Family planning devices: Social Pharmacy Practical
ER20-15P Social Pharmacy Practical
Methods of contraception include oral contraceptive pills, implants, injectables, patches, vaginal rings, Intra uterine devices, condoms, male and female sterilization, lactational amenorrhea methods, withdrawal and fertility awareness-based methods. These methods have different mechanisms of action and effectiveness in preventing unintended pregnancy.
The effectiveness of methods is measured by the number of pregnancies per 100 women using the method per year. Methods are classified by their effectiveness as commonly used into: Very effective (0–0.9 pregnancies per 100 women); Effective (1-9 pregnancies per 100 women); Moderately effective (10-19 pregnancies per 100 women); Less effective (20 or more pregnancies per 100 women)
Mechanisms of action and effectiveness of contraceptive methods
| Method | How it works | Effectiveness: pregnancies per 100 women per year with consistent and correct use | Effectiveness: pregnancies per 100 women per year as commonly used |
|---|---|---|---|
| Combined oral contraceptives (COCs) or “the pill” | Prevents the release of eggs from the ovaries (ovulation) | 0.3 | 7 |
| Progestogen-only pills (POPs) or “the minipill” | Thickens cervical mucous to block sperm and egg from meeting and prevents ovulation | 0.3 | 7 |
| Implants | Thickens cervical mucous to blocks sperm and egg from meeting and prevents ovulation | 0.1 | 0.1 |
| Progestogen only injectables | Thickens cervical mucous to block sperm and egg from meeting and prevents ovulation | 0.2 | 4 |
| Monthly injectables or combined injectable contraceptives (CIC) | Prevents the release of eggs from the ovaries (ovulation) | 0.05 | 3 |
| Combined contraceptive patch and combined contraceptive vaginal ring (CVR) | Prevents the release of eggs from the ovaries (ovulation) | 0.3 (for patch) 0.3 (for vaginal ring) | 7 (for patch) 7 (for contraceptive vaginal ring) |
| Intrauterine device (IUD): copper containing | Copper component damages sperm and prevents it from meeting the egg | 0.6 | 0.8 |
| Intrauterine device (IUD) levonorgestrel | Thickens cervical mucous to block sperm and egg from meeting | 0.5 | 0.7 |
| Male condoms | Forms a barrier to prevent sperm and egg from meeting | 2 | 13 |
| Female condoms | Forms a barrier to prevent sperm and egg from meeting | 5 | 21 |
| Male sterilization (Vasectomy) | Keeps sperm out of ejaculated semen | 0.1 | 0.15 |
| Female sterilization (tubal ligation) | Eggs are blocked from meeting sperm | 0.5 | 0.5 |
| Lactational amenorrhea method (LAM) | Prevents the release of eggs from the ovaries (ovulation) | 0.9 (in six months) | 2 (in six months) |
| Standard Days Method or SDM | Prevents pregnancy by avoiding unprotected vaginal sex during most fertile days. | 5 | 12 |
| Basal Body Temperature (BBT) Method | Prevents pregnancy by avoiding unprotected vaginal sex during fertile days | Reliable effectiveness rates are not available | |
| TwoDay Method | Prevents pregnancy by avoiding unprotected vaginal sex during most fertile days, | 4 | 14 |
| Sympto-thermal Method | Prevents pregnancy by avoiding unprotected vaginal sex during most fertile | <1 | 2 |
| Emergency contraception pills (ulipristal acetate 30 mg or levonorgestrel 1.5 mg) | Prevents or delays the release of eggs from the ovaries. Pills taken to prevent pregnancy up to 5 days after unprotected sex | < 1 for ulipristal acetate ECPs 1 for progestin-only ECPs 2 for combined estrogen and progestin ECPs | |
| Calendar method or rhythm method | The couple prevents pregnancy by avoiding unprotected vaginal sex during the 1st and last estimated fertile days, by abstaining or using a condom. | Reliable effectiveness rates are not available | 15 |
| Withdrawal (coitus interruptus) | Tries to keep sperm out of the woman’s body, preventing fertilization | 4 | 20 |
Family Planning Devices: A Comprehensive Study Guide
Quiz
Instructions: Answer each question in 2-3 sentences.
- How is the effectiveness of contraceptive methods measured, and what are the four classifications used?
