Causes Of Bleeding While Using Contraceptives 

Swipe to learn common causes of bleeding while using oral contraceptive pills 👩🏻‍⚕️💊

Not every bleeding episode means something dangerous  but understanding the cause matters.

This is one of the most common concerns women have — and the short answer is:

No, an IUD does NOT cause infections by itself.

🔬 What do guidelines say?

According to WHO, CDC, and ACOG guidelines:

Modern IUDs (copper or hormonal) do not increase the long-term risk of pelvic infections.

The only slightly increased risk of infection is during the first 20 days after insertion, and this is related to pre-existing infection, not the IUD itself.

⚠️ When can infections happen?

An infection may occur if:

• A woman already has an untreated STI (like chlamydia or gonorrhea) at the time of insertion
• Poor aseptic technique is used during insertion (rare in clinical settings)
• New exposure to STIs after insertion (IUD does not protect against STIs)

👉 The IUD does not create bacteria, and it does not “store infection” inside the uterus.

🩺 Do we need routine antibiotics before insertion?

No.

Guidelines do not recommend routine antibiotics before IUD insertion.

What is recommended:

Proper history taking

STI screening only for women at high risk

Safe, sterile insertion technique

🚨 When should a woman seek medical advice?

After IUD insertion, seek care if there is:

Persistent lower abdominal pain

Fever

Foul-smelling vaginal discharge

Pain during intercourse

These symptoms are not normal and should be evaluated — whether or not an IUD is present.

🌸 The bottom line

✔️ IUDs are safe, effective, and long-acting contraceptive methods

✔️ They do not cause infections

✔️ Good counseling and proper insertion make them even safer

Fear should never replace facts.

💙 Dr Rabab Cares

If you have symptoms or concerns, don’t remove the IUD on your own — get proper evaluation first.

#DrRababCares

#FamilyPlanning

#IUDFacts

#WomenHealth

#ReproductiveHealth

#FORESTPARKHOSPITAL

 Family Planning Series – Week 10

Natural & Fertility Awareness Methods  

These methods depend on understanding the woman’s natural fertility cycle and avoiding unprotected intercourse during the fertile window.

🔹 Types of Natural Methods:

1️⃣ Calendar (Rhythm) Method  

Based on calculating fertile days according to previous cycles.

2️⃣ Cervical Mucus Method  

Monitoring the changes in vaginal discharge to identify ovulation.

3️⃣ Basal Body Temperature Method  

Daily temperature measurement to detect ovulation after it occurs.

4️⃣ Symptothermal Method  

A combination of temperature + mucus + cycle tracking.

5️⃣ Withdrawal (Coitus Interruptus)  

The male partner withdraws before ejaculation (least reliable).

✅ Advantages:  

- No hormones.  

- No medical intervention.  

- Acceptable for couples who prefer natural methods.  

- Free of cost.

⚠️ Disadvantages:  

- Requires high discipline and daily tracking.  

- Higher failure rate compared to hormonal and long-acting methods.  

- Easily affected by stress, illness, irregular cycles.  

- Does NOT protect from STIs or HIV.

📖 Effectiveness:  

Typical use failure rate ranges from 15–25% per year .

💡 Key Message:  

Natural methods can work for motivated, well-informed couples — but they are not the most reliable options for pregnancy prevention.

#DrRababCares 

#FamilyPlanning #NaturalMethods #FertilityAwareness #ReproductiveHealth #WomensHealth #ForestParkHospital

 Breastfeeding as a Method of Contraception (LAM Method)

 Family Planning Series Week (9)

Many mothers don’t know that exclusive breastfeeding can act as a natural method of contraception but only under strict medical conditions.

What is LAM (Lactational Amenorrhea Method)?

A temporary family planning method based on:

• Exclusive breastfeeding
• Baby feeding day & night
• No return of menstruation

📌 When Is It Effective?

LAM works ONLY if all 3 conditions are met:

1️⃣ Baby is less than 6 months old

2️⃣ Mother has NO periods since delivery

3️⃣ Fully or nearly fully breastfeeding

No bottles

No long gaps (>4 hours day / >6 hours night)

✨ If any condition changes → LAM stops working immediately.

✔️ Effectiveness

Up to 98% effective when used correctly.

Very safe for both mom and baby.

Zero hormones.

