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PERKEMBANGAN KONTRASEPSI TERKINI
Biran Affandi
Klinik Raden Saleh
Departement Obstetri & Ginekologi
Facultas Kedokteran , Universitas Indonesia/
Rumah Sakit Dr. Cipto Mangunkusumo, Jakarta
Affandi B. Perkembangan Kontrasepsi Terkini. Peringatan Hari
Kontrasepsi Sedunia , BKKBN , Jakarta , 30 September 2014
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OBJECTIVES: 1.To overview basic principles of
family planning
2.To overview the possible pattern of contraceptive methods
3.To review new contraceptives
4.To recommend practical points Affandi B. Perkembangan
Kontrasepsi Terkini. Peringatan Hari Kontrasepsi Sedunia , BKKBN ,
Jakarta , 30 September 2014
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PERENCANAAN KELUARGA
1. Seorang wanita telah dapat melahirkan, segera setelah ia
mendapat haid yang pertama (menarche)
2. Kesuburan seorang wanita akan terus berlangsung, sampai mati
haid (menopause)
3. Kehamilan dan kelahiran yang terbaik, artinya risiko paling
rendah untuk ibu dan anak, adalah antara 20-35 tahun
4. Persalinan pertama dan kedua paling rendah risikonya
5. Jarak antara dua kelahiran sebaiknya 2-4 tahun
Affandi, 1984
Affandi B. 1978
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POLA PERENCANAAN KELUARGA
2 - 4
20 35
Fase Fase Fase
Menunda Kehamilan
Menjarangkan Kehamilan
Tidak Hamil lagi
Affandi, 1984
Affandi B. 1978
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Possible patterns of intervention to fertility
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Ideal Contraceptive
100% effective readily reversible use not related to intercourse
easy to use cheap readily available no side effects does not affect
sexual pleasure health benefits
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Contraceptive Options
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CDC , 2014
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Condom effectiveness at a glance
When used correctly and consistently, condoms are an effective
means of preventing pregnancy When used correctly and consistently,
condoms are an effective means of preventing STD/HIV Today's condom
is manufactured with greater precision Condom use is improved by
the right lubricant
Affandi B. Perkembangan Kontrasepsi dan Kesehatan Reproduksi .
Expert Meeting , BKKBN , Jakarta ,3 Feb 2009
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Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan
28-30 July 2008
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Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan
28-30 July 2008
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Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan
28-30 July 2008
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Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan
28-30 July 2008
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Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan
28-30 July 2008
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Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan
28-30 July 2008
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Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan
28-30 July 2008
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Cervical Cap:Leas Shield Cervical Cap yang terbuat dari
Silicone yang bisa dipakai ulang
Kerjanya sebagai Penghalang Sperma untuk masuk
Efektivitasnya 85-90% (tergantung dari spermicida dan tingkat
paritas)
Perlu dibantu Provider pada awal pemakaian
Dipasang segera sebelum berhubungan intim dan dibiarkan 8 jam
setelahnya
Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan
28-30 July 2008
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PIL KB Affandi B. Contraceptive Update . PIT XVII POGI ,
Balikpapan 28-30 July 2008
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MEKANISME KERJA PIL KB * Mencegah pematangan dan pelepasan sel
telur * Mengentalkan lendir leher rahim, sehingga menghalangi
penetrasi sperma
* Membuat selaput lendir rahim tidak siap untuk menerima dan
menghidupi hasil pembuahan
(Leon Speroff, et.al., 2001, Oral Contraception, A Clinical
Guide for Contraception; 2: 39-40) Affandi B. Contraceptive Update
. PIT XVII POGI , Balikpapan 28-30 July 2008
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Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan
28-30 July 2008
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Seasonale Pack berisi
91 Pil 84 Pil aktif (Pink) 7 Inaktif Pil (Putih)
Dosis kombinasi rendah: EE 30 g LNG 150 g
Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan
28-30 July 2008
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KONTRASEPSI IDEAL ? Efektivitas maksimal
Efek samping minimal
Memberikan keuntungan tambahan ?
