Modern family planning methods include both traditional and modern contraceptives. Modern methods have higher effectiveness and include various hormonal methods like oral contraceptive pills, implants, injections, patches, and IUDs. They work mainly by preventing ovulation, thickening cervical mucus, or thinning the endometrium. While highly effective, they can have side effects like irregular bleeding and are not suitable for all. Proper use and counseling is important to achieve the benefits of modern family planning.

1. MODERN FAMILY PLANNING METHODS
GEZAHEGN GETACHEW
By Gezahegn.G

2. 5/30/2018Gezahegn.G

3. 5/30/2018Gezahegn.G

4. Out line of presentation
5/30/2018Gezahegn.G
 Introduction
 Eligibility criteria
 Types of family panning
 Different classes modern contraceptives
Mechanisms of action
Advnatages
Disadvantages
Contraindications

5. 5/30/2018Gezahegn.G
Family planning
The World Health Organization (WHO) defines
family planning as something that “allows
individuals and couples to anticipate and attain their
desired number of children,the spacing and timing of
their births. It is achieved through use of
contraceptive methods and the treatment of
involuntary infertility

6. Modern methods
5/30/2018Gezahegn.G
 Modern methods of family planning include birth control,
assisted reproductive technology and family planning
programs.
 UNFPA states that, “If all women with an unmet need for
contraceptives were able to use modern methods, an
additional 24 million abortions (14 million of which would
be unsafe), 6 million miscarriages, 70,000 maternal
deaths and 500,000 infant deaths would be prevented.”

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7
 Modern contraceptive use in Ethiopia by married
women has steadily increased over the last 15 years
jumping from 6 % in 2000 to 35% in 2016.
 Contraceptive prevalence rate of married women age
15-49 is 36%,with 35% using modern and 1%
traditional.
 58% of sexually active unmarried women use
contraceptive, with 55% modern methods and 3%
traditional.
 Method used commonly, injectable followed by implant.

8. WHO Medical Eligibility Criteria
Classification
Withclinical
judgment
With limited
clinical judgment
1 Use methodin any circumstances
Yes
Use the method
2
Generallyuse:
advantages outweigh risks
3
Generallydo not use:
risks outweigh advantages No
Do not use the method
4 Methodnot to be used 5/30/2018Gezahegn.G

9. Pearl index
Gezahegn.G
 Method used for determination of pregnancy
failure rate:
Pregnancy rate = no. of pregnancies x 12
____________________ x100
no.of women x no.of months

10. Types of family planning methods
 Breast feeding
(Lactational
Amenorrhea Method -
LAM)
 Abstinence
 Fertility awarness
methods
o Rhythm (safe period)
o Mucous (Billings)
o Temperature charts
o Combining Billings
with temperature
 Barrier methods: Condoms,
spermicides, diaphragms & cervical
caps
 Combined oral contraceptives
(COCs)
 Progestin only methods:
o Progestin-only oral contraceptives
o DMPA and NET-EN injectables
o Implants
 IUCDs
 Permanent methods –
o Female sterilization5/30/2018Gezahegn.G
Traditional methods Modern Methods

11. 1 Barrier methods of contraception
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11
Two types :
1. Physical barrier methods such as condoms,
diaphragm, and cervical caps, that prevent pregnancy
by blocking the entry of sperm into the upper genital
tract.
2. Chemical barrier methods (spermicides) that kill or
inactivate sperm on contact. (less effective, used in
combination , no STDs protection )

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 Easily available, reversible, and have fewer side
effects than hormonal methods.
 Effective and acceptable if used consistently and
correctly.
 Protect against STD
 May help protect against conditions caused by STIs:
o Recurring PID and chronic pelvic pain
o Infertility (male and female)
o Cervical cancer

13. Disadvantage
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Gezahegn.G
 May accidentally break or slip off during coitus
 Inadequate sexual pleasure
 Allergic reaction (Latex)
 Failure rate — 15%

14. 2 Hormonal
contraceptives
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14
 Hormonal contraceptives are female sex
steroids, synthetic estrogen and synthetic
progesterone (progestin),or progestin only.
 They can be administered in the form of OCs,
patches, implants, and injectables or vaginal
rings that release either estrogen–progestin or
progestin alone.