- Explain the primary mechanism of action for combined oral contraceptives (COCs) and combined contraceptive patches.
- What is the main difference in mechanism between Progestogen-only pills (POPs) and Combined Oral Contraceptives (COCs)?
- Describe how an Intrauterine Device (IUD) containing copper prevents pregnancy.
- What is the effectiveness range for “very effective” contraceptive methods according to the common use classification?
- Compare the effectiveness of male condoms and female condoms when commonly used, noting the significant difference.
- How does the Lactational Amenorrhea Method (LAM) prevent pregnancy, and what is its effectiveness in the first six months?
- What is the general principle behind fertility awareness-based methods like the Standard Days Method and the TwoDay Method?
- Explain the mechanism of action for emergency contraception pills (ECPs).
- What is the key difference in effectiveness reporting between “consistent and correct use” and “commonly used” for methods like oral contraceptives?
Quiz Answer Key
- The effectiveness of contraceptive methods is measured by the number of pregnancies per 100 women using the method per year. Methods are classified as Very effective (0–0.9 pregnancies), Effective (1-9 pregnancies), Moderately effective (10-19 pregnancies), and Less effective (20 or more pregnancies).
- Combined oral contraceptives (COCs) and combined contraceptive patches primarily prevent pregnancy by inhibiting the release of eggs from the ovaries, a process known as ovulation. This stops the egg from being available for fertilization.
- Combined Oral Contraceptives (COCs) prevent ovulation, whereas Progestogen-only pills (POPs) primarily thicken cervical mucus to block sperm and egg from meeting, though they also prevent ovulation in some cases.
- A copper-containing Intrauterine Device (IUD) prevents pregnancy by damaging sperm. The copper component creates an inflammatory reaction in the uterus that is toxic to sperm, preventing them from reaching and fertilizing an egg.
- According to the common use classification, “very effective” contraceptive methods result in 0–0.9 pregnancies per 100 women per year. This category includes methods like implants, IUDs, and sterilization.
- When commonly used, male condoms have an effectiveness of 13 pregnancies per 100 women per year, while female condoms have a significantly lower effectiveness of 21 pregnancies per 100 women per year. This indicates a higher failure rate for female condoms in typical use.
- The Lactational Amenorrhea Method (LAM) prevents the release of eggs from the ovaries (ovulation) during intensive breastfeeding. Its effectiveness is 2 pregnancies per 100 women in six months when used commonly.
- Fertility awareness-based methods like the Standard Days Method and the TwoDay Method work by preventing pregnancy through avoiding unprotected vaginal sex during the most fertile days of the menstrual cycle. Users track their cycle to identify these days.
- Emergency contraception pills (ECPs) primarily work by preventing or delaying the release of eggs from the ovaries (ovulation). They are taken up to 5 days after unprotected sex to prevent pregnancy, not to terminate an existing pregnancy.
- “Consistent and correct use” reflects the theoretical effectiveness of a method when used perfectly, resulting in lower pregnancy rates. “Commonly used” accounts for typical human error and inconsistent adherence, leading to higher pregnancy rates for most methods.
Essay Format Questions
- Compare and contrast the mechanisms of action for hormonal contraceptive methods (e.g., COCs, POPs, implants, injectables, patches, vaginal rings) versus barrier methods (e.g., male and female condoms). Discuss how their different mechanisms contribute to their varying effectiveness rates in both “consistent and correct use” and “commonly used” scenarios.
- Analyze the concept of “effectiveness” as presented in the source, distinguishing between “pregnancies per 100 women per year with consistent and correct use” and “pregnancies per 100 women per year as commonly used.” Explain why this distinction is crucial for individuals choosing a contraceptive method and what factors might contribute to the disparity between these two figures for certain methods.
- Discuss the role of sterilization (male and female) as a family planning method. Compare its effectiveness with other highly effective, reversible methods like IUDs and implants. What are the implications of choosing sterilization as a family planning option?
- Evaluate the range of fertility awareness-based methods (e.g., Standard Days Method, Basal Body Temperature, TwoDay Method, Sympto-thermal Method, Calendar method). Discuss their underlying principles, common challenges that might affect their “commonly used” effectiveness, and the types of individuals for whom these methods might be more or less suitable.
