Methods of Family Planning
By Dr Bimal Buch - Family Physician, Rajkot (reproduced
from Integrated management of Mother & Child - published on occasion of
NAT.RAJ.CON 98 hosted by FFPAI - Rajkot)
Now with the welcome entry of a child in your family, spacing of the next child must be
your top priority. If your family is complete with this child, you should still wait
before considering sterilization and wait till your youngest is about 4-5 yr old.
Temporary methods are divided into:
- Natural methods: Abstinence, lactation, withdrawal, and safe period methods.
- Barrier methods: Condoms with/without spermicide, diaphragm, cervical cap, sponge,
- Hormonal methods: Oral pills, Injectables, Implants
- Others: Intrauterine devices e.g. Cu T
This involves removal of the penis from the vagina just before ejaculation. Complete
cleaning of the penis in case of repeated intercourse is a must for success of this
method. Ejaculation should be away from the interoitus.
- Extreme self-control is required
- Pre-ejaculatory fluid may contain spermatozoa. This may enter the vagina leading to
pregnancy and contributes to high failure rate of approx 35-40%
|Condoms (get you
hubby to master the technique)
They act as an umbrella against shower of sperms. Pre-tested condoms are available. The
foreskin of the erect penis should be retracted. The condom should be held from the teat
so that no air is trapped. Go on derolling the condom till entire shaft of the penis is
covered. After ejaculation remove the penis holding the rim of the condom immediately
while the penis is still stiff, otherwise there are chances of sperms entering the vagina.
Non contraceptive benefits:
- Protection from sexually transmitted diseases Hepatitis B and HIV.
- Diminished risk of infertility
- Diminished risk of cervical cancer
- Messy post coital discharge can be avoided
If properly used, almost 98% successful.
With the advent of newer and better methods, vaginal barriers like sponge, diaphragm,
cervical cap are hardly used. ;
Foams, creams, gels, pessaries and films are available They are more effective when used
with condoms and vaginal barriers.
Most of these offer combination of estrogen and progesterone in low doses. Their effects
are as follows:
- Inhibits release of eggs from the ovary
- Accelerates transport of eggs in the fallopian tube
- Causes changes in the lining of the uterus and prevents implantation
- Forms a thick cervical mucus plug which inhibits transport of sperms
- The enzyme that permit the sperm to penetrate the ovum is not activated
- Inhibits implantation by causing changes in the uterus lining
- Increase the regularity of periods
- Decrease menstrual cramps, bleeding, pre-menstrual tension as the hormonal axis of the
body is resting and external hormones from the pill are working
- Protect against pelvic inflammatory disease, ovarian cancer, uterine cancer, ovarian
cysts, benign breast cysts, fibroadenoma, osteomalacia (weakening of bones during
- Decreases chances of ectopic pregnancy
(These occur on prolonged use. Ideally pills should be
taken in the format of 6 months ON and 1month OFF.)
- Missed periods or scanty bleeding
- Inter-menstrual (Inter-period) spotting
- Breast fullness or tenderness
- Mood swings
- Weight gain
- Darkening of skin over cheeks (chloasma)
Pills should not be taken in cases of breast cancer, heart
problems, pregnancy, liver disorders, hypertension, major surgery or a condition requiring
prolonged bed rest.
Contact your doctor in case of
- Chest pain
- Abdominal pain
- Leg pain
- You need to take some medication as the pills may alter their effect. Certain drugs like
anti-tuberculars have specific drug-interaction with OCPs
Note: Stop the pill 2-3 mths before you
plan your next pregnancy as sometimes body's own hormones take that long to swing back
These are less effective than combined pills. They have to be taken continuously without
any pill free interval. Also they have to be taken at the same time daily.
|Non Hormonal Pills
These are marketed under the name of "Saheli". It acts by altering the lining of
the uterus and make implantation impossible. Has to be taken twice a week, in the first 3
months and later only once a week.
- Morning after pills: Two tablets of OCPs containing 50 micrograms of estrogen and 5 mg
of progesterone should be taken within 72 hrs of unprotected intercourse and 2 pills 12
hours later. These may cause nausea and vomiting. If 3 weeks pass without menses, consult
- IUD insertion, morning after unprotected intercourse.
Devices (IUD's) - Loop, Copper T etc.
They act by immobilizing the sperms and prevent then from fusing with the ovum (egg). They
cause changes in the lining of the uterus and prevent implantation of the fertilized egg.
When should the IUD be inserted?
- Six weeks after child birth
- Immediately after or within 3 weeks of spontaneous or induced first trimester abortion
- Any time of menstrual cycle if pregnancy is ruled out. Ideally it should be within one
week of menses as the mouth of uterus is slightly open, facilitating insertion
- Within 6 days of unprotected intercourse for post - coital contraception.
- Your doctor should teach you to feel the strings of Cu-T as it can at times slip out
unnoticed in the toilet etc.
- Infection of the genital tract
- Known or suspected pregnancy
Side - effects
- Spotting, bleeding, anemia
- Expulsion of the IUD - partial/ complete
- Uterine perforation
- Pelvic inflammatory disease
Contact your doctor immediately if you have
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- Pain - abdominal both upper & lower
- No periods or abnormal spotting
- Infection exposure
- IUD string is missing, shorter or longer