Family Planning Methods & Common Gynaecological Disorders
Key Takeaways
The Cu-T 380A is effective for 10 years and the Cu-T 375 for 5 years; a post-partum IUCD is inserted within 48 hours of delivery.
Antara (DMPA 150 mg) is an intramuscular injectable contraceptive given every 3 months, and Chhaya (centchroman 30 mg) is a non-hormonal pill taken twice a week for 3 months and then weekly.
The levonorgestrel emergency pill (1.5 mg) should be taken as soon as possible and within 72 hours of unprotected intercourse.
The Pearl Index expresses contraceptive failure as accidental pregnancies per 100 woman-years: failures × 1,200 ÷ total months of exposure.
NACO's syndromic STI/RTI kits are colour-coded from Kit 1 (grey, urethral or cervical discharge) to Kit 7 (black, inguinal bubo); Kit 6 (yellow) treats lower abdominal pain or PID.
Midwifery & Gynaecological Nursing is one of the 16 Annexure-II subjects. Recruitment papers ask about contraceptive choices under India's National Family Planning Programme and about common gynaecological conditions a nurse meets in the OPD, the labour room and at Ayushman Arogya Mandirs.
1. The National Family Planning Programme
India launched the world's first national family planning programme in 1952. The current approach is a "basket of choices"—offering couples a range of methods with informed choice and no targets. Mission Parivar Vikas (2016) focuses on high-fertility districts. NFHS-5 (2019–21) recorded India's total fertility rate at 2.0, just below replacement level (2.1).
India's basket of contraceptive methods
| Category | Method | Key facts |
|---|---|---|
| Barrier | Male condom (Nirodh) | Only method that also protects against STIs/HIV |
| Oral pills | Combined oral contraceptive (Mala-N) | 21 hormonal tablets + 7 iron tablets per cycle |
| Progestin-only pill (POP) | Suitable for breastfeeding mothers | |
| Chhaya (centchroman 30 mg) | Non-hormonal, non-steroidal; one tablet twice a week for the first 3 months, then once a week | |
| Emergency contraceptive pill (levonorgestrel 1.5 mg) | Single dose as soon as possible and within 72 hours of unprotected sex; not a regular method | |
| Injectables | Antara (DMPA 150 mg IM) | One injection every 3 months |
| MPA-SC (104 mg subcutaneous) | Every 3 months; can be self-injected after training (introduced in selected states in 2023) | |
| IUCD | Cu-T 380A | Effective for 10 years |
| Cu-T 375 | Effective for 5 years | |
| Post-partum IUCD (PPIUCD) | Within 48 hours of delivery (best within 10 minutes of the placenta) or during caesarean section | |
| Implant | Single-rod subdermal implant | About 3 years; introduced at district level in 2023 |
| Natural | LAM, Standard Days Method (cycle beads) | LAM needs exclusive breastfeeding, amenorrhoea and a baby under 6 months |
| Permanent | Female sterilization: minilaparotomy (Pomeroy technique) or laparoscopic (Falope ring) | Interval, post-partum (within 7 days) or post-abortion |
| Male sterilization: No-Scalpel Vasectomy (NSV) | Not effective immediately—use condoms for 3 months or until semen analysis shows no sperm |
IUCD nursing points
- Interval insertion within 12 days of the start of menstruation (pregnancy excluded); post-abortion insertion is also possible.
- Teach the woman to check the threads after each period; follow up after the first period or at 4–6 weeks.
- Side effects: heavier, more painful periods and spotting. Warning signs (PAINS): Period late, Abdominal pain, Infection or abnormal discharge, Not feeling well or fever, String missing or changed.
- Contraindications include pregnancy, active pelvic infection or STI, unexplained vaginal bleeding, and distorted uterine cavity.
Measuring effectiveness: the Pearl Index
Pearl Index = (number of accidental pregnancies × 1,200) ÷ total months of exposure, giving failures per 100 woman-years.
Worked example: 200 women use a method for 12 months each (2,400 woman-months) and 6 become pregnant: (6 × 1,200) ÷ 2,400 = 3 per 100 woman-years.
The WHO Medical Eligibility Criteria (MEC) classify each method for a given condition from Category 1 (no restriction) to Category 4 (unacceptable risk).
2. Menstrual Disorders
- Normal cycle: about 28 days (range 21–35), bleeding for 2–7 days; ovulation about 14 days before the next period.