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Manfaat: 1. Kontrasepsi
kontrol siklus yang baik
aman untuk jangka panjang
OC Plus (EE + CPA)
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Manfaat Tambahan:
2. Kulit halus dan cantik
mengatasi masalah kulit langsung pada akarnya menghilangkan
jerawat dan hirsutisme secara cepat dan efektif
OC Plus (EE + CPA)
Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan
28-30 July 2008
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Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan
28-30 July 2008
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The Contraceptive Patch Ortho Evra
Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan
28-30 July 2008
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INJECTABLE CONTRACEPTIVE 2003
Period Formula Status monthly 1. DMPA 25 mg + EC 5 mg
2. Net-En 50 mg EV 5 mg 3. Net-En 20 mg 4. DMPA 50 mg + EE 10 mg
5. Others
Market Market Phase II Market
2-3 months 1. Net-En 200 mg 2. DMPA 150 mg 3. Net Microcapsul
100 mg
Market Market Phase I - II
6 months 1. DMPA 450 mg 2. Net microcapsul 200 mg
Market Phase I II
Affandi, 2003
Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan
28-30 July 2008
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Contraceptive choices no ideal contraceptive more methods
available more likely a
couple or individual will find a suitable method
long-acting reversible contraceptives (LARC): Implanon, Mirena ,
IUD-T380A have very low failure rates
LARCS require little action on part of user
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Strategies to improve compliance
Developing and encouraging use of long-acting methods that
require no regular action on part of user
Improving access to information which is provided in a form
centred on an individuals requirements
Accurate information about likely side effects and encouragement
to continue
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Long-acting reversible contraceptives
Sub-dermal implants Implanon
Jadelle
Intrauterine devices Hormonal
Copper-bearing
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IUD IUD mencegah kehamilan dengan cara
Mencegah fertilisasi dengan cara membuat sperma menjadi lemah
dan tidak mencapai tuba.
Menyebabkan reaksi peradangan di endometrium
Mengganggu transportasi tuba terganggu
Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan
28-30 July 2008
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Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan
28-30 July 2008
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Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan
28-30 July 2008
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The levonorgestrel intrauterine system
Levonorgestrel
intrauterine
system
Detail
Uterine
wall
Section of
system
Affandi B. Mirena, Beyond Contraception
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STATUS & DEVELOPMENT OF IMPLANTABLE CONTRACEPTIVES 2006
TRADE NAME PROGESTIN IMPLANTS DURATION STATUS
Norplant LNG 6 rods 5 years Market
Implanon ENG 1 rod 3 years Market
Jadelle LNG 2 rods 5 years Market
Uniplant NMA 1 caps 1 year Phase III-IV
Nestrone ST1435 1 rod 2 years Phase III
Elcometrine ST1435 1 caps 6 months Market
Indoplant LNG 2 caps 3 years Market
Affandi B. Contraceptive Update . PIT XVII POGI , Balikpapan
28-30 July 2008
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Implantable contraceptives
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The Implanon rod
R a t e - c o n t r o l l i n g m e m b r a n e ( 0 . 0 6 m m
)
C o r e : 40% Ethylenevinylacetate (EVA) 6 0 % e t o n o g e s t
r e l
M e m b r a n e : 1 0 0 % E V A
Core 2 mm
40 mm
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Implanon
Single rod 4cm x 2mm inserted under the skin of the inner
surface of upper arm Preloaded sterile applicator Needle inserted
under skin under sterile conditions Inserter removed leaving
implant in place Insertion takes 1-2 minutes Removal takes 2-3
minutes through a 2mm incision Implant invisible but can be felt
under skin
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Implanon Mode of Action
Follicular development without ovulation
LH surge prevented Increased viscosity of cervical mucus
Endometrium thin but not atrophic
with weak proliferation Pregnancy rate 0 -0.01% per year Return
of ovulation rapid on removal
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Kontrasepsi Permanen tanpa Operasi: Essure
Permanen, Non-hormonal Keunggulannya
Tdk ada sayatan, tdk perlu anesthesi umum
Prosedur pemasangan < 1 jam (92 % wanita kembali berkerja<
24 jam)
Efektif (99.8 % setelah 2 tahun pemakaian)
Keterbatasannya Perlu 3 bulan sebelum efektif
Kemungkinan kegagalan insersi (microinsert)
Perlu operasi untuk mengangkat
Perlu Obgyn yg terlatih dalam hysteroscopy
Mahal ( US$ 1,500) Affandi B. Perkembangan Kontrasepsi dan
Kesehatan Reproduksi . Expert Meeting , BKKBN , Jakarta ,3 Feb
2009
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Essure: Bagaimana kerjanya ?
