Knauss is a natural contraceptive by avoiding intercourse during ovulation. The effectiveness of this method depends on the individual and the level of monitoring to determine the correct ovulation period or not. In addition, this method is characterized by difficult to apply for women who do not have the habit of regular menstrual monitoring, in lactating, amenorrhea. Failure rates range from 2-21%.

Measures for amenorrhea

Can be used in women who are exclusively breast-feeding, have not returned from menstruation and children under 6 months of age. Contraceptive effectiveness can be up to 98%.

Measures based on breastfed babies act on the hypothalamus, affecting the level and rhythm of the secretion of releasing hormones, inhibiting oocyte release.

This is a highly recommended contraceptive method in developing countries.

Cervical cap, vaginal diaphragm

A metal or plastic device that prevents sperm from entering the uterus. The failure rate of the vaginal diaphragm, cervical cap is nearly 20% for each type. These methods are currently very little used.

Voluntary sterilization. Sterilization is a highly effective, simple and reversible measure with surgical intervention.

Female sterilization

Is a method of blocking the uterine tube, permanently preventing sperm and eggs from meeting for fertilization?

Contraindications and contraindications

All women voluntarily apply.

Advantages and disadvantages of the female sterilization method

Contraceptive effectiveness can reach 100% if cut and tied correctly, does not affect menstruation, health, psychophysiology and sexual performance.

Perform the female sterilization method

Time:

Postpartum: Taking it from 24 to 48 hours is easiest.

After curettage, after miscarriage.

Combine sterilization in cesarean section, gynecological surgery.

Technique: Sterilization is a small surgery, just cut the abdominal wall about 2 cm to pair 2 oviducts to constrict and cut. In addition, female sterilization can be done through endoscopy with a bronchoscope, which is inserted through a small cut into the abdomen, followed by an electrosurgical procedure. This method requires expensive and complex equipment and is also not easy to do.