❌ When LAM is NOT recommended

• If periods returned
• Baby older than 6 months
• Mixed feeding (formula + breast)
• Mother cannot breastfeed frequently
• Mother has medical issues affecting milk supply

🔄 When to Switch to Another Method

As soon as:

Baby reaches 6 months

Periods return

Baby sleeps long stretches

Supplementation begins

Recommended next-step options:

Progestin-only pill, Implant, IUD, Sayana Press, Depo, or condoms — depending on medical history.

💙 Final note

Breastfeeding is beautiful — but it’s not a guaranteed contraceptive unless used exactly as guided.

If you need help choosing the safest method after childbirth, you are welcome to visit me at Forest Park Hospital.

#FamilyPlanning #DrRababCares #LAM #Breastfeeding #Contraception #PostpartumCare  #WomensHealth

 Family Planning Series – Week 8:

( Injectable Contraceptives )

 What are Injectable Contraceptives?

They are hormonal birth-control injections that prevent ovulation and thicken cervical mucus, making it harder for sperm to reach the egg.  

The most common types are:  

• Depo-Provera  150 mg Medroxyprogesterone acetate | IM | Every 3 months (13 weeks)
• Sayana Press  104 mg Medroxyprogesterone acetate | SC | Every 3 months (13 weeks) 
• Noristerat 200 mg Norethisterone enanthate  IM | Every 2 months.

How They Work ?

1️⃣ Inhibit ovulation.  

2️⃣ Thicken cervical mucus to block sperm.  

3️⃣ Thin the uterine lining to prevent implantation.  

Advantages :

✅ Very effective (97–99% if taken on time).  

✅ Long-acting and reversible.  

✅ Safe for breastfeeding (after 6 weeks postpartum).  

✅ Can reduce menstrual pain and bleeding.  

✅ Suitable for women who can’t take estrogen.  

⚠️ Possible Side Effects:

- Irregular bleeding or no periods.  

- Mild weight gain or bloating.  

- Headache or mood changes.  

- Delayed fertility return (4–10 months) after last dose.  

- Slight bone density reduction if used for more than 2 years.  

- Does not protect against HIV or STIs.

 📋 Guideline Notes (WHO & ACOG):

- Start within first 7 days of menstruation or 6 weeks postpartum.  

- Keep injections on schedule (every 8–13 weeks depending on type).  

- If > 2 weeks late → rule out pregnancy before reinjection.  

- Regular BP check and counseling about delayed fertility are essential.  

💬 Key Message :

Injectables are safe, effective, and convenient — but timing and follow-up are everything.  

They don’t protect against STIs, so condoms are still important for protection.  

#DrRababCares

 #FamilyPlanning #Injectables #DepoProvera #Noristerat #SayanaPress #Contraception #ReproductiveHealth #WomensHealth #OBGYN #Lusaka #ForestParkHospital

 Family Planning Series – Week 7:

 Vasectomy (Male Sterilization)

🔹 What is Vasectomy?

Vasectomy is a permanent method of contraception for men.  

It involves cutting or sealing the vas deferens, the tubes that carry sperm from the testicles to the urethra, preventing sperm from mixing with semen.  

It is a minor surgical procedure , usually done under local anesthesia, and takes about 15–30 minutes.  

📋 Indications

•  Men who have completed their families.  
•  When pregnancy may endanger the woman’s health (e.g., cardiac disease, hypertension, diabetes).  
•  When couples desire a simple, permanent method.  
•  When other contraceptive methods are unsuitable or have failed.  
•  When both partners agree after good counseling that the man will take responsibility for contraception.  

⚙️ How it works

• The procedure blocks the vas deferens on both sides — either by ligation, cauterization, or clips.  
• Semen is still produced, but it contains no sperm, so pregnancy cannot occur.  
• It does not affect hormones, sexual desire, or the ability to have an erection.  

 🌟 Advantages

✅ Permanent and highly effective (>99%).

✅ Simple outpatient procedure.  

✅ No effect on libido or testosterone.  

✅ Safe, low-risk, and cost-effective in the long term.  

✅ Allows shared family planning responsibility between partners.  

 ⚠️ Disadvantages / Possible Side Effects

- Requires minor surgery.  

- Discomfort, bruising, or swelling for a few days after the procedure.  

- Rare complications (infection, hematoma, chronic pain).  

- Takes about 3 months or 20 ejaculations for sperm to clear completely — another contraceptive method must be used until semen analysis confirms azoospermia.  

- Permanent – reversal is difficult and not always successful.  

- Does not protect against HIV or other STIs.  

📖 Guideline Notes (WHO & CDC)

- Pre-operative counseling is essential for both partners.  

- Written informed consent must be obtained.  

- Post-operative semen testing should confirm the success of the procedure before stopping other contraceptive methods.  

