By: Ni Made Dwi Suparningsih  Immediately post-coitus

 Type of emergency contraceptive ;

Contraceptive for ♀ > 35years 1. Mechanical (IUD)→ best used within 5-7
days of unprotected sex.
 Contraceptive ♀ > 35years → need safe and 2. Medical → best used within 3 days of
effective (High risk). unprotected sex ;
 Combination birth control pill and Pill (High dose) → 2 x 2 tablet
combination birth control injection/shot → (microgynon50, ovral, neogynon, nordion,
more safe if there no other risk factor. eugynon)
 Being Smoker not recommended for use of Pill (Low dose) → 2 x 4 tablet
combined pill/shot. (mycrogynon30, mikrodiol, nordtte)
 Progestin contraceptive can be used by ♀
>35years and smoker. Cotraceptive Method
Contraceptive for Postpartum
A. Lactational Amenorrhoea Method
 Rely on breastfeeding
 Infertility postpartum who haven’t  If full breastfeeding more than 8 times
breastfeeding average 6 weeks, for
 Mens-period haven’t resumed
breastfeeding longer.
 The infant is under 6 monts of age
 Lactational amenorrhoea method (LAM) if:
 Effective until 6 months.
1. Mens-period haven’t resumed
 Suppress of ovulation
2. The infant fully breasted frequently/more
B. Natural family planning
than 8 times (on demand)
 Fertile period ; Longest cycle (-11);
3. The infant is under 6 month of age
shortest cycle (-18)
 The recommended time to begin
1. Ovulasi Billings method
contraceptive when breastfeeding ;
2. Simptothermal method
1. Immediately (Barrier, LAM)
3. Calender method/pantang berkala
2. 3 weeks (IUD)
4. Basal Temperature method
3. 6 weeks (Permanent contraceptive and
C. Combination birth control pill
Progestin contraceptive)
 Can used for emergency contraceptive
4. 6 months (Combined contraceptive)
 Not recommended for breastfeeding
 The recommended time to begin
contraceptive haven’t breastfeeding ;
1. Immediately (Barrier, Progestin) Mechanism;
2. 3 weeks ( IUD, Combined)
3. 6 weeks (Permanent)  Suppress ovulation
 Prevent of implantation
Contraceptive for Post-Abortion  Thicken the cervical mucus
 Immediately ( Combined pill/shot; progestin;
Type of;
implant,)
1. Monofasik ; esterogen and progesterone
 Recommended on TM1 → interval period
within same doses
 Recommended on TM2 → Postpartum period
2. Bifasik ; esterogen and progesterone
 IUD (TM1→immendiately; TM2→4-6 weeks)
within different doses
3. Trifasik ; estrogen and progesterone
Emergency Contraceptive within 3 different doses
(Morning after pill; morning after treatment) The advantage;
1. High effectiveness such as tubectomy
2. Prevent to anemia D. Combination birth control injection/shots
3. The fertility back soon  Contain (25mg-Depo
4. Used to emergency contraceptive Medroksiprogesteron As. & 5mg-
5. Stopped any time Estradiol Sipinoat)→every 1 month
6. Not interfere sexuality (Cyclofem)
7. Prevent some disease (Cancer, KET)  Contain (50mg-Noretindron Enantat &
5mg-Estradiol Valerat)→every 1 month
Disadvantage ;
1. Expensive The mechanism ;
2. Nausea
3. Spotting  Supperssing ovulation
4. Headache  Thicken servical mucus
5. Breast pain  Infertere implantation
6. Not recommended for breastfeeding
Advantage ;
(decreas of ASI)
7. Not prevent for IMS
 Prevent anemia, KET, Ca
The recommended ;  Decreas pain, blooding