Merangsang tumbuhnya jaringan parut (scarification) didalam tuba
fallopii
Alat ini ditanamkan kedalam masing masing ujung tuba Falopii
dengan menggunakan kateter khusus yang dipandu dengan suatu
hysteroscope melalui vagina.
Occlusi (Penutupan) di periksa setelah 3 bulan
Affandi B. Perkembangan Kontrasepsi dan Kesehatan Reproduksi .
Expert Meeting , BKKBN , Jakarta ,3 Feb 2009
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CONTRACEPTIVE METHOD RATIONAL CHOICE
2 - 4
20 35
Phase DIFFERING SPACING COMPLETING
- Pill - IUD - Conventional - Inject. - Implant
- IUD - Inject. - Pill - Implant - Conventional
- IUD - Inject. - Pill - Implant - Conventional - Steril
- Steril - IUD - Pill - Implant - Inject. - Conventional
Phase Phase
Affandi B,1984
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Simplified Classification of Eligibility Criteria (WHO)
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1
WHO guidelines classify conditions that affect medical
eligibility for various
contraceptive methods into 4 categories
A condition for which there is no restriction for the use of the
contraceptive method
A condition in which the advantages of using the method
generally outweigh the theoretical or proven risks
A condition in which the theoretical or proven risks usually
outweigh the advantages of using the method
A condition that represents an unacceptable health risk if the
contraceptive method is used
World Health Organization. Medical Eligibility Criteria for
Contraceptive Use, 4th ed. 2010.
2
3
4
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Unmet Need : Fertility Preferences of Postpartum Women
Key Findings in Indonesia (IDHS 2012)1 : 85% of currently
married women and 53% of currently
married men who have 2 living children do not want to have more
children. The percentage wanting no more children increases rapidly
with the number of living children.
According to many DHS surveys2: 92-97% of women do not want
another child within 2 years
after giving birth
But 35% of women had their children spaced at 2 years apart or
less
40% of women who intend to use a FP method in the first year
postpartum are not using one
1. IDHS 2012, chapter 6, p 63
2. Ross JA and Winfrey WL, 2001
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ACOG Recommendations
LARC methods should be offered as first-line contraceptive
methods and encouraged as options for most women
LARC methods have few contraindications
Almost all women are eligible for the implant and IUDs
American College of Obstetricians and Gynecologists. Practice
Bulletin No. 121, Long-Acting Reversible Contraception: Implants
and Intrauterine Devices, July 2011.
American College of Obstetricians and Gynecologists. Committee
Opinion No. 450, Increasing Use of Contraceptive Implants and
Intrauterine Devices To Reduce Unintended Pregnancy, December
2009.
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Nulliparous Women and Adolescents
Can Be Offered LARC Methods
ACOG , 2014
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CDC Medical Eligibility Criteria
Category Restriction
1 No restriction
2
Advantages generally outweigh theoretical or proven risks
3
Theoretical or proven risks usually outweigh advantages
4
Unacceptable health risk
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http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6026a3.htm#tab3
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Counseling about hormonal contraceptive options is an important
part of the clinical consultation
even if the users appear knowledgeable about
their contraceptive method, there are likely
some areas where their knowledge could be
improved.
Costa A, et al. 2010 11th Congress of the European Society of
Contraception and Reproductive Health
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BIRTH RATE
STILL HIGH ! ! !