- Men should be informed that vasectomy is a permanent choice.  

💡 Key Message

Vasectomy is a safe, permanent, and reliable method of contraception for men who have completed their families.  

It does not affect sexual function, but requires good counseling for both partners before the decision.  

#DrRababCares

 #FamilyPlanning #Vasectomy #MaleSterilization #WomensHealth #ForestParkHospital #Lusaka #OBGYN #Contraception #ReproductiveHealth

 Family Planning Series – Week 6: 

Bilateral Tubal Ligation (BTL)

🔹 What is BTL?  

Bilateral Tubal Ligation (BTL) is a permanent surgical method of contraception where the fallopian tubes are blocked, tied, or sealed to prevent the egg from meeting sperm.  

🔹 How is it done?

•  Laparoscopic: using a camera and small incisions.  
•  Mini-laparotomy:small abdominal incision, often after childbirth.  
•  Laparotomy:usually combined with other abdominal surgeries (e.g., C-section).  

🔹 Advantages:

•  Highly effective (>99%).  
•  One-time procedure – no daily pills or injections.  
•  Does not affect hormones, so natural periods continue.  
• Can be safely done immediately after delivery (C-section or vaginal).  

🔹 Disadvantages / Possible Side Effects:

- Permanent – reversal is very difficult.  

- Small surgical risks (bleeding, infection, anesthesia).  

- No protection against STIs/HIV.  

- Some women may experience:  

  - Heavier menstrual flow

  - Pelvic congestion (chronic pelvic pain or fullness)  

  - Rare failure, which increases risk of ectopic pregnancy.  

🔹 Counseling is essential

- Both partners should be counseled thoroughly before the procedure.  

- The woman must clearly understand the permanent nature.  

- Consent is mandatory according to **WHO and ACOG guidelines**.  

🔹 Who can consider it?

- Women who have completed their families.  

- Women with medical conditions where pregnancy would be dangerous.  

👉 Key message:

BTL is safe, effective, and permanent – but requires good counseling for the couple before making the decision.

#DrRababCares 

#FamilyPlanning #TubalLigation #BTL #Contraception #WomensHealth 

#ObGyn #ReproductiveHealth #DrRababCares #ForestParkHospital 

#LusakaHealth #PermanentContraception #GynecologyCare

 Family Planning Series – Week 5:

 Contraceptive Implants 

Contraceptive implants are small, flexible rods inserted under the skin of a woman’s upper arm. They slowly release a hormone (progestin) to prevent pregnancy.  

⏳ Duration  

- 3 years: Single-rod implant (e.g., Implanon/Nexplanon).  

- 5 years: Two-rod implants (e.g., Jadelle).  

⚙️ How do they work?  

1. Prevent ovulation.  

2. Thicken cervical mucus, making it harder for sperm to reach the egg.  

3. Thin the uterine lining, reducing the chance of implantation.  

🌟 Advantages  

✅ Highly effective (>99%).  

✅ Long-term protection (3–5 years).  

✅ No daily pill needed.  

✅ Rapid return of fertility after removal.  

✅ Safe for breastfeeding women and for those who cannot take estrogen.  

⚠️ Disadvantages / Side effects  

- Irregular bleeding or spotting (especially in the first 6–12 months).  

- Headaches, mood changes, or acne.  

- Possible weight changes or breast tenderness.  

- Requires trained provider for insertion and removal.  

- Does not protect against HIV/STIs (condoms are still essential).  

📋 Clinical Guidelines  

- Before insertion: Take a medical history, rule out pregnancy, and provide counseling.  

- Timing of insertion:  

   • Within first 5 days of cycle → protection is immediate.  

   • At any other time → use backup (condoms) for 7 days.  

- Special groups: Safe for breastfeeding (from 6 weeks postpartum).  

- Follow-up: 

Only if side effects occur. Removal/replacement must be done by a trained provider.  

- Seek medical advice if: bleeding is heavy, implant is not palpable, or severe side effects occur.  

💡 Key Message  

Implants are one of the most reliable and low-maintenance family planning methods, ideal for women seeking long-term contraception without daily effort. Always consult your doctor to confirm if this method is right for you.  

#DrRababCares

 #FamilyPlanning #ContraceptiveImplant #WomensHealth #ForestParkHospital #OBGYN #Lusaka

 Family Planning Series (Week 4)

🌸 Family Planning Series – Week 4: Intrauterine Devices (IUDs) 🌸

An Intrauterine Device (IUD) is a small T-shaped device placed inside the uterus by a trained healthcare provider. It is one of the most effective, reversible, and long-acting contraceptive methods worldwide.