1. All reproductive have/haven’t of chidren Disadvantage ;

2. Not breasfeeding postpartum
 Spotting
3. Post-abortion
 Not prevent for IMS
4. Anemia
5. Period-pain  Fertility restoration longer
6. Irregular period  Weight gain
7. KET  Side effect (stroke, heart attack)
8. Disrorder breast benign  Dependence of health care
9. Diabeth
The recommended ;
10. PID, Tyroid, TBC, Varices
1. All reproductive have/haven’t children
Not Recommanded ;
2. Breastfeeding > 6 month
1. Breastfeeding 3. Not-breastfeeding
2. Smoker 4. Anemia
3. Heart, stroke, Hyper >180/110 5. Disminorroe
4. Breast cancer 6. KET history

The time to start using comination pill ; Not recommended ;

1. Every time while menstrual-period 1. Breastfeeding , 6bweeks

2. 1-7 days of menstrual-period 2. Unknown bleeding
3. Postpartum; 3. Storke, heart,
- 6 month breastfeeding 4. hyper >180/110
- 3 month not breastfeeding 5. Breast ca
4. Post-abortion within 7 days
The time to start using comination shot ;
The instruction ;
1. 1-7 days of mens-period, ; > 7 days not
1. To recommended used within 1-7 days recommended for sexual within 7 days ;
menstrual-period. if haven’t period → every time if haven’t
 pregnant and not recommended for  Cannot stopped any time before the
sexual within 7 days (an other next shot
contraceptive)
 Spotting
2. 6 month postpartum and breastfeeding
3. > 6 month postpartum, breasfeeding  Haven’t mens-period
and have period  Weight gain
4. 3 month postpartum and not  Not prevent for IMS
breastfeeding  Fertility restoration longer
5. Post-abortion
 At long time have decrease of bone
E. Progestin Contraceptive shots dentisty, libido, headache, acne
 High effective
The recommended ;
 Safe
 All reproductive 1. Reproductive; Have and Haven’t
 Fertility restoration longer (± 4 month);
children
DMPA (10 month); NET-EN (6 month)
2. Breastfeeding
 Recommanded for breastfeeding period
cause cann’t suppressing ASI 3. Postpartum and not breastfeeding
4. Post-abortion
Type of ; 5. Grandemulti
 DMPA ( Depo MedroksiProgesteron 6. Smokers
Asetat)- 150 mg ; every 3 months 7. Hyper <180/110
 NET-EN (Depo Noretirteron 8. For user of epilepsy/TBC
Enantat/Depo Noristerat)- 200 mg; every 9. Cannt using of estrogen
2 months 10. Anemia
Mechanism ;
Not Recommanded ;
 Prevent of ovulation
1. Pregnant
 Thicken servical mucus
2. Unknown bleeding
 Make uterine mucus more slight 3. Breast cancer
 Infertere gamet transportation 4. Complicated of diabet
Advantage ; The time to start using of progestin
contraceptive shot ;
 High effective
 Not contain of estrogen → nothing 1. 1-7 days of period
impact for heart and coagulation blood 2. Anytime who haven’t period, after 7 days
disorder not recommended for sexuality
 Haven’t effect for ASI 3. For IUD → 1-7 days of period
 Decrease of binign breast, anemia
 Prefent to PID, Ca How to use of Progestine shot ;

Disadvantage ;  DMPA ; every 3 months

 NET-EN ; every 2 months/8weeks untul
 Perio disorder found 4 times,,the fifth shot and the next 3
 Dependence of health care months/12 weeks
 An other information ;
 Often cause amenorrea
 Weight gain, headache, chest pain
 The fertility restoration longer
 Don’t forget to use (at night)
 The sexuality should be 3-20 hours after
used
The advantage ;

To handling of disorder of period; 1. Safe for breastfeeding

Amenorrea; need only counseling
Bleeding ; if bleeding countiues have to
found the causes of; if the bleeding > 8 days
or 2 times more than before within normal
cycle its normal on 1 month shot
2. The fertility restoration quick resumed
3. Not contain of estrogen
4. Decrease of pain, period bood, anemic,
PMS
5. Prevent of PID
6. Can used for endometriosis
Disadvantage ;

