Your SlideShare is downloading. ×
Contraception
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Saving this for later?

Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime - even offline.

Text the download link to your phone

Standard text messaging rates apply

Contraception

849
views

Published on

Published in: Health & Medicine

0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
849
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
31
Comments
0
Likes
1
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Contraception The way to evidence
  • 2. 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)
  • 3.
    • 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 ??
  • 4. 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
  • 5. Contraceptive Choice above the age of 40 years
    • Choice is influenced by :
    • Frequency of intercourse
    • Natural decline in fertility
    • Menstrual dysfunction
    • Concurrent medical disorders
    • Wish for non-contraceptive benefits
    • Acceptance of the couple.
    • Age of the couple.
  • 6. No contraceptive method is contraindicated by age alone. RCOG FFPRHC Guidance Grade C 2005 Women aged over 40 years can be advised that:
  • 7. Women should be counseled for the risks and non-contraceptive benefits of all contraceptive methods. Medical eligibility criteria for contraceptive ( MECC ) WHO 2004
  • 8. 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
  • 9. WHO Medical Eligibility Criteria for Contraceptive Use (WHOMEC) 2004 / 2008 Eligibility rather than ineligibility (or contraindication) : 4 Categories
  • 10. 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)
  • 11. 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
  • 12.
    • 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
  • 13. B. Progestagen Implants: Implanon Norplant and Implanon
  • 14. The Implanon rod
    • Core: 40% EVA Copolymer
    • 60% Etonogestryl
    • Membrane: 100% EVA
    • EVA: Ethylene Vinyl Acetate
  • 15. Applicator Obturator cannula
  • 16.
    • 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®
  • 17. D. Injectables NET-EN and DMPA
  • 18. C. Progestin only pills (POP)
  • 19. WHO Medical Eligibility Criteria: Diabetes IUD Mirena PO Implant PO Injectable POP E+P P - I - R 1 1 1 1 1 History of G. Diabetes 2 2 2 2 2 Uncomplicated Diabetes 2 2 2 2 3 Diabetes + other Risk factor 2 2 3 2 4 1-Vascular Diabetes (Nephropathy, Retinopathy, Neuropathy) 2-Diabetes >20 years
  • 20. 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 E ligibility2 & FR:0.5-5HWY
    B