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Métodos Naturais de Planeamento Familiar

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Para citar este documento:
Francisco Vilaça Lopes. Métodos naturais de planeamento familiar [palestra]. Encontro Saúde da Mulher no Algarve e Andaluzia 2013: Portimão, Hotel Júpiter, 6-12-2013. Diapositivos em http://bit.ly/1VnQ3f4

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Métodos Naturais de Planeamento Familiar

  1. 1. MétodosMétodos Naturais deNaturais de PlaneamentoPlaneamento FamiliarFamiliar Francisco Vilaça LopesFrancisco Vilaça Lopes Interno MGF CS-PortimãoInterno MGF CS-Portimão vilaca.lopes@gmail.com Hotel Júpiter, 6-Dezembro-2013Hotel Júpiter, 6-Dezembro-2013
  2. 2. 17% 87% 56% Instituto Nacional de Estatística I.P., Instituto Nacional de Saúde Doutor Ricardo Jorge I.P. Inquérito Nacional de Saúde 2005/2006: p231. Lisboa, Portugal: INE; 2009. Necessidade não atendidaNecessidade não atendida
  3. 3. Trussell J, Contraceptive Efficacy. In: Hatcher RA, Trussell J, Nelson AL, Cates W, Kowal D, and Policar M (editors). Contraceptive Technology: Twentieth Revised Edition. New York: Ardent Media, 2011. 12 14 11-22 2-20 > > > > > > > > > > >
  4. 4. Trussell J, Contraceptive Efficacy. In: Hatcher RA, Trussell J, Nelson AL, Cates W, Kowal D, and Policar M (editors). Contraceptive Technology: Twentieth Revised Edition. New York: Ardent Media, 2011. > > > > = = = = =
  5. 5. Consulta IVG: Método PF usadoConsulta IVG: Método PF usado UCSP-Portimão 2010-2011UCSP-Portimão 2010-2011 44,4% 38,5% 0,3%1,1% 14,9% 0,8% (n=369) Nenhum Hormonal oral H. transdérmico H. intravaginal Preservativo m. DIU Agradecimento: Sr.ªs Enfermeiras da consulta de PF do CS-Portimão
  6. 6. Métodos Naturais de PFMétodos Naturais de PF Definição: Métodos de PF em que a mulher determina quais os dias férteis do seu ciclo menstrual mediante a auto-observação dos biomarcadores (sinais, sintomas, ou analitos) associados às fases fértil ou infértil do seu ciclo menstrual. = Métodos baseados na percepção da fertilidade (fertility awareness-based m.) = Métodos de abstinência periódica (periodic abstinence) Manhart MD, Duane M, Lind A, Sinai I, Golden-Tevald J. Fertility awareness-based methods of family planning: A review of effectiveness for avoiding pregnancy using SORT. Osteopathic Family Physician 2013;5(1):2-8. Smoley BA, Robinson CM. Natural family planning. Am Fam Physician. 2012 Nov 15;86(10):924-8. Haghenbeck-Altamirano FJ, Ayala-Yáñez R, Herrera-Meillón H. Métodos de planificación familiar basados en el conocimiento de la fertilidad. Ginecol Obstet Mex. 2012 Apr;80(4):276-84. Freundl G, Sivin I, Batár I. State-of-the-art of non-hormonal methods of contraception: IV. Natural family planning. Eur J Contracept Reprod Health Care. 2010 Apr;15(2):113-23. Pallone SR, Bergus GR. Fertility awareness-based methods: another option for family planning. J Am Board Fam Med. 2009 Mar-Apr;22(2):147-57. Pyper CMM, Knight J. Fertility awareness methods of family planning: The physiological background, methodology and effectiveness of fertility awareness methods. J Fam Plann Reprod Health Care 2001:27(2);103-10.