🔹 Types of IUDs:

1️⃣ Copper IUDs (Non-hormonal)

• Copper T 380A → effective for up to 10 years.
• Multiload IUD → curved design, better fit to the uterus, effective 5–10 years.
• Silver IUD → copper with added silver core to reduce corrosion, effective for about 5 years.
• Gold IUD → marketed in some regions, lifespan 5–10 years depending on brand.

2️⃣ Hormonal IUDs (Levonorgestrel IUS – e.g., Mirena, Kyleena, Jaydess)

• Release a small amount of hormone locally.
• Effective for 3–5 years depending on the brand.

🔹 How do they work?

Copper IUDs: copper ions are toxic to sperm → prevent fertilization and implantation.

Hormonal IUDs: thicken cervical mucus, thin the endometrium, and sometimes suppress ovulation.

✅ Advantages:

• Over 99% effective.
• Long-acting → “fit and forget.”
• Fertility returns quickly after removal.
• Copper IUD can also be used as emergency contraception (within 5 days).

⚠️ Disadvantages:

• Copper IUD: heavier or more painful periods at first.
• Hormonal IUD: spotting, irregular bleeding, mood changes.
• Small risk of perforation or expulsion (rare).
• Requires insertion by a skilled provider.

🔹 Non–Family Planning Uses of the Hormonal IUD:

• The hormonal IUD is not only for contraception — it has proven therapeutic benefits:
• Management of heavy menstrual bleeding (menorrhagia).
• Treatment for endometriosis-related pain.
• Protection of the endometrium in women using estrogen therapy.
• Sometimes used in adenomyosis to reduce symptoms.

📖 Guideline Note (WHO MEC):

• IUDs are safe for most women, including adolescents and women who have not given birth.
• Contraindicated in women with pelvic infection, unexplained bleeding, or uterine abnormalities.

💡 Key Message:

IUDs come in many types — copper, silver, gold, multiload, or hormonal — giving women safe and long-term choices.

The hormonal IUD goes beyond family planning, offering real health benefits in managing gynecological conditions.

But remember: IUDs do not protect against HIV or STIs. Condoms remain essential for dual protection.

#DrRababCares 

#FamilyPlanning #IUD #Contraception #WomensHealth #ForestParkHospital

 Family Planning Series – Week 3: Local / Topical Methods & HIV Prevention 

Family planning isn’t only about avoiding pregnancy — it’s about protecting health and making safe choices for the future.

🔹 Local / Topical Methods in Family Planning

These are methods used directly in the vagina before intercourse:

• Spermicides (gels, foams, creams).
• Vaginal suppositories (pessaries) with spermicide.
• Vaginal sponge or diaphragm with spermicide.

👉 All of these methods help prevent pregnancy by killing sperm or blocking them — but ❌ they do not protect against HIV or other STIs.

Sometimes they may even irritate vaginal tissues, which can increase the risk of infection.

🔹 Condoms: The Only Dual Protection

• Male condoms and female condoms protect against both pregnancy and HIV/STIs.
• Consistent and correct condom use reduces HIV transmission risk by >90%.
• Condoms remain the cornerstone of HIV prevention worldwide.

🔹 If exposure already happened (unprotected sex, condom break):

Post-Exposure Prophylaxis (PEP):

✔ Start as soon as possible, within 72 hours.

✔ 28-day course of antiretroviral drugs.

✔ Available in hospitals and HIV clinics.

✔ Follow-up HIV testing is required.

💡 Key Message for Youth:

Pills, injections, implants, local gels or suppositories = pregnancy prevention only.

Condoms are the only family planning tool that also protects from HIV/STIs.

After risky exposure, PEP is your safety net — but timing is critical.

#DrRababCares 

#FamilyPlanning #HIVPrevention #YouthHealth #Condoms #PEP #WomensHealth #ForestParkHospital

 🌸 Family Planning Series – Week 2: Progestin-only Pills (POPs) & Emergency Pills 🌸

Not all contraceptive pills are the same. Today we focus on two important types:

🔹 1. Progestin-only Pills (POPs – “Mini pill”)

• Composition: contain only progestin (no estrogen).
• How they work: mainly thicken cervical mucus, thin the endometrium, sometimes suppress ovulation.

Best for:

1. Breastfeeding mothers.
2. Women who cannot take estrogen (e.g., smokers >35, clotting disorders).
3. Key point: must be taken at the same time every day. Missing a pill by >3 hours can reduce effectiveness.

