Hormonal Contraception and Family Planning Quiz

Family Planning

• Family planning aims to decrease birth rates, maternal mortality, unwanted pregnancies, and infant mortality.

Types of Contraception

• Natural contraception
• Mechanical contraception
• Hormonal contraception
• Surgical contraception

Comparing Contraceptive Effectiveness

• Implants, IUDs, female sterilization, and vasectomy are more effective than other methods (less than 1 pregnancy per 100 women in a year).
• Injectables, condoms, diaphragms, fertility awareness methods, withdrawal, and spermicides are less effective (about 30 pregnancies per 100 women in a year).

Natural Family Planning Methods (NFP) & Fertility Awareness Methods (FAM)

• NFP/FAM uses signs, symptoms, and cycle data to determine ovulation.

• Couples using NFP abstain from intercourse during fertile days.

• FAM often combines NFP with another method, such as barriers or withdrawal.

• The same techniques used for preventing pregnancy can also help women become pregnant.

• Methods: Calendar (rhythm) method, basal body temperature, cervical mucus method, symptothermal method (cervical mucus + body temperature), lactational amenorrhea method, and withdrawal (coitus interruption).

Who Can Use Which Methods?

• Clients may have personal reasons, religious beliefs or may not have access to other methods/healthcare.

Withdrawal (Coitus Interruption)

• Ejaculation outside the vagina intends to stop sperm from entering the uterus.
• This method is unreliable as sperm can leak before ejaculation.
• The failure rate is high (15% - 15 pregnancies per 100 women).

Calendar (Rhythm) Method

• Record menstrual cycle for 6-12 months.
• Calculate shortest and longest cycles.
• Subtract 18 days from the shortest cycle to determine the start of the fertile period.
• Subtract 11 days from the longest cycle to determine the end of the fertile period.
• The fertile period is calculated in days from the start of a woman's menstrual cycle.

Lactational Amenorrhea Method (LAM)

• LAM is an effective family planning method based on breastfeeding.
• It's effective only under specific conditions.
• Mother must be breastfeeding exclusively (day and night on demand).
• At least 90% of the baby's nutrition is derived from breastfeeding.
• The infant is less than six months old.

Mechanical Contraception/Barrier Methods

• Barrier methods prevent sperm from entering the cervical os.
• Methods: Male condoms, female condoms, diaphragms, spermicidals, sponge.

Barrier Methods: Action, Advantages, and Disadvantages

• Action: Create a barrier to prevent sperm entry into the vagina.
• Advantages: Easily available; help protect against STIs,
• Disadvantages: Interrupts intercourse, potential for allergies.

Male Condoms

• Thin latex or plastic sheath placed over the erect penis during intercourse.
• Traps sperm at ejaculation.
• Applied before any genital contact.
• Important for protecting against STIs.

Male Condoms: Characteristics

• Safe and easy to use; Widely available
• Prevent STIs like gonorrhea and chlamydia.
• No hormonal side effects.
• Can help with premature ejaculation.
• Temporary backup method.
• Partner communication required.
• Can be damaged by oil-based lubricants, heat, humidity, or light.
• May reduce sensation.
• Can interrupt intercourse.

Diaphragm

• Thin rubber dome with a metal rim to maintain shape.
• Available in different sizes requiring doctor fitting.
• Remains in place for several years.
• Spermicide is placed before insertion.
• Left in place for several hours after intercourse.
• Must be washed and inspected after removal.

Spermicides

• Spermicidal creams, vaginal tablets, jellies, and pessaries.
• Kill sperm or slow their movement.
• Must be applied immediately before or 10 minutes before intercourse (depending on the type).
• Not very effective when used alone.

Cervical Cap & Vault Cap

• Cervical caps are placed deep in the vagina before sex, covering the cervix.
• These devices adhere to the cervix by suction.
• Similar to diaphragms but uncommon.
• Latex female condoms are sheath that fit loosely inside a vagina
• Severe latex allergy is the only condition that prevents use.

Intrauterine Contraceptive Device (IUD)

• IUD is a birth control device placed in the uterus.
• Small plastic device with copper sleeves (or wire).
• It's inserted through the vagina and cervix.
• Highly effective and reversible (94-99%).
• Long-acting (up to 10 years).
• Requires a trained provider for insertion and removal.

IUD Mechanism of Action

• Prevents fertilization by impairing sperm viability.
• IUDs create an inflammatory response, increasing leukocytes (tissue cells) destroying the fertilized ovum; interferes with sperm movement.
• Copper IUD changes endometrial enzymes, making the endometrium inappropriate for implantation.

IUD Insertion Timing

• 5th day of menstruation.
• Immediately after vaginal or cesarean deliveries (if no infection or bleeding complications).
• At least 6 weeks postpartum.
• Immediately or within 12 days post-abortion (if no infection).

IUD Side Effects

• Heavier, prolonged menstrual bleeding.
• Menstrual cramping.
• Spotting between periods.
• Side effects often subside after 3–6 months.
• Perforation is a very rare side effect, occurring once per 1,000 IUD insertions (PID)
• Expulsion of IUD

Hormonal Contraception

• Birth control methods that affect the hormonal system.

