Which Of The Following Are Effective Methods Of Contraception?

• Intrauterine Devices
• Oral pills
• Combined hormonal pills
• Barrier contraceptive

Intrauterine devices

• These devices are put into the uterine cavity and are of two types: 
• Copper or progestogen-bearing. 
• Thin plastic strings protruded through the cervix and pulled to remove the device. They are changed every 5–10 years. 
• Types of IUDs Copper-containing devices operate primarily by preventing fertilization, the copper ion being toxic to sperm. 
• They also act to block implantation. The copper is either wound around an inert frame that sits within the uterine cavity or threads attached to the fundus.
• Hormone-containing devices contain the progestogen, which is slowly released locally over five years.

Complications

• Pain 
• Cervical shock 
• Perforation of the uterine wall.

Indications 

• IUDs indicated when hormonal contraceptive contraindicated
• Menorrhagia
• Dysmenorrhoea

Contraindications to the intrauterine device (IUD)

• Pelvic infection
• Vaginal bleeding
• Excessive menstrual bleeding loss 
• HIV positive 

Advantages 

• The IUD is an extremely safe method.
• Menstrual loss reduced if progestogen-containing devices are used (IUS). 

The IUD considered emergency contraception if it inserted the early days of ovulation.

Oral contraceptives

• Its effects on gonadotropin release and thereby inhibiting ovulation. 
• It is the combination of both estrogen and progesterone, and it is taken three weeks and spotted with 7 days.
• Vaginal bleeding occurs after taking oral contraceptives.
• The cycle restarted. Pill packets can be taken consecutively without a break (‘back-to-back’) to reduce the frequency of the withdrawal bleed, although increased irregular spotting may occur.

Indications

• All women can use hormonal contraceptions but without significant complications.
• It is suitable for the teenager and the older woman with no cardiovascular risk factors until the age of 50. 
• It is also useful for premenstrual symptoms, menstrual cycle control, menorrhagia, dysmenorrhoea, acne.

Disadvantages

Major: complications:

• Venous thromboembolism 
• Focal migraine
• Hypertension, 
• Jaundice
• Cervical and breast carcinoma

Minor side effects: 

• Nausea
• Headaches 
• Breast tenderness. 

Advantages:

• Less pain and less flow of menstruation.
• There is protection against simple ovarian cysts, benign breast cysts, fibroids, and endometriosis. 
• The risk of pelvic inflammatory disease (PID), but not HIV, is reduced possibly because of thicker cervical mucus. 
• The longer time it reduces the chance of ovarian, endometrium, and bowel cancer.

Other combined hormonal contraception

it is the combination of estrogens and progesterone pills.

Combined vaginal ring

• It is a latex-free daily release of the progesterone etonogestrel to inhibits ovulation. 
• It is inserted easily into the vagina for three weeks and then removed by the 7th day; then, the new ring inserted.
• It recommended that the ring not be removed during intercourse but, if necessary, be removed for a maximum of 3h.

Progestogen-only pill (POP)

• The standard progestogen-only pill (‘mini-pill’) contains a low dose and must be taken every day without a break and at the same time (±3h).
• It makes cervical mucus hostile to sperm, and in 50% of women inhibits ovulation too. 
• Failure rates are 1 per 100 woman years: higher than the combined pill. 

Side effects:

• Vaginal spotting (breakthrough bleeding)
• Weight gain, 
• Functional ovarian cysts can occur.

Emergency contraception

• In emergency contraception, a drug or IUD is used shortly after unprotected intercourse to prevent pregnancy. 
• The chance of conception after unprotected intercourse can reduce by taking the ‘morning-after pill.’ 
• Two types are available. Levonelle contains a single 1.5-mg dose of the progestogen levonorgestrel. 
• It is best taken within 24h, and no later than 72h, after unprotected intercourse.
• It affects sperm function and endometrial receptivity and, if given just before ovulation, may prevent follicular rupture. 
• The method has a 95% success rate if used within 24h, reduced to 58% if delayed until 72h.
• Vomiting can occur plus menstrual disturbances in the following cycle. 
• Ulipristal (ellaOne) is a selective progesterone receptor modulator (SPRM), like mifepristone. It prevents or delays ovulation, and may also reduce embryo implantation. 
• It is at least as effective as Levonelle and, further, can be used up to 120h after unprotected intercourse. 
• As it blocks the action of progesterone, Ella One will reduce the effectiveness of progesterone-containing contraceptives and so women should use condoms or avoid unprotected intercourse until the next period.

Barrier contraception

• Barrier methods physically prevent sperm from getting through the cervix. A principal advantage, especially with condoms, is the protection against STIs. 

Male condom: 

it consists of a sheath that fits onto the erect penis.

• The failure rate is 2–15 per 100 woman years; this is dependent on using it properly. It affords the best protection against disease, including HIV, and should always be used for casual intercourse, even if in conjunction with other methods. 

Female condom: 

• It fits inside the vagina. Failure rates are similar to the male condom, but it is less well accepted. It, too, protects against STIs. Diaphragms and caps are fitted before intercourse and must remain in situ for at least 6h afterward.

Cervical caps: 

• • Fit over the cervix, the spring of the latex dome of the diaphragm holds it between the pubic bone and the sacral curve, covering the cervix.
  • Types and sizes vary, and selection it determines by trained personnel.
  • Some women find them inconvenient, and they are best suited to a woman with proper motivation. 
  • Spermicides Barrier methods used in conjunction with a spermicide containing nonoxynol-9, in the form of a jelly, cream or pessary. Spermicides are not using for use on their own