FAMILY PLANNING.

• Copper-t:-

Definition:-

➡️Copper-t is a 2nd generation intrauterine device and it is a small t-shaped device which is inserted in the uterus.
➡️copper reduces fertility.
➡️It is used for contraception & family planning.

Parts:-

1) T-shaped plastic frame
2) horizontal stem
3) vertical stem
4) copper wires
5) thread

Types:-

1) CuT 200B
2)Multiload 250
3) Multiload 375
4) CuT 380A

1)CuT 200B:-

➡️The vertical stem of this device has copper wire in 215 sq mm surface area and contains 120mg copper.
➡️Lifespan: 4 years.

2)Multiload 250:-

➡️It has copper wire in 250 sq mm surface area.
➡️It releases 60-100 micro gram copper per day.
➡️Lifespan:- 3 years

3)CuT 380A:-

➡️It covers 380 sq mm surface area.
➡️ vertical stem contains 176mg & horizontal stem contains 66.5mg copper.
➡️Lifespan:- 10 years
➡️It is mostly used.

4)Multiload 375:-

➡️It covers 375 sq mm surface area.
➡️Lifespan:-5 years.

Mode of Action:-

1) Biochemical & Histological changes in Endometrium.
2) Increases tubal motility.
3) Impairs sperm descent.
4) Prevent implantation of blastocyst.

Indication:-

1) Normal menstrual cycle.
2) No history of pelvic inflammatory diseases.
3) Contraceptive misuse.
4) Failed coitus interrupts.

Contraindication:-

1) Prolapse uterus
2) severe dysmenorrhea
3) Presence of pelvic inflammatory diseases
4) Dysfunctional uterine bleeding
5) Ectopic pregnancy
6) Nullipara
7) HIV & AIDS

Time of Insertion:-

➡️Interval
➡️Post abortion
➡️Post partum
➡️Post placenta delivery

Methods of Insertion:-

1) Preliminaries:-
➡️History taking.
➡️examination.
➡️consent.
➡️Remove the device from the sealed packet.
➡️Fold thread, vertical stem & horizontal stem with vertical stem.
➡️Now the device is ready to introduce.

2)Actual Steps:-
➡️Ask the patient to empty the bladder & then give lithotomy position.
➡️Uterine size & position to be checked.
➡️Introduce posterior vaginal speculum & clean vagina and cervix with antiseptic solution.
Grasp the anterior lip of cervix with Allis forceps.
➡️Uterine sound should be passed through cervical canal and the length of uterine cavity & position of uterus should be noted.
➡️ Then introduce the device of the size of the uterine cavity length.

Indication for Removal:-

1) Persistent excessive uterine bleeding
2) Perforation of uterus
3) flaring up of salpingitis
4) Pregnancy
5) missing thread

Complication:-

• Cramp like pain
  -Partial or complete perforation
• Abnormal menstrual bleeding
  -pelvic infection
  -spontaneous expulsion
  -perforation of uterus

Advantage:-

➡️Effective Contraceptive.
Fertility can be restored.
➡️inexpensive & easy to use.
➡️No need for constant supervision.
➡️Free from harmful effects.

Disadvantage:-

➡️pain
➡️bleeding
Ectopic pregnancy
➡️spontaneous expulsion
➡️pelvic infection
➡️perforation of uterus

Condom

Male condom:

It is made of thin latex or plastic.

• It covers the penis before the sexual act.
• Before the contact of vajaina, male has to wear kare.
  -Withdraw semen after ejaculation without spilling it
  -It works as a barrier, it does not allow semen to come into contact with the female so that sexually transmitted diseases can be prevented.
  -Use of condom with spermicidal jelly before intercourse increases its effectiveness.

Advantages:

be easily found,
Inexpensive & safe,
Easy to use,
No side effects,
Sexually transmitted diseases can be prevented,
Light, compact and disposable,

Disadvantages

Breaks or slips during intercourse.

Female condom:

-It is a pouch made of polyurethane with an internal ring that covers the cervix and an external ring that covers the vagina.
It is an effective barrier to prevent sexually transmitted diseases.

Failure rate: 13%

Antara/DMPA-depot medroxyprogesterone acetate

Group: progestin
Dose: 150 mg/ml
Route: IM (upper arm and buttocks)

Mode of action:

It inhibits the production of gonadotrophin, preventing the follicle from maturing and forming an ovum. Thins the endometrium. It prevents monthly ovulation, and thickens the cervical mucus so that sperm stops.