• Methods: Skin patch, vaginal ring, pills (combined and minipill), injections, implants.

Hormonal Method of Contraception

• Hormonal contraceptives can be given orally (pills), vaginally, transdermally (skin patch), and via injections.

Oral Progestin-Only Pills

• Known as mini-pills, containing only progesterone.
• Thicken cervical mucus to prevent sperm entry into the upper reproductive tract (main mechanism).
• Also involves ovulation suppression (in about 50% of cycles).
• Important to take pill at the same time each day, during menstrual cycle.

Progestin-Only Pills: Benefits

• Safe for breastfeeding women.
• No effect on breastfeeding; milk production or infant growth after the baby is six weeks old.
• Adds to the contraceptive effect of breastfeeding (if taken correctly, failure rate is less than 1% during the first year).
• No interference with intercourse.

Progestin-Only Pills: Limitations

• Less effective for non-breastfeeding mothers (if taken correctly; 3–10 women per 100 will become pregnant during the first year).
• Daily pill-taking requirement.
• Bleeding changes (more frequent and irregular) are common but not harmful.
• Some women may have headaches, dizziness, or breast tenderness.

Combined Oral Contraceptive Pills (COCs)

• COCs contain low doses of progestin and estrogen, which is referred to as "the pill".
• Work primarily by preventing the release of eggs from the ovary and thickening cervical mucus, preventing sperm entry to the uterus.

COCs: Key Benefits

• Highly effective when taken daily (0.1 to 0.5% failure rate in the first year).
• Controlled and can be stopped by the woman.
• Does not interfere with intercourse.
• Helps protect against uterine cancer, ovarian cancer, PID, and anemia.

COCs: Who Should Not Use

• Women with breast cancer
• Women aged 35+ and smoking 15 cigarettes daily
• Women with diabetes (>20 years duration)
• Women with liver tumors
• Women who need major surgery with prolonged bed rest

COCs: Counseling Considerations

• Discuss limitations (side effects).
• Can start three weeks after childbirth (if not breastfeeding), six months after childbirth (if breastfeeding).
• Initiate use even if menstruation hasn't begun if reasonably sure of not being pregnant; use condoms or abstain for first week.

COCs: Counseling on Missed Pills

• Take missed pill as soon as possible.
• Continue taking pills as usual, even if it means taking two pills in one day.
• Missed 1 or 2 pills: Take the pill as soon as possible;
• Missed 3 or more pills in week 1 or 2: Take the pill as soon as possible and use a backup method for 7 days.

Emergency Contraception (EC)

• Methods to prevent pregnancy after unprotected intercourse.
• Use regular contraceptive pills (COCs or POPs) in higher doses.
• Use methods as soon as possible after unprotected sex (within 120 hours or 5 days).
• Does not stop a pregnancy already started.

Vaginal Ring

• Soft, flexible ring releasing low doses of estrogen and progestin into the body.
• Suppresses ovulation and thickens cervical mucus to inhibit sperm entry into the uterus.
• Inserted into the vagina for 3 weeks, removed for 1 week during menstruation, then a new ring inserted.

Implants

• Progestin-only contraceptives inserted under the skin of the upper arm.

• Long-acting (lasts for 3-5 years).

• Advantages: Long lasting contraceptive.

• Disadvantages: Irregular menstruation, or amenorrhea, possible insertion/removal discomfort, and skin discoloration may occur.

Injectables

• (a) Depo Provera: progesterone injection every three months.
• (b) Noristerat: a 2-monthly progesterone injection.
• (c) Norigynon: a monthly injection of progesterone and estrogen combination, recalled in 2002.

Side Effects of Hormonal Methods

• Nausea
• Weight change
• Dizziness
• Mild headaches
• Breast tenderness
• Mood swings
• Breast tenderness
• Amenorrhea

Contraindications of Hormonal Methods

• Family history of CVA.
• History of thromboembolic diseases.
• History of liver diseases.
• Undiagnosed vaginal bleeding.

Vasectomy (Male Sterilization)

• Permanent contraception for men.
• Safe, convenient, and highly effective procedure.
• Performed under local anesthesia in an outpatient setting.
• Surgery involves closing off the vas deferens.
• Highly effective after three months (99.6-99.8% effective).

Tubal Ligation (Postpartum Female Sterilization)

• Permanent contraception for women.
• Performed by mini-laparotomy, a procedure involving small incisions.
• Blocks or cuts the fallopian tubes preventing the embryo/egg from traveling down to the uterus.
• Highly effective (99.5%).
• Ideally performed within 48 hours after delivery or during cesarean section.

Test your knowledge on hormonal methods of contraception and family planning! This quiz covers side effects, contraindications, effectiveness of vasectomy, postpartum sterilization timing, and mechanisms of tubal ligation. Enhance your understanding of reproductive health choices through this informative quiz.