3. GGUUIIDDEELLIINNEE OONN CCHHOOIICCEESS OOFF
CCOONNTTRRAACCEEPPTTIIOONN
1 The use of the contraceptive method is
unrestricted
2 The benefits of using the contraceptive method
outweigh the risks
3 The risks associated with using the method
outweigh the benefits
4 The use of the contraceptive method poses an
unacceptable health risk
5. ADOLESCENT FERTILITY RRAATTEE GGLLOOBBAALLLLYY
22001100
Countries Per 1000 women aged 10-19 yo
Bangladesh 127
Kenya 116
Mexico 82
India 46
Thailand 45
USA 41
Egypt 27
UK 26
Canada 14
Malaysia 13
Germany 10
Denmark 8
Saudi Arabia 7
China 5
6. Consequences(of(unprotected(
adolescent(sexual(intercourse((
Community)
Family)
Increased financial burden Shame
Adolescent))$$$
Psychological problems Unsafe abortions
Unprotected$
adolescent$sexual$
intercourse$
Unwanted pregnancies STIs
Poverty
Drop out of school
Social outcast
Increased social and
Baby abandonment financial burden
Increased health and
safety concerns for baby
stigma
HIV and AIDs
11. CONTRACEPTIVE
METHODS
WHO Age-specific
Medical Eligibility
Criteria
Strengths Weaknesses
Barrier 1 Offers protection
from STI
Easily available
Less protection
against pregnancy
Coital-related
Reliant on user
COC Unrestricted from
menarche
1
Highly effective
Other non-contraceptive
benefit
No protection
against STI
Reliant on user
Minor side-effects
Have to attend
clinical service
POP Unrestricted from
menarche
1
Effective No protection
against STI
Reliant on user
Menstrual side-effects
12. CONTRACEPTIVE
METHODS
WHO Age-specific
Medical Eligibility
Criteria
Strengths Weaknesses
Injectables 2 Easier compliance
More private
Not coitally-related
No protection
against STI
Menstrual side-effects
Weight gain
Delay return of
fertility
Implanon 1 Easier compliance
More private
Not coitally-related
No protection
against STI
Amenorrhea – may
be unacceptable
Minor operative
procedure
Patch 1 Easier compliance
More private
Not coitally-related
No protection
against STI
Reliant on users
Patch detachment
13. CONTRACEPTIVE
METHODS
WHO Age-specific
Medical Eligibility
Criteria
Strengths Weaknesses
Intra-uterine system
(Mirena)
2
Restricted in an
individual with
high-risk of STI - 3
Highly effective
protection
Not-coitally
dependent
Reduces
dysmenorrhea
No protection
against STI
Amenorrhea
VE and invasive
procedure required
Difficult insertion
in nulliparous
IUCD 2
Restricted in an
individual with
high-risk of STI - 3
Highly effective
protection
Not-coitally
dependent
Reduces
dysmenorrhea
Increased menstrual
bleeding and pain
No protection
against STI
VE and invasive
procedure required
Difficult insertion in
nulliparous
19. CONTRACEPTIVE
METHODS
WHO Age-specific
Medical Eligibility
Criteria
Strengths Weaknesses
Barrier 1 More proficient
Failure rates fall
with increasing age
Protection from STI
Hypersensitivity to
latex
Non-hormonal – no
benefits to those
with menstrual
problems and
climacteric
Hormonal COCs 2
Cautious in CVS
disease, VTE, breast
cancer
Non-smokers – no
increased risk in
CVS disease.
50% reduced risk of
endometrial &
ovarian cancer (after
3 years usage and
continues till 15
years after
discontinuation.
Symptomatic
improvement of
vasomotor
symptoms.
Small risk of
ischemic stroke (but
not haemorrhagic
stroke).
Risk of VTE.
24% risk of breast ca
> 40yo.
20. CONTRACEPTIVE
METHODS
WHO Age-specific
Medical Eligibility
Criteria
Strengths Weaknesses
POP/Injectables/Su
bdermal implant
1, 2 (Injectables)
Useful in women
with relative
contraindications
for estrogen.
No increased risk
for CVS disease,
VTE, stroke.
No significant risk
for breast ca (unless
PR +ve)
Current VTE – risks
outweigh benefits.
Previous VTE –
benefits outweigh
risks.
Abnormal bleeding
(Clinicians should
consider
investigation for
abnormal bleeding).
Reduced BMD –
improves after
cessation.
Natural family
planning
1 (C) Lower failure rates
than younger
couples
Irregular cycle –
difficult to calculate
fertile period
No benefits for
climacteric
symptoms
21. CONTRACEPTIVE
METHODS
WHO Age-specific
Medical Eligibility
Criteria
Strengths Weaknesses
Intrauterine system
(Mirena)
1
Progestogen – as
HRT
Highly effective.
Reduction in
menstrual flow.
Prevent anaemia.
Reduce risk of
hysterectomy.
Suppress
endometrium –
treatment of
endometrial
hyperplasia.
-
Intrauterine device 1 Lower rates of
infection, expulsion
and perforation.
May not require
removal after 3
years.
May be
unacceptable to
women with pre-existing
menstrual
disorders / DUB
The World Health Organization Medical Eligibility Criteria for Contraceptive Use (WHOMEC) provides evidence-based recommendations to ensure that women can select the most appropriate method of contraception without unnecessary medical barriers.
1 YES – Periods during puberty are different than those in other phases, and although overall reproductive functioning is still in development, intermittent ovulation and anovulation occur and therefore effective contraception is required for sexually active women to prevent unintended pregnancy.
2 YES – Despite the reproductive system is still developing, women can still become pregnant.
3 Adolesecent fertility rate – 5.5%, birth rate – 11%
4
Bone mineral density (BMD)- a concern as adolescents have not yet reached their peak bone mass, esp with use of DMPA. Systematic reviews of studies show substantial recovery in BMD after DPMA is discontinued13,14. Other factors can affect BMD – preg,diet, smoking , exercise.
Perimenopause, or menopause transition, is the stage of a woman's reproductive life that begins several years before menopause.
The average age of onset of the perimenopause is 46 years and the average duration of the perimenopause is 5 years.
1 YES During the perimenopause, intermittent ovulation and anovulation occur and therefore effective contraception is required for sexually active women to prevent unintended pregnancy. This means that during perimenopause the woman's cycle is going to change , most likely becoming more irregular. She may not ovulate every month, but when she does ovulate her menses will likely be different than what she used to have. They may be heavier at times and lighter at others.
2 YES Despite a decline in fertility during the perimenopause stage, women can still become pregnant.
3 40-44 years : 10 %, 45-49 years:2-3 %
4 The risks of congenital and chromosomal abnormalities, and spontaneous abortion increase for women over 40 years.
By the age of 35 years a woman has a 1 in 500 risk of developing breast cancer. This increases to a 1 in 100 risk by the age of 45 years.
Women can be informed that combined contraceptive use over the age of 40 years may be associated with an increase in BMD, does not appear to reduce overall risk of fractures before the menopause, but may reduce the risk of hip fracture in the postmenopause.
Women using combined HRT cannot be advised to rely on this as contraception, and that a POP can be used with HRT to provide effective contraception.
