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Contraception

Contraception

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Published by: jslum on Jul 06, 2011
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12/24/2012

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onracepon
 
Fertility Awareness MethodsCalendar Method (Rhythm Method)
Based on assumption that menstrual cycle relatively constantPregnancy rate  40/100 women years
Rule
Record length of 6 cycles
EstimateBeginning of Fertile Period End of Fertile Period
Substracting 20d from length of shortest cycleSubstracting 10d from length of longest cycle
Cervical Mucus Method (Billing Method)
During follicular phase, cervical mucus appear like raw egg white (fertile)Final day of fertile mucous  most likely ovulation occurAbstinence from start until 3d after peak dayAppearance of infertile mucus  scanty, viscous (end of fertile period)Failure rate  22/100 women years
Symptothermal Method
Basal body temperature recorded before getting out of bedProgesterone secretion  associated with  0.5°CPrior to ovulation, temperature is below normal body temperatureAbstinence until night of 3
rd
day of a shift in temperature
Personal Fertility Monitoring (PERSONA)
Measure levels of LH, estrogen-3-glucoronide (early morning urine)Red light  intercourse should be avoidedNeed to be programmed for 3 monthsNeed to be programmed after post-coital contraceptionFailure rate  6/100 women years (with perfect use)
Minor Clinical Indicators
Ovulation pain (Mittelschmerz)Mid cycle show of bloodOnset of breast symptomsSkin, mood changes
Lactational Amenorrhoea Method
Breast feeding  amenorrhoiec during 1
st
6 months (after giving birth)2% of still getting pregnant
Oral Contraceptive PillsCombined Oral Contraceptive Pills (COCP)Preparation
Ethynil estradiolProgesterone  levonorgestrel, desogestrel, gestodene, norgestimate
MOA
Suppress ovulation
y
 
Prevent ovarian follicular maturation
y
 
I
nterrupt estrogen-mediated +ve feedback  prevent LH surgeThicken cervical mucus( permeability of sperm)Alteration of endometrium( implantation likelihood)
Advantages/ DisadvantagesAdvantages Disadvantages
High efficacy (0.1-3/100 WY failure)ReversibleNot related to intercourse Menstrual blood flow (
I
DA) Dysmenorrhoea( prostaglandin -  contraction)Predictability of menses PMS Breast disease (benign) Ovarian cyst (functional) Ectopic pregnancy Ovarian, endometrial cancerThromboembolic disease
y
 
V
enous thrombosis
y
 
Myocardial infarction
y
 
StrokeBreast cancerCervical cancerLiver adenoma, carcinomaCholestasisGallstones
Progestogen-Only Pills (POP)UsesSuitable For Contraindication
V
TEMigraineOlder womenSmokeHypertension
V
alvular heart diseaseDiabetes mellitusPregnancy
V
aginal bleeding (undiagnosed)Severe arterial diseaseLiver adenoma
MOA
Thicken cervical mucus( permeability of sperm) Receptivity of endometriumto implantation Ovulation Fallopian tube motility
Advantages/ DisadvantagesAdvantages Disadvantages
High efficacy (0.3-5/100 WY failure)Effective when used correctlyWell toleratedNo estrogen side effectsReversibleEfficacy  with age,  if >70kgDo not affect  FSH, estradiol levels(associated with menopause)Strict adherencePattern of bleeding  unpredictable Ovarian follicular cysts Ectopic pregnancy
 
 
Injectable ContraceptionPreparationsDepo-Provera Noristerat
Depot medroxyprogesterone acetate Norethisterone enantateDeep
I
M injectionEvery 3 months +/- 2 weeksFailure rate  0.25-0.5/100 WYEvery 8 weeks +/- 2 weeksLess effect on bleeding pattern0.4-2.0/100 WY
MOA
I
nhibition of ovulationEffect on endometrial, cervical mucus
Benefits/ RisksBenefit Side Effects/ Risks
Those forgot to take pills (travellers)Estrogen contraindicated patients Sickling crises (sickle cell disease) Seizures (epileptic women)No effect on ovarian, endometrial caNo association with stroke, M
I
,
V
TE( HDL)
I
rregular frequent vaginal bleedingAmenorrhoea WeightHeadache, dizzinessBreast tendernessMood changesDelay in return to normal fertility
ImplantsImplanon
Etonorgestrel (active metabolite of desogestrel)Single rod implant, biodegradableEffective for 3 years (lower for overweight women)
MOA
I
nhibit ovulation (prevent LH surge)Affect cervical mucus thickening, endometrium
Benefits/ RisksBenefits Side Effects
Failure rate < 0.1/100 WY
I
ndependence of user complianceRapid return to fertilityEfficacy not affected by antibioticsMenstrual disturbancesAlopecia, emotional labilityDepressive symptoms, dysmenorrheaHeadache, acne, breast pain
Norplant
6 capsules labelled for 5 years usageFailure rate  0.2-1/100 WY
 
 
Intrauterine Contraceptive Devices (IUD)Copper IUCD
Licensed for 5 years (Multiload Cu 375)
Complications
Expulsion (occur in 1
st
year, especially 1
st
3 months)PerforationPelvic infection (P
I
D) Menstrual lossAbdominal pain, dysmenorrhoeaPregnancy (remove as soon as diagnosed -  miscarriages)
Gynefix
Licensed for 5 years
I
nserted by those who have received appropriate trainingSimilar efficacy to Cu T 380 ( expulsion rate)
LNG-IUS (Mirena)
Long-acting, rapidly reversibleFrame is radio-opaque (barium sulphate)Licensed for contraception for 5 years
MOA
Endometrial glandular, stromal atrophy (decidualization effect)Change in cervical mucus (prevent ascent of spermatozoa)
Advantages/ DisadvantagesAdvantages Disadvantages
Rapid return to fertilityManagement of menorrhagia( Menstrual blood loss)Dysmenorrhoea Ectopic pregnancyEndometrial hyperplasia managementProtection against STD
y
 
Thickening of cervical mucus
y
 
I
nactivation of endometrium
y
 
 BleedingCost effectivenessDifficulty insertion (nulliparous)
I
rregular bleedingAmenorrhoea Functional ovarian cystsProgestogenic side effects
y
 
Edema
y
 
Headache
y
 
Breast tenderness
y
 
AcneExpulsion
Barrier MethodCondom (Male)
Failure rate  2-15/100 WY
Advantages/ DisadvantagesAdvantages (Polyurethane) Disadvantages
Baggier, less restrictive aroundglands (more sensation)Lack of sensitivity aroundglands of penisNot affected by fat soluble products(baby oils  cause breakage)
Reasons for Condom Failure
Put on after genital contactNot completely unrolled onto penisSlippage (when penis withdrawn from vagina, during sexual intercourse)BreakageOil-based lubricants (inc. lipsticks) (latex condom break)Mechanical damage (eg. fingernails)Concurrent use of vaginal preparations of drugs
Female Condom (Femidom)
Lines the vagina1 sizeDesign for single use, expensiveFailure rate  5-20/100 WY
Diaphragm
Thin, latex rubber hemisphereUse with spermicidal ( effectiveness)
Causes of failure
Poor motivation
I
ncorrect insertionDisplacement during sexual intercourse
Failure rate
4-8/100 WY (with spermicidal)10-18/100 WY (without spermicidal)
Cervical Cap (FEMCAP)
Nonallergic silicone rubberStop sperm from entering cervixFailure rate  8-20/100 WY
Spermicide
Kills spermsUnscented, clear, unflavoured, non-staining, lubricativeNonoxynol-9

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