- Primary amenorrhoea: no menarche by 15 years in a girl with normal secondary sexual characteristics. Secondary amenorrhoea: absence of periods for 3 months in a woman with previously regular cycles (6 months if irregular). Pregnancy is the commonest cause of secondary amenorrhoea—always exclude it first.
- Dysmenorrhoea: primary (no pelvic disease; prostaglandin-mediated; responds to NSAIDs and heat) or secondary (endometriosis, PID, fibroids).
- Heavy menstrual bleeding (menorrhagia): check hemoglobin; causes include fibroids, adenomyosis, IUCD and bleeding disorders.
- Postmenopausal bleeding always needs investigation to exclude endometrial cancer.
3. Common Gynaecological Conditions
| Condition | Key features | Nursing points |
|---|---|---|
| Polycystic ovary syndrome (PCOS) | Rotterdam criteria: any 2 of 3—oligo/anovulation, clinical or biochemical hyperandrogenism (hirsutism, acne), polycystic ovaries on ultrasound | Weight reduction, exercise, cycle regulation; screen for diabetes |
| Uterine fibroid (leiomyoma) | Commonest benign uterine tumour; intramural most common; submucous types cause the heaviest bleeding | Monitor anaemia; myomectomy or hysterectomy |
| Uterovaginal prolapse | Descent of uterus and vaginal walls; risk factors: multiparity, prolonged labour, menopause, chronic cough, constipation | Kegel exercises, pessary (ring), vaginal hysterectomy or repair |
| Pelvic inflammatory disease (PID) | Lower abdominal pain, fever, discharge, cervical motion tenderness | Complete antibiotics, treat partner; risk of infertility and ectopic pregnancy |
| Infertility | Failure to conceive after 12 months of regular unprotected intercourse (6 months if the woman is 35 or older) | Evaluate both partners; counsel the couple |
Vaginal discharge
| Cause | Discharge | Other clues |
|---|---|---|
| Candidiasis | Thick, white, curdy ("cottage-cheese") | Intense itching; diabetes, pregnancy, antibiotics |
| Trichomoniasis | Frothy, greenish-yellow, foul | "Strawberry" cervix; treat partner |
| Bacterial vaginosis | Thin, grey-white, fishy odour | Positive whiff test; clue cells |
NACO colour-coded STI/RTI syndromic kits
| Kit | Colour | Syndrome treated |
|---|---|---|
| Kit 1 | Grey | Urethral discharge, cervicitis, ano-rectal discharge, painful scrotal swelling |
| Kit 2 | Green | Vaginitis (vaginal discharge) |
| Kit 3 | White | Genital ulcer disease, non-herpetic |
| Kit 4 | Blue | Genital ulcer disease, non-herpetic, for penicillin-allergic patients |
| Kit 5 | Red | Genital ulcer disease, herpetic |
| Kit 6 | Yellow | Lower abdominal pain (PID) |
| Kit 7 | Black | Inguinal bubo |
4. Cancer Screening and Menopause
- Cervical cancer is linked to persistent high-risk HPV (types 16 and 18). Women aged 30 and above are screened by Visual Inspection with Acetic acid (VIA) at Ayushman Arogya Mandirs under the NCD programme; a positive (acetowhite) area is referred for colposcopy.
- Breast cancer: clinical breast examination at screening; monthly breast self-examination about 7–10 days after the period starts.
- Menopause is diagnosed after 12 consecutive months without menstruation. Symptoms include hot flushes, night sweats, vaginal dryness, mood changes and bone loss. Nursing advice covers calcium, vitamin D, weight-bearing exercise and reporting any bleeding after menopause.
A woman wants a long-acting reversible method and asks how long a Cu-T 380A protects against pregnancy. What should the nurse tell her?
3 years
Until menopause, without replacement
10 years
5 years
In a study, 300 women each use a contraceptive for 12 months and 9 become pregnant. What is the Pearl Index?
1.5 per 100 woman-years
3 per 100 woman-years
9 per 100 woman-years
30 per 100 woman-years
A man asks whether he can stop using condoms immediately after a No-Scalpel Vasectomy. What is the correct advice?
Yes; the procedure is fully effective as soon as it is completed
No; he must avoid intercourse completely for at least 1 year
No; use condoms for about 3 months or until semen shows no sperm
Yes, provided his partner takes one emergency pill after the procedure
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