4.5 5 Million/year
Affandi B. Unsafe Abortion : Indonesian Experience . 1st
International Congress on Women Health & Unsafe Abortion ,
Bangkok , Thailand , 20-23 January 2010
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FAKTA 1.Pascasalin OVULASI
dapat terjadi dalam waktu 21 hari
2.Pascakeguguran OVULASI dapat TERJADI dalam waktu 11hari
Affandi B. Kontrasepsi Terkini dan IUD Pascaplasenta . Pertemuan
Koordinasi Peningkatan KB Pascapersalinan di Rumah Sakit , Makassar
31 Agustus 2010
Contraceptive choices for breastfeeding women .Journal of Family
Planning and Reproductive Health Care 2004; 30(3): 181189
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Postplacental (preferably within 10 minutes after expulsion of
the placenta) and immediate postpartum insertion during the first
week after delivery (but preferably within 48 hours) are convenient
effective and safe times to insert copper IUDs.
Affandi B. Perkembangan Kontrasepsi, Teknik Penapisan dan KB
Postpartum , BPMPPKB, Balikpapan , 24 Juni 2010
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Teknik Pemasangan AKDR
Affandi B. Postpartum Contraception & Medical Barrier.
Department of Obstetrics & Gynecology , University of Indonesia
, Jakarta , 22 Sept. 2010
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Affandi B. Postpartum Contraception & Medical Barrier.
Department of Obstetrics & Gynecology , University of Indonesia
, Jakarta , 22 Sept. 2010
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Practice Points When counselling men and women about
contraception, remember that there are many different methods
available
Balanced messages, giving the advantages and disadvantages of
oral pill, lead to greater user acceptability and continuation.
Emphasis should be placed on the safety, efficacy & non
contraceptive benefits of Yasmin.
Affandi B. Oral Contraceptive Pills & Weight Gain,
FKUI/RSCM, April 2008
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Good clinical decisions are founded on 3 essential elements:
Experience Perspective Evidence
Providers bring experience, perspective and evidence from their
education and clinical practice in specific communities.
Patients bring their own experience and perspectives, coloured
by issues such as geography, finance, culture and spirituality.
It is in this context and not in isolation, that available
evidence informs decisions.
Affandi B. Oral Contraceptive Pills & Weight Gain,
FKUI/RSCM, April 2008
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Knowing is not enough, we
must apply Willing is not
enough, we must do Goethe
PERKEMBANGAN KONTRASEPSI TERKINISlide Number 2PERENCANAAN
KELUARGAPOLA PERENCANAAN KELUARGASlide Number 5Ideal
ContraceptiveContraceptive OptionsSlide Number 8Slide Number 9Slide
Number 10Slide Number 11Slide Number 12Slide Number 13Slide Number
14Slide Number 15Slide Number 16Cervical Cap:Leas ShieldSlide
Number 18Slide Number 20Slide Number 21Seasonale Slide Number
23Slide Number 24Slide Number 25Slide Number 26The Contraceptive
PatchOrtho Evra INJECTABLE CONTRACEPTIVE 2003Contraceptive
choicesStrategies to improve complianceLong-acting reversible
contraceptivesIUDSlide Number 33Slide Number 34Slide Number 35Slide
Number 36Slide Number 37Slide Number 38Slide Number 39Slide Number
40Slide Number 41Slide Number 42Slide Number 43Slide Number 44Slide
Number 45Slide Number 46Slide Number 47Slide Number 48Slide Number
49Slide Number 50Slide Number 51Slide Number 52Slide Number 53Slide
Number 54Implantable contraceptivesSlide Number 56Slide Number
57Implanon Mode of ActionSlide Number 59Kontrasepsi Permanen tanpa
Operasi: EssureEssure: Bagaimana kerjanya ?Slide Number 62Slide
Number 63Slide Number 64CONTRACEPTIVE METHOD RATIONAL
CHOICESimplified Classification of Eligibility Criteria (WHO)WHO
guidelines classify conditions that affect medical eligibility for
various contraceptive methods into 4 categoriesUnmet Need :
Fertility Preferences of Postpartum WomenSlide Number 69Nulliparous
Women and Adolescents Can Be Offered LARC Methods Slide Number
71Slide Number 72Counseling about hormonal contraceptive options is
an important part of the clinical consultationSlide Number 74Slide
Number 75FAKTASlide Number 77Slide Number 78Slide Number 79Slide
Number 80Good clinical decisions are founded on 3 essential
elements:Knowing is not enough, we must applyWilling is not enough,
we must doGoethe