Download - Contraception
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Contraception
The way to evidence
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A 42 year‑old woman P5+1 was
wearing an IUD for 6
months ,that was removed 2
months ago because of partial
expulsion(2nd expulsion)
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She is diabetic for 21 years Husbanded refuses condom, coitus
interrupts or vaginal tablet
She is seeking for another effective contraceptive method
What is the best advice ??
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What Is The Best Advice ?? The most suitable& effective?
A- E/P vaginal ring: Nuva Ring
B- Progestagen implant: Implanon
C:Levonorgestrel IUD: Mirena
D: Depoprovera
E: Progesagen only pills
B
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Contraceptive Choice above the age of 40 years
Choice is influenced by :
1. Frequency of intercourse
2. Natural decline in fertility
3. Menstrual dysfunction
4. Concurrent medical disorders
5. Wish for non-contraceptive
benefits
6. Acceptance of the couple.
7. Age of the couple.
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No contraceptive method is contraindicated
by age alone.
RCOG FFPRHC Guidance Grade C 2005
Women aged over 40 years can be advised that:
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Women should be counseled for the risks and non-
contraceptive benefits of all contraceptive methods.
Medical eligibility criteria for contraceptive ( MECC ) WHO 2004
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The WHO Medical Eligibility Criteria
The WHO Medical Eligibility Criteria for Contraceptive Use
provides evidence-based recommendations to ensure that
women can select the most appropriate method of
contraception without unnecessary medical barriers.
RCOG FFPRHC Guidance Grade C 2005
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WHO Medical Eligibility Criteria for Contraceptive Use
(WHOMEC )2004 / 2008
Eligibility rather than ineligibility )or contraindication( :
4 Categories
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Category 1: The use is unrestricted )Used in any circumstances(
Category 2: The advantages outweigh the theoretical or proven risks.) Generally can be used(
Category 3: The risks outweigh the benefit. )Not used unless other appropriate methods are not available or acceptable(
Category 4: The use an unacceptable health risk )Method not to be used(
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A. E/P vaginal ring: Nuva Ring
Review 12 RCTs
• Superior cycle control than COC
• Lower incidence of nausea and breast tenderness
Roumen. Contraception, 2007
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• May be more effective than proper COC use.
• Long-term studies is limited: but expected that benefits
and risks are similar to COC.
Evidence-based guidance A WHO Family Planning Cornerstone 2007
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B. Progestagen Implants: Implanon
Norplant and Implanon
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The Implanon rod
• Core: 40% EVA Copolymer
60% Etonogestryl
• Membrane: 100% EVA
EVA: Ethylene Vinyl Acetate
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ApplicatorApplicator
ObturatorObturator
cannulacannula
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• Alleviate menorrhagia, dysmenorrhea & PMT
• Reduce the size of fibroid
• Regression of endometriosis
• Regression of endometrial hyperplasia
• Endometrial protection in HRT.
• Prevention of PID
• Can be left up to 7 years )Normal = 5 y(
Particularly useful for the perimenopausal woman
C. Mirena®
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D. Injectables
NET-EN and DMPA
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C. Progestin only pills )POP(
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E+P
P - I - R
POPPO
Injectable
PO
Implant
IUD
Mirena
History of G. Diabetes 11111
Uncomplicated Diabetes 22222
Diabetes + other Risk factor32222
1-Vascular Diabetes )Nephropathy, Retinopathy, Neuropathy(
2-Diabetes >20 years42322
WHO Medical Eligibility Criteria: Diabetes
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What Is The Best Advice ??
A- E/P vaginal ring: Nuva Ring : Eligibility 4
B- Implanon Eligibility 2.& FR 0.0-0.05HWY C:Levonorgestrel IUD: Mirena Previous 2 expulsions
D: Depoprovera Eligibility 3
E: Progesagen only pills Eligibility2& FR:0.5-5HWY
B