✅ Advantages: Safe during lactation, fewer contraindications.

⚠️ Disadvantages: Irregular bleeding, strict timing.

🔹 2. Emergency Contraceptive Pills (ECPs)

Purpose: prevent pregnancy after unprotected sex or contraceptive failure.

Types:

• Levonorgestrel (LNG): most effective within 72 hrs.
• Ulipristal acetate: up to 5 days after unprotected sex.
• How they work: delay ovulation; do not terminate pregnancy.
• Key point: the earlier they are taken, the more effective.

✅ Advantages: last-chance protection, widely available.

⚠️ Disadvantages: not for regular use, may cause nausea/irregular bleeding.

 Family Planning, HIV Prevention & Youth Health  

Family planning is not only about preventing pregnancy — it is about protecting health, choices, and the future.  

 🔹 What is Family Planning?  

According to WHO guidelines, family planning allows women and men to decide:  

•  If and when to have children.  
•  How many children to have.  
•  What method of contraception is safest and most effective for them.  

Methods include:  

•  Hormonal (pills, injectables, implants, IUD).  
•  Non-hormonal (copper IUD).  
•  Local/barrier methods.  

 🔹 What about HIV and STIs?  

-Most contraceptive methods only prevent pregnancy.  

- They do not prevent HIV or sexually transmitted infections.  

-Condoms (male & female) are the only method that provide dual protection:  

  ✔ Prevent pregnancy  

  ✔ Reduce the risk of HIV & STIs  

Guideline Note: 

WHO and CDC recommend condoms as essential in all family planning counseling where HIV/STI risk is present.  

 🔹 What if exposure already happened?  

In case of unprotected sex or condom failure with risk of HIV:  

•  Post-Exposure Prophylaxis (PEP) should be started as soon as possible — within 72 hours.  
•  PEP = a 28-day course of antiretroviral drugs.  
•  The earlier you start, the more effective it is.  
•  Follow-up HIV testing is required (baseline, 6 weeks, 3 months).  

 💡 Key Message  

- Family planning saves lives and supports healthy families.  

- Condoms are the only family planning method that also protects against HIV/STIs.  

- If exposure occurs, PEP (post-exposure prophylaxis) is a lifesaving emergency option — but it must be started quickly.  

Written by Dr Rabab Mustafa, Consultant OB/GYN and Medical Director at Forest Park Hospital, Lusaka.  

When it comes to contraception, there is no single “best method.”

Every woman is unique — and the right choice depends on health, lifestyle, and personal needs.

Contraceptive methods are divided into three main groups:

1️⃣ Hormonal methods – pills, injectables, implants, hormonal IUD.

2️⃣ Non-hormonal methods – copper IUD, condoms, diaphragm.

3️⃣ Local methods – spermicides, vaginal ring, contraceptive sponge.

✨ Today, we start with one of the most common hormonal methods: Combined Oral Contraceptives (COCs).

🔹 What are COCs?

• Pills containing estrogen + progestin.
• Taken daily, usually 21 days with a 7-day break (or placebo).

🔹 How do they work?

Suppress ovulation.

Thicken cervical mucus to block sperm.

Thin the endometrium to prevent implantation.

✅ Advantages:

Dual role: reliable contraception + therapeutic benefits.

Improves quality of life for many women.

⚠️ Disadvantages

Daily intake is essential.

Side effects: nausea, mood changes, irregular bleeding.

⚠️ Not suitable for , contraindication:

Smokers above 40 years old.

Migraine with aura.

History of blood clots.

. Cholecystitis (Gall bladder disease)

Uncontrolled hypertension.

🔹 Other Medical Uses of COCs:

Cycle Regulation:

• Helpful for women with irregular periods.
• Management of Menstrual Disorders:
• Reduce heavy menstrual bleeding (menorrhagia).
• Relieve painful periods (dysmenorrhea).

Polycystic Ovary Syndrome (PCOS):

• Control irregular cycles.
• Improve acne and hirsutism by lowering androgen levels.

Endometriosis:

Reduce pelvic pain and suppress endometrial tissue growth.

Premenstrual Syndrome (PMS) & PMDD:

Alleviate mood changes, bloating, and discomfort before periods.

Cancer Risk Reduction:

Long-term use lowers the risk of ovarian and endometrial carcinoma.

📖 Guidelines:

According to WHO MEC and ACOG, non-contraceptive benefits are well-established and often considered when prescribing COCs for women without primary need for family planning.