For the attention ; virus (hepar), heart and 1. Bleeding disorder

stroke not to recommended to use shot 2. 1 pill lose ; filed
contraceptive. 3. Strained breast, nausea, headache,
acne
F. Pill Progestin / Minipill 4. High risk of KET
 Recommanded for breastfeeding 5. The effectiveness lower for TBC
 Very effective for breastfeeding 6. Not prevent for IMS
 Low doses
The recommended
 Not to decrease ASI Product
 Not show like the estrogen 1. Reproductive age
 The main side effect ; spotting, disorder 2. Breastfeeding
bleeding, irregular bleeding 3. Smokers
 Can used for emergency contraceptive 4. Hyper (180/110)
5. Not recommended for estrogen
Type of ;
Not Recommanded ;
 35 pill ; 300miug levonorgestrel/350miug
noretindron 1. Pregnant
 28 pill ; 75 miug desogestrel 2. Unkown bleeding
3. Confuse of disorder mens-period
Mechanism ; 4. Using TBC Medicine/epilepsy
5. Breast ca.
 Suppressing secretion of gonad and
6. Stroke
synthesis of sex steoid in the ovarium
 The transformation of endometrium The time for using Minipill
faster so that the implantation more
difficult  1-5 days of period
 Thicken the servical mucus  Anytime ; if used 5 days not for
 Change of motility tube so that the recommended sexuality within 2 days
tranfortation of sperma disorder (another contraceptive)
 For breastfeeding ; between 6 weeks-6
The effectiveness ; months
 Post-abortion ; immediately
 High
 If change using shot to minipill
recommended to using on the next
schedule of shot
The Instruction for client :
1. To use at the same time
2. First pill at first period
3. If forget use another contraceptive
Disadvantge ;
 Changes of mens-period
 Spotting
 Hypermenorroea, Amenorroea
 Headache, weight, breast-pain,
 Nausea
 Require of minor surgery
 Not for free-sex

The recommended
Implan Contraceptive
1. Reproductive age
 High effective
2. Have/not of child
 Norplant →5 years
3. Require of long term contraceptive
 Jadena/Indoplan/Implanon→ 3years 4. For breasfeeding
 The fertility immediately resumed 5. Postpartum and not breasfeeding
 Side effect ; irregular period. Spotting; 6. Post-abortion
amenorroea 7. Unwanted pregnancy but not ready for
 Recommended for breastfeeding permanent
8. KET-History
Type of ;
9. Hyper<180/110
10. Not recommaned for estrogen
 Norplant ; 6 silastik stick; 36 mg
11. Often forget to use pill method
levonorgestrel
 Implanon ; 1 flexible white stick; 68 mg Not for Recommended
3-keto desogestrel
 Jadena & Indoplant ; 2 stick; 75 mg 1. Pregnancy
Levonorgestrel 2. Unkown bleeding
3. Benign/ca. breast history
Mechanism ;
Time
 Ticken the servical mucus
 Interfere of endometrium synthesis 1. 2-7 days
procces to difficult of implantation 2. >7 days not to recommende for sex
 Decrease of sperma transportation 3. Breasfeeding 6week-6month
 Suppressing ovulation 4. If b4 using shot implant can used accord
the schedule
Advantage ; 5. Postpartum
6. From AKDR ; 7days and not
 High efficiency recommended to sex
 Long term protection
 The fertility immediately resumed Instruction
 Free-estrogen
1. Keep the insertion
 Doesn’t require of toucher
2. Side effect of the insertion
 Not interfere sex, ASI 3. The bandage opened >48hours
 Can stopped anytime 4. Storm warning of insertion
 Decreases of pain, blood count, anemic, 5. Explain about ; effectiveness ; period
another benign, endometriosis disorder 6-12month
 protect of endo.ca, PID