15. Combined Oral contraceptive pills
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15

16. Gezahegn.G
 World wide used
 very convenient method
 Reversible methods
 Contain various amounts of estrogen (ethinyl
estradiol) and one of a variety of progestins.

17. mechanism of action
5/30/2018Gezahegn.G
 Inhibition of ovulation (they act on various stage of
Hypothalamic- Pituitary- Ovarian- Endometrial axis)
 Static endometrial hypoplasia
 Alter the character of cervical mucus
 Interfere with motility of the fallopian tube
 Interfere with the secretions of fallopian tube
 E&P act synergistically

18. Non-contraceptive benefits of COC
5/30/2018Gezahegn.G
I Improvement of menstrual abnormalities
 Regulation of menstrual cycle
 Reduction of dysmenorrhea (40%)
 Reduction of excessive menstural bleeding (50%)
 Reduction of premenstrual tension syndrome
 Protection against Fe deficiency anemia
 Reduction of mid-cycle pain

19. 2 Protection against health disorders
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 PID
 Ectopic pregnancy
 Myoma
 Hirsutism & acne
 Functional ovarian cyst
 Benign breast diseases
 Osteopenia & osteoporesis
 Autoimmune disorders of the thyroid
 Rheumatoid arthrits

20. 3 Prevention of malignancies
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 Endometrial cancer (40%-60%)
 Ovarian cancer (40-80%)
 Colorectal cancer (40%)

21. Adverse effects of COC
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1) Minor complications
 Nausea, vomiting & headache (E) & leg cramps (P)
 Mastalgia (E+P)
 Weight gain
 Chloasma & acne
 Menstrual abnormalities: amenorrhea, hypo menorrhea
& breakthrough bleeding
 Libido: may be decreased due to progestrone
 Leucorrhea: infection/physiological

22. 5/30/2018Gezahegn.G
2) Major complications:
 Depression, mood changes, sleep disturbances &
psychotic manifestations: altered tryptophan
metabolism
 Hypertension (E): less than one percent
 Vascular complications: venous thromboembolism is
4-6 X than non users
 Cholestatic jaundice: Susceptible ones are those
with history of jaundice or hepatitis
 Neoplasia: cervical cancer, breast cancer
&hepatocellular adenoma

23. Contraindications to COC
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Absolute:
 Previous thrombo-embolic event or stroke
 History of an estrogen-dependent tumor
 Active liver disease
 Pregnancy
 Undiagnosed abnormal uterine bleeding
 Cerebral vascular or coronary artery disease
(past or current history), complicated valvular
heart disease
 Women over age 35 years who smoke

24. 5/30/2018Gezahegn.G
Relative:
 Obesity
 Migraine
 Women age > 35 years
 Anti convulsant therapy
 Hypertension, asthmatics
 Smoking
 Depression
 Gall bladder disease, varicosities
 Nursing mothers

25. Indications for withdrawal of the pill:
5/30/2018Gezahegn.G
(1) Severe migraine;
(2) Visual or speech disturbances;
(3) Sudden chest pain;
(4) Unexplained fainting attack or acute vertigo;
(5) Severe cramps and pains in legs;
(6) Excessive weight gain;
(7) Severe depression;
(8) Prior to surgery (it should be withheld for at
least 6 weeks to minimize postoperative vascular
complications)

26. Missed pills
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Missed 1 or 2 pills?
Take a hormonal pill as soon as possible.
Little or no risk of pregnancy
Missed 3 or more pills in the first or second week?
Take a hormonal pill as soon as possible.
Use a backup method for the next 7 days.
Also, if she had sex in the past 5 days, can
consider ECPs

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Missed 3 or more pills in the third week?
Take a hormonal pill as soon as possible.
Finish all hormonal pills in the pack.
 Throw away the 7 non hormonal pills in a 28-
pill pack.
Start a new pack the next day.
Use a backup method for the next 7 days.
Also, if she had sex in the past 5 days, can
consider ECPs

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28
Missed any non hormonal pills?
 Discard the missed non hormonal pill(s).
 Keep taking COCs, one each day.
 Start the new pack as usual

29. Progestin only modality
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 Includes;
1. Minipill (oral daily pill)
2. DMPA (depo-medroxy progesterone acetate)
injectable
3. Implants
4. Progestin containing IUDs
5. Plan- B (morning after pill)

