Family Planning

Women’s Health& Gynecology

Women's Health& Gynecology

Women’s Health& Gynecology Gynecology literally means “the science of women”, but in medicine this term refers to the surgical specialty dealing with diseases of the female reproductive system.

Gynecology is typically a consultant specialty. In most countries, women must first see a general practitioner (GP; also known as a family practitioner (FP)) prior to seeing a gynecologist. If their condition requires knowledge, surgical technique, or equipment unavailable to the GP the patient is then referred to a gynecologist.

As in all of medicine the main tools of diagnosis are clinical history and examination. Gynecological examination is special in that it is quite intimate, and it involves special equipment, the speculum. The speculum consists of two hinged blades of concave metal or plastic which are used to retract the tissues of the vagina and permit examination of the cervix the lower part of the uterus located within the upper portion of the vagina. Gynecologists typically do a bimanual examination (one hand on the abdomen two fingers in the vagina) to palpate the cervix, uterus, ovaries and bony pelvis. It is not uncommon to do a rectovaginal exam for complete evaluation of the pelvis particularly if any suspicious masses are appreciated. An abdominal and/or vaginal ultrasound can be used to confirm any abnormalities appreciated with the bimanual examination or when indicated by the patient’s history.

Diseases The main conditions dealt with by a gynecologist are:

Cancer of the reproductive organs including ovaries, fallopian tubes, uterus, vagina, and vulva.

Incontinence of urine.

Amenorrhea (absent menstrual periods)

Dysmenorrhoea (painful menstrual periods)

Infertility

Menorrhagia (heavy menstrual periods). This is a common indication for hysterectomy.

Prolapse of pelvic organs

Natural Family Planning (NFP)

The natural family planning includes several methods for spacing, avoiding or increasing the possibilities of pregnancy without using any chemical or other methods of conversation or without any physiological alteration of the reproductive system either in the male or female. NFP uses no birth control drugs or devices. To use NFP, a couple voluntarily avoids sexual intercourse during the fertile phase of the woman’s cycle (time when the woman can become pregnant). There are a number of methods employed in NFP methods

Lactational Amenorrhea Method (LAM) LAM is the use of breastfeeding as a contraceptive method. It is based on the physiologic effect of suckling to suppress ovulation. To use breast feeding effectively as a contraceptive requires that the mother either feed the baby nothing but breast milk or, at the very least, breastfeed for almost all feedings. In addition the baby must be less than 6 months old and the mother’s menses cannot have returned.

The Billings Ovulation Method (BOM) BOM is the most modern natural way to achieve or avoid becoming pregnant. Once four commonsense guidelines are learned it is applicable whether a woman has short or long cycles. It can be used by a woman who is breastfeeding, approaching menopause, recovering from stress or coming off contraceptive medication. It teaches women to recognize their own individual pattern of fertility and infertility and to understand that they are infertile more often than fertile throughout their reproductive years. They learn to recognize the fertile phase of their menstrual cycles, when conception may occur. Fertility is signaled by the development of a particular type of mucus from the crypts of the cervix. Without this mucus, sperm die within an hour or so. The mucus symptom, telling the woman she has begun her fertile phase, develops a few days prior to ovulation. The Peak day (the last day of the lubricative sensation) occurs very close to the time of ovulation. The daily chart is very important in reminding the woman to pay attention to the changes in sensation at the vulva and the appearance of any discharge seen. It also gives valuable information to the couple so that they can make decisions about their joint fertility. To ensure that the authentic Billings Ovulation Method is learned it is important to find a gynecologist near you.

Withdrawal is a traditional family planning method where by a man withdraws right before he ejaculates. As a result, sperm does not enter the vagina and fertilization is prevented

Symptothermal Method To practice the Sympto-thermal Method you need to learn to identify the naturally occurring fertile and infertile phases of the women’s menstrual cycle and to apply this information so as to achieve your pregnancy goals. The Sympto-thermal Method of natural family planning is a method that helps you observe three main indicators of fertility, changes in basal body temperature, cervical mucus changes and your own calendar calculation. Individual minor indicators of fertility you observe and use, the more likely you are to accurately recognize ovulation time. The Sympto-thermal Method of natural family planning enables an understanding of your fertility as a couple. You can then choose how to apply your knowledge – abstaining from intercourse when potentially fertile to avoid a pregnancy or making love when potentially fertile when hoping to conceive.