Contains:

Medroxyprogesterone acetate

Pharmaceutical form:
Sterile aqueous suspension

Indications:

7 days during periods,
Breast feeding mother – after 6 weeks,
Non breast feeding mother – at the time of delivery,
Abortions- Seven days after abortion

Contraindication:

Unexplained vaginal bleeding,
breast cancer,
stroke,
severe diabetes,
liver disease,
Pregnant woman
BP – 160/150 mmHg
Genital cancer

Side effects:

Increases risk of cardiovascular disease by 40%,
Hypertension,
Irregular menstrual cycle,
Brest swelling,
Abdominal bloating,
Headache, body pain,
Dizziness,
weight gain,
body etching,
moodswing,
Decreases milk production

Benefits:

For a breastfeeding mother, after 7 days of good delivery,
Menstrual cramps and blood loss are reduced,
Safe in HIV AIDS,
One injection provides protection for up to 3 months

How to take:
To be taken every 3 months. And take MPA card as per given date.

Nursing Responsibilities:

Assessment of patients,
Explain about medical history, allergies, medication history, other contraceptive method,
Explain its advantages, disadvantages, side effects, BP and weight,
Ask for follow up, fill MPA card ma details and write date of stomach injection in that card, give that card to the client.

Chhaya tablet/ centchormen/ ormeloxifene

Group: Selective estrogen receptor modulators
Dose: 30mg each tablet

Mode of action: It works as a modulator of selective estrogen receptor. It avoids the hormonal action on the uterus and inhibits implantation. Blocks the estrogen receptor so that the endometrium does not grow and the implantation of the egg is prevented.

Indications:
Contraceptive pills,
In the treatment of abnormal uterine bleeding,
Anti-osteoporotic,
Palliative measures in advanced breast cancer

Contraindication:
Polycystic Ovarian Disease,
Cervical hyperplasia,
Past ma jaundice or liver
DCS,
Hypersensitivity, TB, kidney disease

Side effects:
In some women, those 3 month periods come late.
Bleeding is reduced.

How to take:
Take that pill on the first day of periods and then take another pill on the third day. So after taking it for 3 months, in the fourth month, take the pill on the day on which you have taken it.
Like.. If the day of periods is Sunday then take it then take it on Wednesday and thus take it for 3 months and take one day on Sunday in the fourth month.

If you forget to take a pill:
If the pill is forgotten. Taking the valley rhythm as possible. But in less than seven days
Take and use a backup method (like condom). If missed for more than seven days, discard the packet of tablets and start a new packet again.

Nursing Responsibilities:
Explaining about contraceptive pills,
How to take it
Its effects, side effects,
Dose, time, follow up, to tell if you forget to take a tablet,
Documentation

MALA-N TABLE

GROUP : oral contraceptive pill
DOSE: It contains 21 days and 28 days package of pills, in which 21 active hormone pills, 7 inactive hormone pills.
If you have taken the pills on the first day, take the pills at the same time on the second day
Ex: If taken today at 8 o’clock, tomorrow also at 8 o’clock.
ROUTE : Orly
MODE OF ACTION: Its mode of action is to prevent the release of ovum from the ovary.
This blocks the secretion of pituitary gland and elicits gonadotropin which is responsible for ovulation.

INDICATIONS:

Contraceptive

Period pain

Abnormal uterine bleeding

Postmenopausal osteoporosis

Ovarian cyst

Endometriosis

Amenorrhea
Contraindication:

High blood pressure

Breast cancer

Heart disease

Liver diseases

NGO Edema

Kidney disease

Depression

Hypercalcemic

Pregnancy

Jaundice history

Genital track malignancy

Cycle cell diseases
SIDE EFFECTS:

Nozia

Vomiting

Weight gain

Dizziness

Head one

Tender breast
START Of MALA -N
It is started on the 5th day of menstruation.

NURSING RESPONSIBILITY OF MALA-N:

ASSESSMENT:
Check the medical history of the patient after giving Mala N Tablet.
Investigating the patient’s reproductive health history.

