Family Planning-Part 2

By: Siti Nurulismah bt Che Haron

Surgical Patch Implant Injections IUD

23/09/2012

INJECTIONS
Progestin only
DMPA NET-EN

Monthly

23/09/2012

Progestin only injectable

Mechanism: preventing ovulation Efficacy: 3 per 100 women Benefits:
Dont require daily action Cause no monthly bleeding Can be used throughout breastfeeding Help protect against endometrial ca, uterine fibroids, IDA May help to gain weight

23/09/2012

 Method:
-

IM Repeat in 3 months (DMPA) and 2 months (NET-EN)

Side effects:
-

Bleeding changes Headaches Dizziness Increased blood pressure Mood changes Loss of bone density

Return of fertility: DMPA 4 months longer, NET-EN 1 month longer

23/09/2012

Picture from: Family Planning; A Global Handbook For Providers WHO 2011 Update

 Contraindications:

- Serious active liver disease - High blood pressure (160/100 mmHg) - Diabetes more than 20 years or with complications (arteries, vision, kidneys, nervous system) - Stroke, DVT, heart attack - Breast ca
Migraine aura

Can come 2 weeks early for injections DMPA: can come up to 4 weeks late NET-EN: can come up to 2 weeks late
23/09/2012 6

Monthly injectable
Contains progestin + estrogen

Mechanism: preventing ovulation

Efficacy: 3 per 100 women Benefits:
- Dont require daily action - Cause no monthly bleeding - May help to gain weight

23/09/2012

 Method:

- IM - Repeat every 4 weeks

Side effects:
-

Bleeding changes Headaches Dizziness Increase blood pressure Breast tenderness

Return of fertility: about 1 month longer

23/09/2012

Picture from: Family Planning; A Global Handbook For Providers WHO 2011 Update

 Contraindications:

- Serious active liver disease - High blood pressure (140/90 mmHg) - Diabetes more than 20 years or with complications (arteries, vision, kidneys, nervous system) - Stroke, DVT, heart attack - Breast ca - Migraine aura - Fully breastfeeding - 35 years old and smokes >15 cigarettes/day - Taking lamotrigine/ritonavir

Can come 7 days early or late for injections

23/09/2012 9

Combined patch
Contains progestin + estrogen

Mechanism: preventing ovulation

Method:
- Worn on body every day and night - Can be worn on arm, back, abdomen or buttock - New patch every week for 3 weeks followed by a week with no patch
23/09/2012 10

Side effects:
Bleeding changes Headaches Dizziness Skin irritation URTI

Return of fertility: immediately

Can apply it up to 48 hours late
23/09/2012 11

Implants
Small plastic rods/capsule that contains progestin Mechanism:
- Thickening cervical mucus - Preventing ovulation

Efficacy: 5 per 10 000 women Benefits:

Dont require daily action Can be used during breastfeeding Cause no monthly bleeding Protect against PID, IDA
12

23/09/2012

Implanon TYPES OF IMPLANTS

The effectiveness will be lose earlier in heavier women

3 years Jadelle 5 years Norplant 7 years

23/09/2012

13

 Method:
- Minor surgical procedure - Placed under the skin

23/09/2012

Picture from: Family Planning; A Global Handbook For Providers WHO 2011 Update

14

 Side effects:
-

Bleeding changes Headaches Dizziness Weight gain Breast tenderness Abdominal pain Can either improve/worsen acne Infections at site of implant Expulsion of the implant Enlarged ovarian follicles

Return of fertility: immediately

23/09/2012 15

 Contraindications:
- Serious active liver disease - DVT - Breast ca

23/09/2012

Picture from: Family Planning; A Global Handbook For Providers WHO 2011 Update

16

IUD
Copper bearing Levonorgestrel

23/09/2012

17

Copper-bearing IUD
Mechanism: causing chemical change damage sperm Efficacy: 6 to 8 per 1000 women Benefits:
Dont require daily action Can be used throughout breastfeeding Help protect against endometrial ca Long lasting
23/09/2012 18

 Method:

- Effective up to 12 years - Determine the uterus size and anatomical position

Side effects:

- Bleeding changes - More cramps and pain during monthly bleeding - Perforation of the IUD

Return of fertility: immediately

23/09/2012

Picture from: Family Planning; A Global Handbook For Providers WHO 2011 Update

19

 Contraindications:
- Gynecological/obstetric problems e.g. cervical ca - AIDS - STD - Pregnant - Anatomical abnormality of uterine cavity

23/09/2012

20

Levonorgestrel IUD
Contains progestin

Mechanism: suppress endometrium growth

Efficacy: 2 per 1000 women

23/09/2012

21

 Benefits:
-

Dont require daily action No monthly bleeding Can be used throughout breastfeeding Protect against IDA, PID Reduces menstrual cramps

Method:

- Effective up to 5 years - Determine the uterus size and anatomical position

23/09/2012

Picture from: Family Planning; A Global Handbook For Providers WHO 2011 Update

22

 Side effects:
-

Bleeding changes Acne Headaches Breast tenderness Ovarian cyst Perforation

Return of fertility: immediately Contraindications:

- DVT, severe liver disease, breast ca
23/09/2012 23

STERILIZATION

Male

Female

23/09/2012

24

Vasectomy
Mechanism: closing off vas deferens

Efficacy: 2 per 1000 women

Benefits:
- Permanent - Fewer side effects and complications

23/09/2012

Picture from: Decision-making tool for family planning clients and providers WHO 2005

25

 Complication (rare):
- Severe scrotal/testicular pain - Infections at the incision sit

3 months delay in taking effect Return of fertility: None

23/09/2012

26

Caution, delay & special arrangement for vasectomy

CAUTION
Previous scrotal injury Large varicocele/hydrocele One side undescended testicle Diabetes, depression Young age

DELAY
Active STD

SPECIAL ARRANGEMENT
Hernia in groin Both sides undescended testicle AIDS Coagulations disorder

23/09/2012

27

Female sterilization
Mechanism: blocked fallopian tubes

Efficacy: 5 per 1000 women

Benefits:
No side effects Easy to use Protect against PID, ovarian ca

23/09/2012

28

 Method:
- Tubal ligation - Minilaparotomy or laparoscopy

Return of fertility: none

23/09/2012

Picture from: Decision-making tool for family planning clients and providers WHO 2005

29

Caution, delay & special arrangement for female sterilization

CAUTION
Breast ca Uterine fibroids Previous abdominal/pelvic surgery Controlled hypertension Kidney disease

DELAY
Currently pregnant PID STD

SPECIAL ARRANGEMENT
AIDS Endometriosis Abdominal wall/ umbilical hernia 160/100 mmHg Hyperthyroidism

DVT Severe IDA (Hb <7 g/dL)

23/09/2012

30

Comparing methods

23/09/2012

Source: Decision-making tool for family planning clients and providers WHO 2005

31

References: 1. Family Planning; A Global Handbook For Providers WHO 2011 Update 2. Medical Eligibility Criteria For Contraceptive Use 4th Edition WHO 2009 3. Selected Practice Recommendation For Contraceptive Use WHO 2008 Update 4. Decision-making Tool For Family Planning Clients And Providers WHO 2005

THANK YOU

23/09/2012

32