Barrier Methods

These are match stick sized implants which release progesteron which suppresses Ovulation.Each Implant lasts for 5 years and are placed in upper arm in form of fan.

Efficiency 99.9% effective in first 2 years and then reducing to 96% in year 5. These are available only in specialized centers. Side Effects Irregular Vaginal Bleeding_ May be Heavy. Pelvic Pain. High Chances of Ectopic Pregnancy. High chances of PID. Disadvantages IUCDs are not the first choice for women with no children or those who are at risk of STDs.

Oral Contraceptive Pills

In Pakistan all available pills are of Combined variety called Combined Oral Contraceptive Pills.

Mechanism of Action They Prevent Ovulation by negative feed back effect. Thickens Cervical Mucous thus making it impermeable to entry of sperms. Advantages Very Effective form of contraception when used properly. 97% to 99.9% effective. Decreases risk of PID, Uterine and Ovarian Cancers. Regulates Menstrual Cycle. Reduces Dysmennorhea. Reduces menstrual blood loss. Reduces incidence of Benign ovarian cysts. Quickly reversible. Disadvantages Minor Side Effects. Have to be taken daily. Reduces Breast milk so not suitable during first 3 to 6 months of lactation. Side Efects Nausea. Breast Tenderness. Headache and worsening of migraine. Weight gain due to salt and water retention. Mood Changes. Irregular Vaginal Bleeding and Spotting. Serious Side effects like effect of Lipid metabolism, CVS side effects. Increased chances of stroke and venous problems. Donot take if Pregnant Unexplained Vaginal bleeding. Breast Lump/cancer. Severe Diabetes. Severe Hypertension/Heart Disease. Smoker aged over 35. Breast Feeding {less then 6 months}. Active Liver Disease. History of Heart disease. History of Liver/gall bladder disease. Chronic Headaches. History of Stroke. Medications usage like Anti epileptics, anti-TB. History of Thrombosis. Method of Use The Combined Pills are taken on the 1st day of menstrual bleeding i.e. when bleeding starts. They must be taken at the same time of day daily. Start next pack straight away. If 1 pill is missed , that missed pill is taken as soon as it is remembered while taking that day pill as usual and continue taking pills. 1 on each day as before. When 2 pills are missed take 2 pills each day for as many days as the number of pills and then continue taking 1 pill each day. If 3 or more pills are forgotten, also use another method of contraception besides taking pills like Condoms or abstinence. Danger Signs When any one of these signs are present, the client must report to doctor as early as possible.

Severe lower abdominal pain. Severe Headache. Loss or Blurring of Vision. Slurred Speech. Severe leg/calf pain.


Voluntarily Sterilization

Tubal occlusion is a voluntary surgical procedure for permanently terminating a woman’s fertility. Tubal occlusion can be done by minilaparatomy or laparoscopy. Tubal occlusion blocks the fallopian tubes (tying and cutting, rings, clips or electrocautery) and sperm are prevented from reaching the ova and causing fertilization.

Vasectomy is a voluntary surgical procedure for permanently terminating a man’s fertility. Vasectomy can be done by the standard method or the no-scalpel technique which is the preferred method. Vasectomy blocks the vas deferens (ejaculatory duct) so that sperm are not present in the ejaculate.

Injectable Contraceptives

There are 2 types of Injectable Contraceptives.

One injected every 2 months. One injected every 3 months.

Mechanism of Action

These act by Suppressing Ovulation through negative feed back effect. They also thicken cervical mucous thus making it impermeable to sperms.

Advantages

Very Effective.99.6% to 99.7% effective. Lasts for 3 months so compliance is much better. There is no effect on Breast feeding after 6 weeks. Protection against Endometrial Cancer. Reversible. Reduces Anemia due to amennorhea.

Disadvantages

Irregular Bleeding. Delay in return to fertility.

Donot take if

Pregnant Breast feeding{less then 6 weeks}. Diabetes. Hypertension. History of Stroke. Breast Lump/cancer. Unexplained Vaginal Bleeding. Jaundice/Liver problems. Heart/vascular Disease.

Side Effects

Irregular Vaginal Bleeding. Weight gain. Amennorhea causing worries about pregnancy. May result into heavy bleeding.

Methods of Use The first injection is given during the first 7 days of menstrual cycle.Effect last for 3 months in case of Depo Provera {long acting Progesteron}.When client wants to conceive, no more injections are given and fertility is restored within 6 to 12 months of last injection.