Contraception by Dr. A. Kumwenda MBChB-unza

Contraception Dr. A. Kumwenda MBChB lecture Wednesday 22nd Sept., 2021 Definition The term contraception includes all measures, temporary or permanent, designed to prevent pregnancy due to the coital act An ideal contraceptive This should fulfil the following criteria: Widely acceptable, Inexpensive, Simple to use, safe, highly effective and Requiring minimal motivation, maintenance and supervision. No one single universally acceptable method has yet been discovered. Methods of contraception Temporary Permanent •Barrier •Natural •IUCDs •Steroidal contraception Female – BTL Male - vasectomy An approach Faced with a number of options, it can be difficult to choose the most suitable contraceptive A useful approach to consider is the following: Is she wishing to conceive? How devastating would it be for the woman to conceive, or is the aim to space out the pregnancies? An approach How reversible does the method need to be? Is she not likely to want to get pregnant ever again, or in the next 5 years, or in a few months? Which methods seems acceptable to her? Are there any absolute or relative contraindications to the method? Always discuss the risk of STIs and using condoms to protect against them History (all types of contraception) Age Current contraception Past contraception including likes, dislikes, myths Pregnancy – numbers, pregnancy induced problems, types of delivery, whether currently lactating History (all types of contraception) Past major illness – specifically HTN, CVA, SCD, thromboembolic disease (TED) Allergies Regular medication Menstrual history Previous gynaecological history and any other symptoms e.g post coital bleeding History (all types of contraception) STIs and sexual history, including last unprotected sexual intercourse Smoking Cervical smear history Family history Methods available Natural methods – associated with higher failure rate They rely on the fact that there are only certain days during the menstrual cycle when conception can occur After ovulation, the egg (ovum) is viable for a maximum of 24 hours while The sperm is viable for 3 to 7 days Some of these methods require long periods of sexual abstinence Methods available Natural FP methods include: Coitus interruptus – withdrawing penis from vagina before ejaculation Rhythm or cycle Temperature Cervical mucus (Billings) LAM - for women fully breastfeeding and not having menses the first 6 months after childbirth Methods available Barrier methods – provide physical barrier to the sperm Diaphragm; Occlusive caps (e.g. cervical cap); Condoms Spermicides – chemicals that cause sperm death. They are usually used in conjunction with barrier methods and include creams, films, foams, jellies, pessaries, sponges Hormonal methods Combined oral contraceptives (COCs)