Contraception | Medical Science Optional Notes for UPSC PDF Download

Indications/Uses/Benefits of Oral Contraceptive (OC) Pills

Non-Contraceptive Benefits

• OC pills provide relief from conditions such as:
• Menorrhagia (heavy menstrual bleeding)
• Dysmenorrhea (painful menstrual cramps)
• Premenstrual syndrome
• Mittleschmerz syndrome (ovulatory pain)
• Iron deficiency anemia
• Endometriosis
• Acne
• Hirsutism/PCOD (Polycystic Ovary Syndrome)
• Autoimmune disorders of the thyroid
• Rheumatoid arthritis

Decreased Risk of

• Benign breast diseases
• Ectopic pregnancy
• Fibroid uterus
• Functional ovarian cysts
• Osteoporosis
• Carcinoma of the endometrium and ovary
• Anorectal cancer
• Effective control of fertility
• Reduced incidence of Pelvic Inflammatory Disease (PID)

Contraindications

• Absolute:
  • Previous thromboembolic event or stroke
  • History of an estrogen-dependent tumor
  • Active liver disease
  • Pregnancy
  • Undiagnosed abnormal uterine bleeding
  • Hypertriglyceridemia
  • Women over age 35 who smoke heavily (>15 cigarettes per day)
• Relative:
  • Hypertension
  • Women receiving anticonvulsant drug therapy

lUCDs

Intrauterine contraceptive devices (lUCDs) are placed in the uterine cavity with the objective of providing long-term contraception, mainly by preventing fertilization.

Indications (Patient Selection)

• lUCDs are a good contraceptive choice for the following groups of women:
• Low risk of STD Multiparous woman Monogamous relationship
• Desirous of long-term reversible method of contraception, but not yet desirous of permanent sterilization
• Unhappy or unreliable users of oral contraception or barrier contraception
  

Contraindications

• Suspected pregnancy
• Pelvic inflammatory disease (PID), lower genital tract infection
• Presence of fibroids—because of misfit
• Menorrhagia and dysmenorrhoea, if Copper T is used
• Severe anaemia
• Diabetic women who are not well controlled—because of slight increase in pelvic infection
• Heart disease—risk of infection
• Previous ectopic pregnancy
• Scarred uterus
• Preferably avoid its use in unmarried and nulliparous patients because of the risk of PID and subsequenttubal infertility
• LNG IUCD in breast cancer
• Abnormally shaped uterus, septate uterus

Complications/Disadvantages

Immediate

• Difficulty in insertion (A medical or paramedical personnel is required to screen and insert an IUCD)
• Vasovagal attack
• Uterine cramps

Early

• Expulsion (2-5%)
• Perforation (1-2%)
• Spotting, menorrhagia (2-10%)
• Dysmenorrhoea (2-10%)
• Vaginal infection
• Actinomycosis

Late

• PID—2-5%. IUCD does not prevent the transmission of HIV
• Pregnancy—1-3 per 100 woman years (failure rate)
• Ectopic pregnancy
• Perforation
• Menorrhagia
• Dysmenorrhoea

MIRENAIUD

It is 32 XD 32 mm IUCD with the vertical rod containing 52 mg LNG progestogen in a silastic reservoir in its vertical arm: 20 meg hormone is eluted in 15 min after its insertion; and the peak level reaches in a few hours.

Mechanism of Action

• IUCD results in 1000 fold higher local progestin levels than systemic levels.
• They act predominantly by inhibiting gamete function and survival via local changes in cervical mucous.

Emergency contraception/postcoital contraception