  7. 7. Métodos Naturais de PFMétodos Naturais de PF Vantagens: - Não têm efeitos adversos - Educam sobre a fisiologia feminina (saúde) - Estimulam a comunicação e o respeito no casal (decisão conjunta) - Permitem também procurar a gravidez (sem atraso no retorno da fertilidade) Manhart MD, Duane M, Lind A, Sinai I, Golden-Tevald J. Fertility awareness-based methods of family planning: A review of effectiveness for avoiding pregnancy using SORT. Osteopathic Family Physician 2013;5(1):2-8. Smoley BA, Robinson CM. Natural family planning. Am Fam Physician. 2012 Nov 15;86(10):924-8. Haghenbeck-Altamirano FJ, Ayala-Yáñez R, Herrera-Meillón H. Métodos de planificación familiar basados en el conocimiento de la fertilidad. Ginecol Obstet Mex. 2012 Apr;80(4):276-84. Freundl G, Sivin I, Batár I. State-of-the-art of non-hormonal methods of contraception: IV. Natural family planning. Eur J Contracept Reprod Health Care. 2010 Apr;15(2):113-23. Pallone SR, Bergus GR. Fertility awareness-based methods: another option for family planning. J Am Board Fam Med. 2009 Mar-Apr;22(2):147-57. Pyper CMM, Knight J. Fertility awareness methods of family planning: The physiological background, methodology and effectiveness of fertility awareness methods. J Fam Plann Reprod Health Care 2001:27(2);103-10. Inconvenientes: - Eficácia dependente do utilizador (colaboração masculina) - Não protegem contra DSTs (pop. comp. risco)
  8. 8. Que Métodos NaturaisQue Métodos Naturais de PF existem?de PF existem? Calendário/ ritmo de Ogino-Knaus Temperatura basal Dias fixos Dois dias Amenorreia da Amamentação Billings Creighton/ ovulação Simptotérmico Electrónicos/ laboratoriais Calendário/ ritmo de Ogino-Knaus Temperatura basal Dias fixos Lactação com Amenorreia Dois dias Billings/ ovulação/ Creighton Simptotérmicos Electrónicos/ laboratoriais Manhart MD, Duane M, Lind A, Sinai I, Golden-Tevald J. Fertility awareness-based methods of family planning: A review of effectiveness for avoiding pregnancy using SORT. Osteopathic Fam Physician 2013;5(1):2-8. Smoley BA, Robinson CM. Natural family planning. Am Fam Physician. 2012 Nov 15;86(10):924-8. Haghenbeck-Altamirano FJ, Ayala-Yáñez R, Herrera- Meillón H. Métodos de planificación familiar basados en el conocimiento de la fertilidad. Ginecol Obstet Mex. 2012 Apr;80(4):276-84. Freundl G, Sivin I, Batár I. State-of-the-art of non-hormonal methods of contraception: IV. Natural family planning. Eur J Contracept Reprod Health Care. 2010 Apr;15(2):113-23. Pallone SR, Bergus GR. Fertility awareness-based methods: another option for family planning. J Am Board Fam Med. 2009 Mar-Apr;22(2):147-57. Pyper CMM, Knight J. Fertility awareness methods of family planning: The physiological background, methodology and effectiveness of fertility awareness methods. J Fam Plann Reprod Health Care 2001:27(2);103-10.
  9. 9. Método dos Dias FixosMétodo dos Dias Fixos (( standard days methodstandard days method )) A janela fértil começa no 8º dia do ciclo menstrual e vai até ao 19º dia inclusive. Indicado só se habitualmente ciclos 26-32 dias inclusive! Precauções: Método barreira/DIU não-hormonal/aborto: inicia D1 (do ciclo seguinte). Descontinuação contraceptivos hormonais: aguarda 2 ciclos consecutivos 26-32 dias, inicia D1 do ciclo seguinte. Hormonal injectável: espera 3 meses, aguarda 2 ciclos consecutivos com 26-32 dias, inicia D1 do ciclo seguinte. Pós-parto: aguarda ≥4 menstruações último ciclo com 26-32, inicia D1 seguinte “Regular” (sic): experimenta, se ciclo fora 26- 32 dias, abandona Se ciclo fora 26-32 dias: abandona método. Taxas eficácia evicção gravidez (cohorte multicêntrica >1100 mulheres) Com uso correcto: 5%/ano Com uso típico: 12%/ano Arévalo M, Sinai I, Jennings V. A fixed formula to