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Artifici*l F*mily Pl*nning Methods

– Most effective w*y of preventing pregn*ncy

". Tempor*ry - provides short time infertility


A. Hormon*l Contr*ceptives - produces synthetic hormones th*t includes synthetic estrogen *nd synthetic
progesterone
– P*tch:

– Depo Prover*: the br*nd n*me for DMPA (depo-medroxyprogesterone *cet*te)

– Impl*nts:

Type of OC Pills
". COC pills: Combined or*l contr*ceptives : Combin*tion of synthetic estrogen *nd progesterone)
– the wom*n who h*s experienced stroke, she c*nnot t*ke COC bec*use she will most likely to develop

*ggreg*tion due to synthetic estrogen.


". Mini pills: only provides synthetic progesterone.
– Bre*st feeding mothers *re *llowed to t*ke this

– Women who experienced stroke c*n t*ke this pill.

– Also the morning *fter pill: * combin*tion of two mini pills within 72 hours *fter unprotected sex.
● Di*ne-35: br*nd n*me of * COC which controls the production of sebum.

● Synthetic estrogen inhibits the ovul*tion

● When the *mount of estrogen incre*ses, the *mount of FSH *nd LH will decre*se. The function of FSH *nd

LH is for ovul*tion
Mech*nisms of Actions
– Inhibition of Ovul*tion (syn estrogen)

– M*kes cervic*l mucus thick *nd sc*nty (syn progesterone) : presence ch*nges the ch*r*cteristics of

cervic*l mucus.
– Prevention of impl*nt*tion.

– Inhibition of c*p*cit*tion
". Or*l Contr*ceptive Pills: *re progestin only or * combin*tion of progestin *nd estrogen, the d*ily int*ke of
which prevents pregn*ncy.
– In the Philippines, the pills should be t*ken on the 1st d*y of the menstru*l flow.

– In Americ*, they t*ke the pills on the first Sund*y *fter their first menstru*l flow.

– 1st to 2nd week, they still need to be on protected sex.

– For women 18-35 ye*rs of *ge.

– For women with he*vy *nd p*inful menstru*tion.

– Pills *re *v*il*ble in 21 or 28 d*y p*ckets in the c*se of combin*tion type of pills *nd 35 d*y p*ckets for

progestin-only type of pills.


– In the Philippines, the usu*l is only for 21 or 28 d*ys p*ckets

> Feb 14: D*y 1 *nd D*y 21, on D*y 22 she must stop t*king the pill *nd needs to count 7 d*ys *nd sheʼll t*ke
pills *g*in on the 29th d*y. 7th pills th*t you miss *re pl*cebo. 4 d*ys *fter t*king the d*y 21 of the pills the
wom*n will experience spotting *nd th*t is completely norm*l.
– Or*l Contr*ceptives pills *re highly effective.

ADVANTAGES OF PILLS
– menstru*l flow becomes regul*r

– Becomes lighter *nd shorter

– P*in during menstru*tion is reduce.

– Contr*ceptive cover*ge is highly effective when properly t*ken.

– DISADVANTAGES
– Bleeding or spotting in between menses especi*lly during the first two months of pill t*king.
– Initi*l n*use*
– Bre*st tenderness *nd swelling
– Minor symptoms such *s emotion*l irrit*bility *nd minor weight g*in.
– Require high motiv*tion to remember to t*ke them everyd*y.

HOW ARE PILLS USED?


– The pills should be t*ken per orem d*ily prefer*bly *t the s*me time of the d*y to prevent n*use*.
– Initi*l dose should be t*ken *t d*y 1 or *t *ny d*y from d*y 1 to d*y 5 of the menstru*l cycle; then 1 t*blet
d*ily until the contents of the whole p*cket *re consumed.

a. Contr*ceptive P*tch
– A tr*nsderm*l p*tch *pplied to the skin th*t rele*ses synthetic estrogen *nd progestin hormones to prevent

pregn*ncy.
● P*p*nicol*ou test/ P*p sme*r

– worn on sever*l of * wom*nʼs body- most typic*lly lower *bdomen or buttocks.

– Applied for 3 consecutive weeks *nd just one p*tch per week. The 4th week will be the rest week.

b. Progestin -only Inject*bles


– * steroid*l hormone resembling the fem*le hormone c*lled the progesterone.

– It is injected intr*muscul*rly deep into the upper outer qu*dr*nt of the buttock or the deltoid *re* of the *rm.

– It is 99% effective.

– For women 18-40 ye*rs old.

ADVANTAGES
– provides long l*sting protection

– E*sily *dministered

– Independent of coitus

– Helps prevent c*ncer of the uterus *nd the ov*ries.

– Does not suppress milk production.

– Suit*ble for women who c*nnot use Contr*ceptives with estrogen component.

– F*cilities regul*r cont*ct with he*lth service providers.

DISADVANTAGES
– return to fertility is del*yed- *ver*ge is *bout 10 months from the l*st injection.

– Does not protect *g*inst STI/HIV/AIDS


When to give DMPA
– within the 1st 7 d*ys of the menstru*l period.

– Within the 1st 14 d*ys *fter *bortion or immedi*tely *fter *bortion.

– Within the 1st 28 d*ys *fter the delivery if the client is not bre*stfeeding.

– Between six weeks *nd six months for fully bre*stfeeding even if she is *mennorheic.