EDUCATION:
After giving Mala N Tablet, explain its dosage, mode of action, indication, contraindication, side effect, and administration.
Administration:
Teach the patient to take Mala N tablets in the correct method. In which if the patient has taken the tablet at 7:00 pm today, ask him to take the tablet tomorrow at 7:00 pm.
MONITORING:
Monitor the patient for any side effects or complications after taking Mala N tablets. Including, bleeding nausea and breast tenderness.
follow UP:
In which asking the patient to take regular follow up.
So that the patient’s no response can be known and he can ask if he has any question.
DOCUMENTATION:
Making Medical Record of Mala N Tablet
And to record if the patient has any side effects or complications.

EMERGENCY CONTRACEPTIVE PILLS:

GROUP: oral contraceptive pills
DOSE: 1.5 milligrams of levonorgestrel
Emergency contraceptive pills should be taken as soon as possible without unprotected intercourse.

Its effectiveness lasts up to 120 hours after taking the pills.

ROUTE: Orly

MODE OF ACTION: Its main mechanism of action is inhibition of follicular development. So formation of corpus luteum does not take place after ovulation. It involves involvement of ulceration of cervical mucus.
Cervical mucus inhibits sperm penetration.

INDICATION:

Its first dose is taken 72 hours after unprotected sex.
NURSING RESPONSIBILITIES:
1- PATIENT ASSESSMENT:
In which the medical history of the patient is assessed. An assessment of any type of allergy or any complications is done
2- EDUCATION:
In it, education is given to the patient like how this tablet works, its side effects, indications, contra-indications, its dosage, education is given.
3- ADMINISTRATION :
Its first dose is taken 72 hours after unprotected sex.
And it works after 5 days of unprotected sex to explain all this to the patient.
4- MOTRING:
Monitor for any side effects or complications after taking the tablets.
5- FOLLOW UP:
Asking the patient to take regular follow up.
So that the response of the patient can be known and if he has any question he can ask.
6- DOCUMENTATION:
To record the medical record after taking this tablet and also to record if the patient has any complications.

When a contraceptive method fails

When the condom breaks and leaks

When ejaculation occurs in the external genitalia

When a woman does not use a contraceptive when sexually assaulted

Mistiment Fertility Awareness

When 2 or more birth control pills are missed
CONTRAINDICATION:

Pregnancy

Undiagnosed Abnormal Genital Bleeding

Hyper tension

Breast cancer

Endometrial cancer

Ischemic Heart Diseases

In hepatocellular adeno

Liver tumor

thrombophlebitis
SIDE EFFECTS:

Nozia

Head one

Ab normal cramping pan

Breast tenderness

Increased vaginal discharge

Decisive lemonade

Tyranny

Change of menstrual cycle

Spotting (light bleeding)

START OF EMERGENCY CONTRACEPTIVE PILLS:

Possible after unprotected sex.

It works after 5 days of unprotected sex.

MALA-N Contraceptive

MALA-N is a combined oral contraceptive pill (COC) provided free under the National Family Planning Programme of India.
It is mainly used for temporary spacing of births and is suitable for women of reproductive age who want a reversible, effective method of contraception.

2. Composition

Each cycle contains 28 tablets:

• 21 Active (Hormonal) tablets
  • Ethinyl Estradiol – 0.03 mg
  • Levonorgestrel – 0.15 mg
• 7 Inactive (Iron) tablets
  • Ferrous Fumarate (non-hormonal)

👉 Iron tablets help prevent anemia and maintain the habit of daily pill intake.

3. Mechanism of Action

MALA-N prevents pregnancy by three main mechanisms:

1. Inhibits ovulation
   → Suppresses LH & FSH, preventing release of ovum
2. Thickens cervical mucus
   → Prevents sperm penetration
3. Alters endometrium
   → Makes uterus unsuitable for implantation

4. Dosage & Schedule

• Start on Day 5 of menstruation
• Take 1 tablet daily at the same time

Tablet order:

• Day 1–21 → White (hormonal) tablets
• Day 22–28 → Brown (iron) tablets

🔁 Next pack should be started immediately after finishing the previous one (no gap).

5. Effectiveness

• Correct use: >99% effective
• Typical use: ~91% effective

Failure is usually due to missed pills.