define the fertile window of the menstrual cycle as the basis of a simple method of natural family planning. Contraception, 1999;60:357-60. Arévalo M, Jennings V, Sinai I. Efficacy of a new method of family planning: the Standard Days Method. Contraception, 202;65:333-8. Gribble JN, Lundgren RI, Velasquez C, Anastasi EE. Being strategic about contraceptive introduction: the ex perience of the Standard Days Method. Contraception 2008;77:147-54. Sinai I, Lundgren RI, Gribble JN. Continued use of the standard days method. J Fam Plann Reprod Health Care (2011). doi:10.1136/jfprhc-2011-100097. Principal vantagem: Previsibilidade e objectividade (motiva homem)
  10. 10. Método dos Dois (2) DiasMétodo dos Dois (2) Dias (( twoday methodtwoday method )) Procurar diariamente ao final da tarde qualquer tipo de secreções cervicais através da sensação, inspecção ou palpação . Hoje notei algumas secreções? E ontem, notei secreções? Se sim a alguma pergunta: estou fértil. Se não às 2 perguntas: estou infértil. Precauções: Menstruação não conta, nem sémen: avaliar-se ao fim do dia Secreções ≥14 dias ou sintomas anormais: consulta médica Anti-histamínicos diminuem secreções (falsos negativos) Dessicantes vaginais: diminuem percepção secreções Mutilação genital feminina aumenta sensação de secreção (falsos positivos) Pós-parto: muitos falsos positivos Taxas eficácia evicção gravidez (cohorte multicêntrica 450 mulheres) Com uso correcto: 4%/ano Com uso típico: 14%/ano Sinai I, Jennings V, Arévalo M. The TwoDay algorithm: a new algorithm to identify the fertile time of the menstrual cycle. Contraception 1999;60:65-70. Dunson DB, Sinai I, Colombo B. The relationship between cervical secretions and the daily probabilities of pregnancy: effectiveness of the TwoDay Algorithm. Hum Reprod. 2001 Nov;16(11):2278-82. Arévalo M, Jennings V, Nikula M, Sinai I. Efficacy of the new TwoDay Method of family planning. Fertil Steril 2004:82(4);885-92. Sinai I, Arévalo M. It's all in the timing: coital frequency and fertility-awareness-based methods of familly planning. J Biosoc Sci 2005;00:1- 15. Principal vantagem: Adaptabilidade
  11. 11. Método da Lactação com AmenorreiaMétodo da Lactação com Amenorreia (( lactational amenorrhea method, LAMlactational amenorrhea method, LAM )) Precauções: AME: mamadas frequentes, a pedido da criança também à noite, sem suplementação, água, ou alimentos, sem chupetas, biberons ou bombas (excepto vacinas, medicamentos, vitamina D) Não se considera menstruação: quaisquer hemorragias antes dos 2 meses spotting só com um dia de duração Final do LAM: usar outro método. - Depois da 1ª menstruação pós-parto, em mulher regular antes da gravidez: Método da “Ponte” para o MDF (Bridge) Eficácia (cohorte 157mulh.) 4-10%/6meses Período de Abstinência: C1: d11ss C2ss: d8-24 ≥C4 26-32 → Método Dias Fixos! - Continuação da amenorreia com aleitamento? Mama antes dos outros alimentos - Método 2 Dias? Outros MPFN? Taxas eficácia evicção gravidez (revisão sistemática Cochrane 2008) Com uso correcto: <1%/6meses Com uso típico: <2%/6meses Contraception. 1997 Jun;55(6):327-36. Contraception. 1997 Jun;55(6):337-46. Contraception. 2000 Nov;62(5):221-30. Fertil Steril. 2003 Nov;80(5):1241-8. Cochrane Database Syst Rev. 2003 [actualizada 6-II-2008];(4):CD001329. Contraception. 2012 Jul;86(1):12-5. Contraception. 2012 Jul;86(1):16-21. Principal vantagem: melhora a adesão ao aleitamento materno exclusivo Infertilidade na presença dos 3 critérios: Amenorreia e aleitamento materno exclusivo desde o parto até aos 6 meses
  12. 12. ConclusõesConclusões Regular Irregular AME Dias Fixos 2 Dias LAM Ponte MuitoMuito obrigado!obrigado! vilaca.lopes@gmail.comvilaca.lopes@gmail.com

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