Subderm*l Impl*nts - progestin-only impl*nts inserted under the skin in the wom*nʼs upper *rm or fore*rm
trough * minor surgic*l procedure under loc*l *nesthesi*, which rele*ses progestin *t * controlled r*te. It is 99%
effective.
– effective for 5 ye*rs.

ADVANTAGES:
– reversible: fertility returns *lmost immedi*tely *fter the c*psules *re removed.

– Dopes not require d*ily int*ke.

– Does not interfere with intercourse

– Effective within 24 hours *fter insertion

– No estrogen rel*ted side effects such *s n*use* *nd dizziness

– Does not *ffect bre*stfeeding- qu*ntity *nd qu*lity of bre*st milk do not seem to be *ffected.

– H*s benefici*l non-contr*ceptive effects:

– Helps prevent iron-deficiency *nemi*

– M*kes sickle cell crises less frequent *nd less p*inful

– Reduces risk of ectopic pregn*ncies

DISADVANTAGES
– clients c*nnot st*rt to stop use on their own.

– Requires minor surgic*l procedure with loc*l *nesthesi* to insert *nd remove c*psules.

– Discomfort up to sever*l d*ys *fter insertion


– Need to remove c*psules *fter * cert*in period
– Initi*l cost is high
– In the very r*re inst*nces when pregn*ncy occurs, *s m*ny *s one in every six pregn*ncies is ectopic
– Does not protect *g*inst STIs including HIV/AIDS
– It is more difficult to remove th*n to insert
– Helps reduce endometri*l c*ncer

". Pl*ced in subcut*neous l*yer


B. Intr*uterine Devices
– sm*ll flexible devices m*de of met*l *nd or/ pl*stic or sil*stic inserted inside the uterine c*vity to prevent

pregn*ncy.
– The method is 99.4% effective.

TYPES OF IUD
". Non-medic*ted IUD: Lippes loop : does not produce *ny hormone
– not 100 percent effective

– C*uses different he*lth concerns such *s pelvic infl*mm*tory dise*se

". Medic*ted IUDs: Copper T380-A LNG20 :

MECHANISMS OF ACTION
– prevents fertiliz*tion

– Inhibits sperm migr*tion in the upper fem*les genit*l *ct

– Inhibits ovum tr*nsport *nd fertiliz*tion (F*llopi*n tube, cervix, ov*ry, v*gin* in r*re c*ses)- ectopic

pregn*ncy

Appropri*te for women who *re:


". Sp*cing pregn*ncies
a. Bre*stfeeding bec*use it does not interfere with production of bre*st milk
b. H*ving problems with b*rrier methods or or*l contr*ceptive use
j. Not re*d to *ccept VSC or inject*bles
k. Looking for * method not requiring d*ily *ction
l. H*ving difficulties in obt*ining contr*ceptives on * regul*r b*sis
m. Encountering priv*cy problems

ADVANTAGES:
– no systemic effects

– E*sy to use

– Cre*tes no mess

– C*n be s*fely used during l*ct*tion; do no *ffect the qu*lity *nd production of milk

– Are less expensive th*n pills

– C*n be used without the knowledge of other people

– C*n e*sily be removed by * tr*ined he*lth worker

DISADVANTAGES:
– M*y be expelled

– H*ve tempor*ry side effects like *bdomin*l cr*mps *nd incre*sed menstru*l flow

– Not 100 percent effective.

– Must be inserted by * tr*ined he*lth worker

ABSOLUTE CONTRAINDICATIONS
– suspected pregn*ncy

– C*ncer of the uterus, cervix, ov*ries, or the pelvic org*ns

– Infection/pelvic infl*mm*tory dise*ses (PID)

– Current STDs

– Recurrent or chronic PID

– Acquired immune suppression

– Recent septic *bortion until infection is completely cle*red


– Women *t high risk of STDs
– Acute cervicitis
– Rheum*tic he*der or other infections *ffecting the v*lves *nd muscles of the he*rt
– History of ectopic pregn*ncy
– Moder*te or severe *nemi*
– Very he*vy menstru*l flow or severe dysmenorrhe*
– For copper-be*ring IUDs, *llergy to copper *nd met*bolic disorders c*used by copper
– Nullip*rity especi*lly with history of PID or ectopic

When to insert the IUD


– m*ny be inserted *ny time during the cycle provided there *re no contr*indic*tions, prefer*bly during

menstru*tion when the cervix is open.


Who inserts it?
– doctor *nd midwife, etc

He*lth instructions:
– clients check up or follow up

– W*rning sign*ls:

– P- periods l*te with sx of pregn*ncy : presence c*n h*rm the growing embryo

– A- *bdomin*l p*in or dysp*reuni* (p*inful sex)

– I- infection, *bdomin*l disch*rge

– N- not feeling well (body m*l*ise) , fever, chills

C. B*rrier Methods
– Spermicid*l- kills 9

a. Perm*nent - requires consent from the m*rried couple bec*use this involves surgic*l procedure.
– this provides lifetime infertility
A. Volunt*ry Surgic*l Contr*ception
– Bil*ter*l Tub*l Lig*tion (BTL)

– V*sectomy : performed *mong m*les

● your client h*s the right to be informed with the procedure th*t you *re going to the p*tient.
● Ver*city - the right to inform the p*tient