6. Indications

MALA-N is recommended for:

• Birth spacing
• Regularization of menstrual cycle
• Reduction of menstrual pain (dysmenorrhea)
• Decreased menstrual blood loss
• Improvement in acne

7. Contraindications

❌ Should NOT be used in women with:

• Pregnancy
• Breastfeeding < 6 months postpartum
• History of thromboembolism
• Severe hypertension
• Breast cancer
• Liver disease
• Migraine with aura

8. Side Effects

Common (usually mild):

• Nausea, vomiting
• Breast tenderness
• Headache
• Weight gain
• Mild spotting

Serious (rare):

• Thromboembolism
• Severe hypertension
• Liver dysfunction

9. What to Do if a Pill is Missed

• 1 pill missed:
  → Take as soon as remembered, continue schedule
• 2 or more pills missed:
  → Take last missed pill
  → Use backup contraception for 7 days

10. Advantages

✅ Highly effective
✅ Reversible
✅ Improves menstrual health
✅ Reduces risk of ovarian & endometrial cancer
✅ Easy to use

11. Disadvantages

❌ Daily compliance needed
❌ No protection against STIs/HIV
❌ Hormonal side effects in some women

12. Nursing Responsibilities

• Assess eligibility (medical history, BP, smoking)
• Explain correct usage and missed-pill rules
• Counsel about side effects and warning signs
• Encourage regular follow-up
• Promote dual protection (condom + pill)

13. Key Exam-Oriented Points (Golden Points)

⭐ MALA-N is a combined oral contraceptive
⭐ Contains Ethinyl Estradiol + Levonorgestrel
⭐ 21 hormonal + 7 iron tablets
⭐ Started on 5th day of menstruation
⭐ Provided free under National Family Planning Programme

MALA-D Contraceptive

---

1. Introduction

MALA-D is a combined oral contraceptive pill (COC) supplied free of cost under the National Family Planning Programme of India.
It is mainly used for temporary contraception (birth spacing) in married women of reproductive age.

2. Composition

Each MALA-D strip contains 28 tablets:

• 21 Active (Hormonal) tablets
  • Ethinyl Estradiol – 0.03 mg
  • Levonorgestrel – 0.15 mg
• 7 Inactive (Non-hormonal) tablets
  • Ferrous Fumarate (Iron tablets)

👉 Iron tablets help prevent iron-deficiency anemia and maintain pill-taking habit.

3. Mechanism of Action

MALA-D prevents pregnancy by:

1. Inhibition of ovulation
   – Suppresses LH and FSH release
2. Thickening of cervical mucus
   – Prevents sperm entry
3. Endometrial changes
   – Prevents implantation

4. Dosage & Schedule

• Start on the 5th day of menstruation
• Take one tablet daily at the same time

Tablet sequence:

• Day 1–21: White tablets (hormonal)
• Day 22–28: Brown tablets (iron)

🔁 Start the next pack immediately after finishing the previous pack.

5. Effectiveness

• Perfect use: >99% effective
• Typical use: ~91% effective

Effectiveness decreases with missed pills.

6. Indications

• Temporary contraception (spacing method)
• Regulation of menstrual cycle
• Reduction in menstrual bleeding
• Relief from dysmenorrhea
• Improves acne in some women

7. Contraindications

❌ Do NOT use MALA-D in:

• Pregnancy
• Breastfeeding < 6 months
• History of thromboembolic disorders
• Severe hypertension
• Liver disease
• Breast carcinoma
• Migraine with aura

8. Side Effects

Common:

• Nausea
• Headache
• Breast tenderness
• Weight gain
• Spotting between cycles

Serious (rare):

• Thrombosis
• Stroke
• Severe hypertension

9. Missed Pill Instructions

• One pill missed:
  → Take immediately when remembered
• Two or more pills missed:
  → Take last missed pill
  → Use additional contraception for 7 days

10. Advantages

✅ Highly effective and reversible
✅ Easy to use
✅ Improves menstrual regularity
✅ Reduces risk of ovarian and endometrial cancer
✅ Free supply by government

11. Disadvantages

❌ Requires daily intake
❌ No protection against STIs / HIV
❌ Hormonal side effects possible

12. Nursing Responsibilities

• Screen for contraindications
• Check blood pressure
• Educate on correct pill use
• Counsel regarding missed pills
• Advise warning signs (ACHES: Abdominal pain, Chest pain, Headache, Eye problems, Severe leg pain)

13. Key Exam-Oriented (Golden Points)

⭐ MALA-D is a combined oral contraceptive pill
⭐ Contains Ethinyl Estradiol + Levonorgestrel
⭐ 21 hormonal + 7 iron tablets
⭐ Started on 5th day of menstruation
⭐ Provided under National Family Planning Programme of India