Mirena contraception

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Mirena contraception

  1. 1. MIRENA IUCD Contraception & Reproductive healthDr AHMED ZAKIMD, MRCOG CONSULTANT & HEAD OF OB/GYN DEPARTMENT CHAIRMAN OF SCIENTIFIC COMMITTEEBAKHSH HOSPITALS – AL SHARAFYIA.JEDDAH
  2. 2. STAGES OF OUR MIRENA TRAININGPROGRAMME Contraception & Menorrhagia reproductive Insertion health Pathology & PART I & scan management PART II STAGE III STAGE II STAGE I
  3. 3. DO YOU HAVE ENOUGH INFORMATION TO MAKE A DECISION INPARTICULAR SITUATIONS ?
  4. 4. Who is medically eligible touse the LNG-IUS? UK-MEC & WHO -MEC
  5. 5. EVIDENCE BASED INFORMATION- UK-MEC-WHO-MEC FFPRHC GUIDANCE RCOG / ACOG GUIDELINES
  6. 6. MENORRHAGIA CONTRACEPTION1 HORMONAL 2 REPRODUCTIVE 3 ROLE IN CONTENTS HEALTH PARTICULAR SITUATIONS
  7. 7. Contraceptive information given to women usingLNG-IUS MODE OF ACTION CONTRACEPTIVE EFFICIENCY DURATION (beyond liecence) PID ECTOPIC PREG RETURN OF FERTILITY EXPULSION PERFORATION HORMONAL SYMPTOMS OVARIAN CYSTS BMD
  8. 8. When can the LNG-IUS be inserted? The LNG-IUS can be inserted at any time in a woman’s cycle if it is certain she is not pregnant and has not been at risk of pregnancy in that cycle. Barrier contraception is advised for the next 7days. Prophylaxis against PID
  9. 9. The inserter of the Mirena®: is• More rigid• Curved• thicker
  10. 10. When can the LNG-IUS be removed? The LNG-IUS may be removed at any time if the woman wishes to conceive; Otherwise unprotected sex should be avoided in the 7 days prior to removal AND If Mirena exchange
  11. 11. Switching Contraception TO PILLS When women using the LNG-IUS are amenorrhoeic and wish to use alternative contraception, in order to maintain contraceptive protection the LNG-IUS can beremoved after seven consecutive combined oral pills, or after two consecutive progestogen-only pills have been taken. TO DMPA The LNG-IUS can be removed 7 days after giving the depot medroxyprogesterone acetate injection or inserting a subdermal progestogen-only implant. TO IUD An IUD can be inserted immediately following LNG-IUS removalwithout the need for any additional contraception
  12. 12. RETURN OF FERTILITY Women can be reassured that there is rapid return of fertility following LNG-IUS removal (Grade B). pregnancy rate of 90 per 100 women in the first year after LNG-IUS removal. The mean time to pregnancy was 4 months following LNG-IUSremoval and 3 months following IUD removal
  13. 13. ECTOPIC PREGNANCY Women can be reassured that the risk of ectopicpregnancy with the LNG-IUS is low (Grade A). WHO-MEC recommends that women with a previous ectopic pregnancy may use the LNG-IUS (WHO Category1: unrestricted use). the risk of ectopic pregnancy being similar for the LNG-IUS and modern IUDs (>250 mm2 copper).
  14. 14. OVARIAN CYSTS Women may be reassured that although ovarian cysts occur in LNG-IUS users, there is no significant risk compared to IUD users A randomised trial investigated the occurrence of ovarian cysts following LNG-IUS insertion or hysterectomy. The incidence of ovarian cysts was higher in the LNG-IUS group at 6 months (17.5% vs 3%) and at 12 months (21.5% vs 8%). However, no correlation was identified between the presence of ovarian cysts and age or bleeding pattern. The majority of cysts wereasymptomatic and resolved spontaneously and no significant increased risk compared to IUD users (Grade A).IF LNG-IUS user C/O ABD.PAIN, OVAIAN CYST MUSTBE IN YOUR DD
  15. 15. CAN MIRENA –IUS BE USED AS EMERGENCYCONTRACEPTION ? NO
  16. 16. DOES LNG-IUS HAS HORMONAL SYMPTOMS? Women may be informed that although hormonal symptoms are reported by LNG-IUS users, these are not significantly different from IUD users(Grade A).These include acne, headache, breast tenderness, nausea & bloating
  17. 17. BREAST FEEDING WOMENDoes LNG goes to Breast Milk?How much?Is it Safe? Levels of LNG in breast milk are low with theLNG-IUS. (1% of daily dose in each 600 mls of milk)Therefore, women who are breastfeeding and are 6 or more weeks postpartum may choose this method (Grade B).