30. Mechanism of action
Gezahegn.G
1. They work at various stage Hypothalamic-
Pituitary- Ovarian- Endometrial axis
2. Inhibition of ovulation by suppressing the midcycle
peaks of luteinizing hormone (LH)
3. Diminishing the function of the corpus luteum
4. Reducing the ciliary action of the fallopian tube,
preventing sperm and egg transport
5. Producing a thin, atrophic endometrium,
precluding implantation
6. Thickening cervical mucus

31. Advantages:
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31
1) Side effects attributed to estrogen in the combined
pill are totally eliminated
2) No adverse effect on lactation and hence can be
suitably prescribed in lactating women and as such
it is often called “Lactation Pill”
3) Easy to take as there is no “On and Off” regime
4) It may be prescribed in patient having (medical
disorders) hypertension, fibroid, diabetes, epilepsy,
smoking and history of thromboembolism
5) Reduces the risk of PID and endometrial cancer.

32. Disadvantages
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 Irregular uterine bleeding
 Functional ovarian cysts
 acne, mastalgia, headache,
 breakthrough bleeding, or at times amenorrhea in about
20–30 percent cases
 Strict time interval difference in taking pills
Contraindications:
(i) Pregnancy
(ii) unexplained vaginal bleeding
(iii) recent breast cancer

33. Minipill (oral daily pill)
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 devoid of any estrogen compound
 Levonorgestrel 75 μg, norethisterone 350 μg,
 desogestrel 75 μg, lynestrenol 500 μg or norgestrel 30μg
 In women who desire a pill, but choose to/need to avoid
estrogen, the progestin only pill is a suitable method

34. Advantage
 No alteration of milk
production and
nearly 100%
effectiveness in
breastfeeding
women
 Tolerance in women
who are unable to
take estrogen
Disadvantage
 Irregular(break through)
vaginal bleeding
 No protection against
STDs
 Need for daily
administration
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34
Aregash T.

35. Injectable Progestin Contraceptives:
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i) Depot medroxyprogesterone acetate (DMPA)
depoprovera 150 mg administered intramuscularly at
deltoid or gluteal region every 3 months
ii) Norethindrone ethanthate (Norgest/noristerate)
NET-EN in a dose of 200 mg given at two-monthly

36. Depot medroxyprogesterone acetate
(DMPA)
Advantage
 Effective for 12 weeks
 Independent of sexual
intercourse
 Safe for use during
breastfeeding
 reduce the risk of
endometrial cancer and the
volume of menstrual bleeding
Disadvantage
 No protection against STDs
 Irregular bleeding and
spotting
 Weight gain in certain
populations
 Prolonged return of fertility
(median time from
discontinuation to return of
fertility, 8.5 months)
5/30/2018
36

37. Implantable progestin
Implantable progestin-containing rods release
hormones at a low but constant rate.
Types
 Implanon: Single rod (etonogestrel ) effective
for 3 years
 implant releases 60μg of etonogestrel per day
 Jadelle : Two rods (levonogestrel) effective for
5 years
 releases 50 mcg of levonorgestrel per day
 Norplant (withdrawn from market) 5/30/2018Gezahegn.G

38. Advantage
 Effectiveness for up to 3
-5 years
 Independent of sexual
intercourse
 Almost immediate return
of fertility after removal
Disadvantage
 Menstrual irregularity
 No protection against STDs
 Requires placement and
removal by a trained provider
5/30/2018Gezahegn.G

39. Combined hormonal injection
5/30/2018Gezahegn.G
 25 mg medroxyprogesterone acetate + 5 mg estradiol
cypionate
 Given monthly
 Menstrual patterns may be irregular during the first year
of use; this is a common reason for discontinuation
 50% of women develop amenorrhea within 1 year of use

40. Transdermal Patch
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41
The transdermal contraceptive patch is 20 cm2.
It is designed to deliver norelgestromin, the active metabolite of
norgestimate, and ethinylestradiol daily for a 7-day period. After 7
days, the patch is removed and a new patch is applied to another
skin site.
Three consecutive 7-day patches are applied in a typical cycle,
followed by a 7-day patch-free period to allow withdrawal bleeding.
Application sites include the buttocks, lower abdomen, upper outer
arm, and upper torso, except for the breasts.
the same contraindications noted for combination oral
contraceptives use apply