- Imagine you are a healthcare professional advising a patient on family planning. Using the provided data, explain how you would present the options, emphasizing both mechanism of action and effectiveness (consistent vs. common use), to help the patient make an informed decision. Provide examples for at least three different categories of methods (e.g., hormonal, barrier, permanent).
Glossary of Key Terms
- Basal Body Temperature (BBT) Method: A fertility awareness-based method that involves tracking a woman’s body temperature each morning to identify ovulation and avoid unprotected sex during fertile days.
- Calendar Method (Rhythm Method): A fertility awareness-based method where a couple avoids unprotected vaginal sex during estimated fertile days based on a calculation of past menstrual cycles.
- Combined Contraceptive Patch: A hormonal contraceptive applied to the skin that releases hormones (estrogen and progestin) to prevent ovulation.
- Combined Contraceptive Vaginal Ring (CVR): A flexible ring inserted into the vagina that releases hormones (estrogen and progestin) to prevent ovulation.
- Combined Oral Contraceptives (COCs) / “The Pill”: Birth control pills containing both estrogen and progestogen that primarily work by preventing the release of eggs from the ovaries (ovulation).
- Effectiveness (Commonly Used): The typical effectiveness of a contraceptive method in real-world use, accounting for human error, inconsistent adherence, or improper use, measured by pregnancies per 100 women per year.
- Effectiveness (Consistent and Correct Use): The theoretical effectiveness of a contraceptive method when used perfectly according to instructions, measured by pregnancies per 100 women per year.
- Emergency Contraception Pills (ECPs): Pills taken after unprotected sex (up to 5 days) to prevent pregnancy, primarily by preventing or delaying ovulation. Examples include ulipristal acetate and levonorgestrel.
- Family Planning Devices: Various methods and tools used to prevent unintended pregnancy or to plan the timing and spacing of pregnancies.
- Female Condoms: A barrier method inserted into the vagina that prevents sperm and egg from meeting.
- Female Sterilization (Tubal Ligation): A permanent surgical procedure that blocks a woman’s fallopian tubes, preventing eggs from meeting sperm.
- Fertility Awareness-Based Methods: Contraceptive methods that involve tracking a woman’s menstrual cycle and fertility signs to identify fertile days and avoid unprotected sex during those times.
- Implants: Small, flexible rods inserted under the skin that release progestogen to prevent ovulation and thicken cervical mucus. Highly effective and long-acting.
- Injectables (Progestogen Only): Hormonal injections given periodically (e.g., every few months) that release progestogen to thicken cervical mucus and prevent ovulation.
- Intrauterine Device (IUD) (Copper-containing): A small T-shaped device inserted into the uterus that releases copper, damaging sperm and preventing fertilization.
- Intrauterine Device (IUD) (Levonorgestrel): A small T-shaped device inserted into the uterus that releases levonorgestrel (a progestogen), thickening cervical mucus to block sperm.
- Lactational Amenorrhea Method (LAM): A temporary method of family planning based on the natural infertility during intensive breastfeeding, which suppresses ovulation.
- Male Condoms: A barrier method worn on the penis that prevents sperm from entering the vagina.
- Male Sterilization (Vasectomy): A permanent surgical procedure that cuts or blocks the tubes (vas deferens) that carry sperm, keeping sperm out of ejaculated semen.
- Mechanism of Action: How a contraceptive method works to prevent pregnancy (e.g., preventing ovulation, blocking sperm, damaging sperm).
- Monthly Injectables (Combined Injectable Contraceptives – CIC): Injections containing both estrogen and progestogen, similar to COCs, that prevent ovulation.
- Progestogen-Only Pills (POPs) / “The Minipill”: Birth control pills containing only progestogen that primarily thicken cervical mucus to block sperm and egg, and can also prevent ovulation.
- Standard Days Method (SDM): A fertility awareness-based method that identifies a fixed fertile window (days 8-19 of the cycle) during which unprotected sex is avoided.
- Sympto-thermal Method: A fertility awareness-based method that combines multiple indicators, such as basal body temperature, cervical mucus, and calendar calculations, to identify fertile days.
- TwoDay Method: A simplified fertility awareness-based method where a woman considers herself fertile if she has observed cervical secretions today or yesterday.