  18. 18. Are there any drugs that interact with LNG-IUS? Women using the LNG-IUS may be reassured that there is no evidence of reduced efficacy with liver enzyme-inducers or other drugs (Grade B). WHO –MEC 2 No drugs are known to interact with the LNG-IUS
  19. 19. EXPULSION / PERFORATION Women should be informed that the most likely cause of LNG- IUS failure is expulsion. The risk of this happening is around 1 in 20 (Grade A). Women may be informed that uterine perforation occurs in fewer than 1 in 1000 LNG-IUS insertions (Grade B).
  20. 20. PREGNANCY ON TOP OF MIRENA-IUSIncidenceAny teratogencity ?
  21. 21. BONE MINERAL DENSITY Women may be reassured that there is no evidence to suggest the LNG-IUS has a detrimental effect on bone mineral density (Grade C).
  22. 22. HANDICAPED PID DVT WOMEN 3 5 1 BREAST HIV CANCER 2 4THIS PRESENTATION SUMMARIZES EVIDENCE FOR LNG-IUD IN ALL APECTS OF CONTRACEPTION &REPRODUCTIVE HEALTH
  23. 23.  There are conditions where the risks of LNG-IUS useoutweigh the benefits because of its progestogencontent, rather than its intrauterine site (CATEGORY 3): -Current deep vein thrombosis or pulmonary embolus, -Ischaemic heart disease, -Active viral hepatitis, severe decompensated cirrhosis,- Benign or malignant hepatoma
  24. 24. Women at risk of sexually transmitted infections andhuman Immunodeficiency virus  WHOMEC recommends that the risks of using the LNG-IUS generally outweigh the benefits for women who are at increased risk of sexually transmitted infection (STI) or HIV (catig.3) as well for Cupper IUD.  Data from a randomized trials suggest that women using the LNG- IUS are less likely to have pelvic inflammatory disease (PID) diagnosed than women using an IUD. No differences were found in the incidence of PID between LNG- IUS and IUD users. Thus there are insufficient data to support a reduction in PID with LNG-IUS use.
  25. 25. WOMEN WITH current or recent PID Women should be advised that a small increase in the risk of pelvic infection occurs following LNGIUS insertion but thereafter the risk of infection is low.After considering other contraceptive methods, a woman may use the LNG-IUS within 3 months of treated pelvic infection, provided she has no signs or symptoms.
  26. 26. Migraine with focal symptoms Women with a history of migraine with focal symptoms may use the LNG-IUS. If, however, migraine with focal symptoms develops in a LNGI-US user, these new symptoms should be investigated and other contraceptive options discussed (catig.2). i.e. remove it No evidence was identified of an association between the LNG-IUS, migraine and stroke.
  27. 27. BREST CANCER Non-hormonal contraception is most appropriate for a woman with a history of breast cancer. However, the LNG-IUS may be considered individually, and in consultation with the woman’s breast surgeon.(help in treatingTamoxifen induced hyperplasia) WHO- MEC 4 FOR CURRENT BREAST CA WHO- MEC 3 FOR PAST H/O BR. CA (NO DISEASE FOR 5 YEARS)
  28. 28. MIRENA IUS AS HRT Women using estrogen replacement may choose the LNG-IUS to provide protection against hyperplasia and malignancy, but this is outside the current license (Grade A). The LNG-IUS should not be used routinely as a treatment for endometrial hyperplasia or malignancy (Grade B).
  29. 29. CAN LNG-IUS BE USED IN CONTRACEPTION OFHANDICAPED PATIENT ADVANTAGES DISADVANTAGES
  30. 30. Is the LNG-IUS effective in the management ofdysmenorrhoea? PMT There is insufficient evidence to support the use of the LNG-IUS routinely for women with pain OR PMT in the absence of heavy bleeding (Grade C)..
  31. 31. CONCLUSION After counseling, the LNG-IUS is a suitable option for most women who need contraception and/or treatment for menorrhagia (Grade C). THE LIMITATIONS OF USE & WHO-MEC CRITERIA MUST BE CONSIDERED
  32. 32. SEE YOU AGAIN IN PART IITHANK YOU

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