Methods of Contraception

1. Department of Pharmaceutical Sciences, Dr H.S.Gour University Sagar (M.P) India

2. Rajiv Academy for Pharmacy, Mathura (U.P) India

3. GLA Institute Of Pharmacy, Mathura (U.P) India

One of the adequate methods of control population growth is family planning . An expert committee  (1971) of WHO defined family  planning  as ‘A way of thinking and living that is adopted voluntarily , upon the basis of knowledge , attitude and responsible decision by the individual and couples , in order to promote health  and welfare of family group and thus contribute effectively to the social development of a country ’ . Till now various contraceptive methods have been developed including the conventional and sustained release formulation and devices on the basis of the mode of action . These devices are generally classified into following categories.

1.Natural method 

Natural method of contraception prevents pregnancy without the use of chemical agent or physical device i.e. coitus interrupts, rhythum method and the utilization of the natural antifertility effect of breast- feeding .Unfortunately the acceptance of newer methods has led to a decrease in use of natural method , according to a FPAI Report , 1971,Das,1989  Status report  series -1 .

(a)    Withdrawal method:  Coitus interrupts involves the withdrawal of the penis from the vagina just before the ejaculations .This prevents the semen from the entering the women , thus also known as ‘Withdrawal method ’.

(b)    Rhythm method: Rhythm method or safe period method is based on restricting the sex act to the infertility period of the female partner and avoiding the possible fertile period . This method aims to predict ovulation , by  recording her menstrual pattern body temperature, change in vaginal mucus or combination of these methods . Intercourse is avoided on the fertile days . This method cannot be used by women having irregular cycle of  after childbirth .

2. Barrier methods

Barrier methods of contraception involve the use of device that prevents the passage of sperm through canal .Due to many reasons use of condom is the most popular conventional  contraceptive device Worldwide(Das, 1989).

These are cheaper and relatively simple to use , but when used alone , the pregnancy rate is relatively high (20%) .Diaphragms and cervical caps are soft rubber caps put in the vagina shortly before intercourse’s to cover the enterence of the womb , thus preventing sperms from entering the womb . It must  be left in place for 6 hours after intercourses and is much more effective when used with spermicide. Tietze and Levitt found a pregnancy rate of 29.3% from a foam tablet , 36.8% for jellies and creams used alone and 17.9% for diaphragm and spermicides use in combination (FPAI Report , 1995) .

The intra-uterine contraceptives devices (IUDs ) providing a effectiveness’ and safety with the advantage of easy insertion and removal are divide in to three generation.

1st  Generation devices – which are easy to insert and remove such as dippis loop , mangulies spiral etc.

2nd  Generation non- medicated dvices such as Grafter bags and Ota’s rings, flower and safticoils etc.

3rd  Generation medicated devices including the “ Copper- ? ”  and “ Progestasert   ” . In general IUD is a small flexible plastic device , usually with copper , which is inserted in to the womb by a doctor , soon after menstruation , abortion or 4-6 weeks after delivery . It mainly prevents the fertilized egg from setting in the womb . The mode of action in not in the uterine cavity due to the presence  foreign body . These cells captures the ascending sperm during intercourse and probably alter or destroy the blastocysts in case these are formed. The failure rate of the most widely used IUD ranged between 1.5 to 5.0% / HWY during 1st year of use and lower rate during subsequent years (FPAI report ,1971) 

3. Permanent Methods

 Sterilization is the one permanent method in contraceptive technology , this is irreversible method and is disadvantageous for motivation and acceptance.

(a)                    Female Sterilization

            Female sterilization is a permanent surgical method in which the fallopian tubes , which carry  the egg from the ovary to the uterus , are closed , thus preventing the egg from traveling down to meet the sperm. The approach to the fallopian tubes includes conventional , laparotomy , laproscopy  and hysteroscopy ( Brosent et al ., 1976).

(b)                   Male Sterilization

           Male sterilization is a surgical method in which the tubes which carry the sperm from the testis to the penis , are blocked  so that sperm cannot be released in the semen at the time of ejaculation (Silber, 1977).

4.The pill as a Form of Abortion

 In those relatively few cases when the pill prevents the implantation of an embryo , those who believe that human life begins at conception may consider this a form of chemically induced abortion . Some therefore reject oral and other chemical contraceptives infavor of natural family planning (the only method of contraception allowed by the Catholic Church ) or barrier methods such as condoms . The medical community generally dose not consider this to be an abortion at this early stage , and many abortion opponents avoid labeling this as abortion by declaring that human life begins with the implantation in the wall of  the uterus .

4.1 Cautions and contraindications with contraceptive pills    

            Female oral contraceptives, colloquially known as the pill , are the most common form of pharmaceutical contraception, the prevention of unwanted pregnancy . They consist of a pill that women take daily and that contains doses of synthetic hormones ( estrogen and progesterone),the doses of  adjusted in synchrony with the mentural cycle .It is used by millions of women around the world  through the acceptance varies by region , approximately one – third of sexually active women in the united kingdom uses it, while in japan what among to a boycott by doctors making huge profile from abortion has led to the pill being banded for nearly 40 years , and its recent introduction has seen very few women take it up .

                 Both combined and sequential preparations are popular among women . Combination pill in which the ovulation is inhibited by a progestogen plus an estrogen , and sequential pill is one in which  ovulation is inhibited by and estrogen , ,with progestogen added towards the end of cycle of administration .

4.2 Mechanism of action       

                     The pill works by preventing ovulation , as well as making the uterus less likely to accept implantation of an embryo if one is created ,and thickness of the mucus in the cervix making it more difficult for sperm to reach any egg .Taken correctly , it is the single most reliable form of reversible contraception , with less than one in 100 women using the pill becoming pregnant in a year of continuous use .

Several different types of ‘The pill’ exist .Generally , they all have revolved around different formulations of (chemical analogues of) the hormone progesterone and estrogen . Most brands use 20 to 40 micrograms of ethinyloestradial as the estrogen component and either  a fixed or varying (the bi and triphasic pills ) amount of progestogen as the progesterone analogue.

4.3 Contraindications

 It also take at least one complete menstrual cycle for the pill  to become effective , many young women have found themselves unexpectedly pregnant during that window. Serious side effects that would indicate a need to discontinue the pill include , pain or swelling ,in the thigh or calf , sever headaches, hypertention ,dizziness , weakness , vision problems ,chest pain or shortness of breath , abdominal pain. These serious side effects are result of the pill affecting coagulation, increasing the risk of blood clots (such as familial factor V Leiden )  women with hypercholesterolaemia (High cholesterol level) and in smokers.   Commonly quoted side effects include , weight gain , nausea headaches, depression, change in intensity of sexual desire and response , vaginits and vaginal discharge , urinary tract infection , changes in menstrual flow  , breast changes , skin problems and gum inflammation. The pill slightly increases the risk of breast cancer , while slightly decreasing the risk of ovarian cancer and uterine cancer.