- Withdrawal (Coitus Interruptus): A method where the penis is withdrawn from the vagina before ejaculation to prevent sperm from entering the woman’s body.
What are the main categories of contraception methods discussed?
The sources categorize contraceptive methods based on their mechanisms of action and effectiveness. These include hormonal methods (like oral pills, implants, injectables, patches, vaginal rings), barrier methods (male and female condoms), intrauterine devices (IUDs), permanent methods (male and female sterilization), behavioral methods (fertility awareness-based methods like Standard Days, Basal Body Temperature, TwoDay, Symptothermal, Calendar, and withdrawal), and emergency contraception.
How is the effectiveness of contraceptive methods measured and classified?
Effectiveness is measured by the number of pregnancies per 100 women using the method per year. Methods are classified into four tiers: “Very effective” (0–0.9 pregnancies), “Effective” (1-9 pregnancies), “Moderately effective” (10-19 pregnancies), and “Less effective” (20 or more pregnancies). It’s important to note that effectiveness rates are often provided for both “consistent and correct use” and “common use,” with the latter typically showing higher pregnancy rates due to factors like user error or inconsistent application.
What are some examples of highly effective contraceptive methods and how do they work?
Highly effective methods often include implants, both types of IUDs (copper and levonorgestrel), and male and female sterilization. Implants and levonorgestrel IUDs primarily work by thickening cervical mucus and preventing ovulation. Copper IUDs damage sperm to prevent fertilization. Male sterilization (vasectomy) keeps sperm out of semen, while female sterilization (tubal ligation) blocks eggs from meeting sperm. These methods generally show less than 1 pregnancy per 100 women per year with common use.
How do hormonal contraceptive pills work, and what is their effectiveness?
Combined oral contraceptives (COCs) or “the pill” work by preventing the release of eggs from the ovaries (ovulation). Progestogen-only pills (POPs) or “the minipill” thicken cervical mucus to block sperm and egg from meeting, and also prevent ovulation. While their effectiveness with consistent and correct use is very high (0.3 pregnancies per 100 women per year), their effectiveness in common use is lower, typically around 7 pregnancies per 100 women per year, due to factors like missed doses.
What are barrier methods of contraception and their typical effectiveness?
Barrier methods physically prevent sperm from reaching the egg. The sources specifically mention male and female condoms. Male condoms have an effectiveness of 2 pregnancies per 100 women with consistent and correct use, but this rises to 13 pregnancies with common use. Female condoms are less effective, with 5 pregnancies per 100 women with correct use and 21 with common use, placing them in the “less effective” category for common use.
Can you explain some fertility awareness-based methods and their effectiveness?
Fertility awareness-based methods involve tracking a woman’s menstrual cycle to identify fertile days and avoid unprotected sex during those times. Examples include the Standard Days Method (SDM), TwoDay Method, and Sympto-thermal Method. Their effectiveness varies significantly between consistent/correct use and common use. For example, SDM has 5 pregnancies per 100 women with correct use but 12 with common use. The Sympto-thermal Method can be very effective with correct use (<1 pregnancy), but its common use effectiveness is 2 pregnancies. Other methods like Basal Body Temperature (BBT) and Calendar Method (rhythm method) do not have reliable effectiveness rates provided in the source for common use, and the Calendar method is noted to have 15 pregnancies per 100 women.
What is emergency contraception and how does it work?
Emergency contraception pills (ECPs), such as ulipristal acetate or levonorgestrel, are used to prevent pregnancy after unprotected sex, typically up to 5 days later. They work by preventing or delaying the release of eggs from the ovaries. Their effectiveness rates vary, with ulipristal acetate ECPs being less than 1 pregnancy per 100 women, progestin-only ECPs at 1 pregnancy, and combined estrogen and progestin ECPs at 2 pregnancies.
What is the distinction between “consistent and correct use” and “commonly used” effectiveness rates?
The sources highlight two distinct effectiveness rates: “pregnancies per 100 women per year with consistent and correct use” and “pregnancies per 100 women per year as commonly used.” “Consistent and correct use” refers to the ideal scenario where the method is always used perfectly according to instructions. “Commonly used” reflects real-world effectiveness, accounting for typical human errors, inconsistencies, or improper use, which generally results in higher pregnancy rates for most methods. This distinction is crucial for understanding the practical reliability of different contraceptive options.
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