42. Vaginal ring
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 The vaginal ring is approximately 5 cm in diameter and 4 mm
thick.The ring is flexible.
 It releases ethinylestradiol and etonogestrel at fairly constant
rates. The ring is worn for 3 weeks per month
 The ring maintains its efficacy even if it is removed for up to 3
hours, although it is designed to be left in place even during
intercourse

44. Emergency Contraception
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 prevent unintended pregnancy following an unprotected sexual
intercourse
 “morning-after pill” or “post-coital contraception”.
 Emergency contraceptive pills (ECPs):
 COC or
 POP
 Copper-releasing IUDs

45. Who can use EC?
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 When no contraceptive has been used
 When there is a contraceptive accident/ misuse
 Condom rupture, slippage or misuse
 IUCD expulsion
 > two COC missed consecutively & late for DMPA injection
by > 2 weeks
 POP contraceptive pill taken 3 or more hours late
 Failure of a spermicidal to melt before intercourse
 Failed coitus interruptus (withdrawal)
 Diaphragm dislodgement or early removal.
 Miscalculation of the safe period when using a fertility
awareness based method.
 In case of sexual assault

46. ECP regimen
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1. Progesterone only pills
 Pills containing 0.75mg levonorgestrel such as
postinor-2, Optinor.
1 pill as soon as possible after unprotected
intercourse followed by a same dose taken 12 hours
later.
 Pill containing 1.5mg levonorgestrel:
1 pill only as soon as possible after unprotected
intercourse
 Pills containing 0.03 mg levonorgestrel (microlute,
norgeston, ovrette)
20 pills for the 1st & 2nd dose

47. 5/30/2018Gezahegn.G
2. Combined OCP/ Yuzpe's method
 High dose pills containing 50 µg of ethinyl
oestradiol & 0.25mg levonorgestrel (neogenon,
ovran, eugynon)
 1st dose: 2 pills as soon as possible after
unprotected with in 5 days
 2nd dose: 2 pills 12 hours later
 Low dose pills containing 30 µg ethinyl oestradiol
& 0.15 mg of levonorgestrel (microgynon,
nordate, lo/femenal)

48. Copper-Releasing IUDs
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 A copper-releasing IUD can be used within 5 days of
unprotected intercourse as an emergency contraceptive
 Efficacy: <1% of women become pregnant.
 Indications: in addition to those for ECPs
 When the hormonal methods are less effective because
more than 72 hours have elapsed.
 The client is considering using an IUD for continuous,
long-term contraception

49. Anti progestrone
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 Mifepristone (RU 486) and Epostane:
 blocking progesterone production (epostane), or
interfering with its action (mifepristone).
 mifepristone is effective up to 17 days after
intercourse

50. How does EC work?
Gezahegn.G
 Delay or inhibit ovulation
 Prevent implantation
 Prevent transport of the sperm & ovum
* Emergency contraceptives are not effective once
implantation has occurred.
*ECPs do not interrupt or abort an established
pregnancy
 Effectiveness
ECP reduce probability of becoming pregnant
By 75% in case of COC &
By 85% in case of POP (Most effective if taken within

51. 5/30/2018Gezahegn.G
 S/E :nausea and vomiting
 Take after food or prophylactic anti emetics; 50mg
meclizine or 10mg metoclopromide 1 hr before
if vomiting occurs with in 2 hours, the dose should be
repeated
 Irregular vaginal bleeding or spotting
 If the menstrual period is delayed for >1 week from
the expected date, consider the possibility of
pregnancy
 Breast tenderness, headache, dizziness & fatigue

52. INTRAUTERINE DEVICES/IUDs/
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52
 Types
1 Copper-releasing: ParaGard
CU T 380A
2 Progestin-releasing: Mirena
Progestasert (LNG-20)
20 ug per day

53. 5/30/2018
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54. Mode of action
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1 . Copper-impregnated IUD
 Copper itself acts as a spermicide.
 The IUD causes a local, sterile
inflammatory reaction in the uterus
producing a lining that is unfavorable
for implantation.

55. 2 Progestin-only IUD
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This IUD exerts its contraceptive effect locally on
the endometrium and the cervix.
 Thickening of the cervical mucus makes the
passage of sperm difficult, creating a barrier.
 Progestin alters the endometrium, rendering it
unfavorable for implantation.
 In addition, both uterine and tubal motility are
impaired, thereby impairing sperm–egg
interaction

56. Advantages
1. copper impregnated
IUDs
 12 years of continuous
contraceptive efficacy
from one IUD
 Can be inserted at any
time during the menstrual
cycle
 Resumption of fertility on
removal
 Can be used as
emergency contraception
2. progestin- only IUDs
 5 years of continuous
contraceptive efficacy from
one IUD
 Useful for treatment of
menorrhagia (heavy
menstrual bleeding) and
dysmenorrhea (painful
menses)
 Resumption of fertility on
removal of the IUD
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57. Who can use IUD?
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Any woman of reproductive age including:
Before the first child
 HIV positive
Are at low or no individual risk for STI
Post partum
Post abortion
Emergency contraception
Women who cannot use hormonal methods

58. When can a women have an IUD
insertion
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 Within first 12 days of the cycle
 Any time it is reasonably certain that she is
not pregnant
 <48 hours post partum or > 4 weeks
 Post abortion- immediately
 For emergency contraception

59. Complications
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Early warning signs:
 Abnormal Bleeding or period related problems
No period
Heavy bleeding (twice as long/as heavy as usual) after 3-6
months
Spotting (between period/after intercourse/few days post
insertion)
 Abnormal discharge
 Pain
Dyspareunia /pain during intercourse
Abdominal pain
 Not feeling well
 Fever, Chills,

60. IUD-contraindications
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 Presence of pelvic infection/puerperal sepsis
 Undiagnosed uterine bleeding
 Suspected pregnancy
 Uterine prolapse
 Distorted uterine cavity as in fibroid
 Severe dysmenorrhea
 Endometrial or cervical cancer
 sexually transmitted diseases current or within
the past 3 months
 Copper allergy and Wilson's disease are
contraindications to the use of copper IUDs

61. Indications for removal:
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 Persistent excessive regular or irregular uterine
bleeding
 (2) Flaring up of salpingitis
 (3) Perforation of the uterus
 (4) IUD has come out of place (partial expulsion)
 (5) Pregnancy occurring with the device in situ
 (6) Woman desirous of a baby
(7) Missing thread
 (8) One year after menopause
(9) When effective lifespan of the device is over.

62. Pregnancy vs. IUDs
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 If a woman becomes pregnant with an IUD in place,
it should be removed immediately because the IUD
increases the risk of pregnancy loss and preterm
labor
 The spontaneous abortion rate is about 50% if an
IUD remains in place.
 If a pregnancy does occur with an IUD in place,
about 5% of women have an ectopic pregnancy.
 The chance of a premature birth is 12% to 15% in

63. Permanent methods of contraception
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 Types
I. Tubal ligation
II. Vasectomy
Counseling is essential,6% women regret

64. Female sterilization
 Can be performed surgically in the postpartum period
with a small transverse infraumbilical incision or during
the interval period.
 Sterilization during the interval period can be performed
with laparoscopy, laparotomy, or colpotomy.
 The methods of fallopian tube sterilization include
occlusion with Falope rings, clips, or bands; segmental
destruction with electrocoagulation; or suture ligation
with partial salpingectomy.
5/30/2018Gezahegn.G

65. Vasectomy
 Vasectomy involves incision of the scrotal sac,
transection of the vas deferens, and occlusion of both
severed ends by suture ligation or fulguration.
 The procedure is usually performed with the patient
under local anesthesia in an outpatient setting.
 Vasectomy prevents the passage of sperm into
seminal fluid by blocking the vas deferens.
 The man is not considered sterile until he has
produced sperm-free ejaculates as documented by5/30/2018Gezahegn.G

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70. Reference
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 Current diagnosis treatment obstetrics gynecology eleventh edition
 Berek & Novak's Gynecology, 15th Edition, Lippincott Williams & Wilkin
 Williams Gynecology, 23rd edition
 Uptudate 21.6
 DC Dutta'ss Textbook of Gynecology - Including Contraception, 6E (2014) [PDF]
[UnitedVRG]