F pabove35

320 views

Published on

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
320
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
0
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

F pabove35

  1. 1. CONTRACEPTION IN THE PERIMENOPAUSE Harlina Halizah Siraj MD(UKM) MOG (UKM) Dept. O&G, Medical Faculty UKM
  2. 2. HISTORY OF CONTRACEPTION • Started even before 1550 BC • More on natural methods (coitus interruptus, rhythm method,sponge) • Family planning in Malaysia: • Started since 1950 with multidisciplinary approach • One of the pillars of safe motherhood
  3. 3. Museum : Contraceptives in the Past
  4. 4. The Changing Scenario Unwanted pregnancy – 40% of pregnancies are unwanted worldwide ( 6 out of 10 ended as TOP) Teenage pregnancy – 51% girls aged 15-19 had engaged in intercourse ( US National Survey-1988) Pregnancy among older women - German survey : from 1988 to 1999, birth among women aged over 34 increased from 9.4% to 16.0%.
  5. 5. Pregnancy at Later Age ( > 35 ) ¤ Increased health risk: ¤ ¤ ¤ ¤ medical disorders ( HPT, DM ) chromosomal abnormal offsprings (Down Syndrome) coexisting uterine fibroids - complicated labour degenerative changes in the lumbosacral joints ¤ In need of safe and effective contraception
  6. 6. Pregnancy at Later Age ( > 35 ) ¤ Advantages : ¤ ¤ ¤ ¤ more commitment & compliance to medical advice secured financial & social status higher confidence & self-esteem Children tend to be more matured and emotionally stable Later Parenthood & Longer Lives Julia Berryman ORGYN No.3 , 2001 Pg 15-17
  7. 7. WHO Medical Eligibility Criteria for Contr aceptive Use
  8. 8. Classification Categories Categorization achieved by weighing the health risks & benefits. Aim to ensure adequate margin of safety to protect clients from adverse effects, while ensuring that they are not denied a choice of suitable methods.
  9. 9. FOUR categories : Class : 1. For which there is NO RESTRICTION for the use of method. 2. Where the advantages generally outweigh the theoretical @ proven risks . 3. Where theoretical risks outweigh the advantages. 4. Which represents an unacceptable health risk.
  10. 10. WHO Classification Framework Wit h clinical j udgem ent Wit h lim it ed clinical j udge. Use method in any circumstances Yes Generally use the method Yes Not recommended No Not to be used No
  11. 11. Contraceptive use for women above 40 : Historical concern • In the past : • High dose of oestrogen in COCs (>50µg EE) • Risk for heart attack, stroke & VTE – contraindicated for elder women • Recent data: • Newer, lower doses of oestrogen (20-30 µg EE) • Safe use till menopause in otherwise healthy women
  12. 12. COCs use among elder women • Safe for healthy women above 40 with no additional risk factors eg. pre-existing IHD, hypertension and history of VTE. • Not to be used in women above 35 with heavy smoking ( WHO definition: more than 20 cigarettes a day ) –WHO class 4. • Not to be recommended for women above 35 who smoke < than 20 cigarettes a day-WHO class 3
  13. 13. Benefits of COCs for perimenopausal women (1) • Effective contraception: • Less need for therapeutic abortions • Less need for surgical sterilization • Fewer ectopic pregnancies & spontaneous abortions • Better cycle control • Less menorrhagia & anaemia • Fewer menopausal symptoms & mood swings
  14. 14. Benefits of COCs for perimenopausal women (2) • • • • • • Better bone preservation Less endometrial and ovarian cancer Fewer ovarian cysts Fewer benign breast cysts Less dysmenorrhoea Fewer indications for hysterectomy and laparotomy
  15. 15. POCs use among elder women ( Implants, PICs & POP) • POCs can be used in the perimenopausal years (40–50s). • POCs can be used safely by women over 35, even if they are heavy smokers. (WHO class 1) • Implants are highly recommended long-term contraception: • especially if client has had trouble using another method • does not want voluntary sterilization.
  16. 16. IUCD use among elder women • May be used safely by older women if not at risk for STDs • May be the preferred method for older women because newer IUDs (copper- and progestinreleasing): • are highly effective, • require no follow-up care unless there are problems • are long-term methods (TCu 380A effective up to 10 years).
  17. 17. Mirena: local mode of action Releases levonorgestrel 20 µg/day1 Prevents endometrial proliferation2 Thickens cervical mucus, inhibiting passage of sperm3 Inhibits sperm motility4 1. Luukkainen et al. Ann Med 1990 3. Jonsson et al. Contraception 1991 2. Silverberg et al. Int J Gynecol Pathol 1986 4. Videla-Rivero et al. Contraception 1987
  18. 18. Implants & LNG-IUS : An alternative to sterilisation?
  19. 19. Alternative to sterilisation • RCOG Guidelines (UK): ‘Non-operative methods of long-term contraception should have been specifically rejected before proceeding with sterilisation’ Royal College of Obstetricians and Gynaecologists, UK
  20. 20. Barrier methods among elder women • Male Condoms : • Only method that protects against STDs (e.g., HIV/AIDS). • Best used by women who can predict acts of intercourse and who are highly motivated to avoid pregnancy. • Diaphragms : • Best used by women who can predict acts of intercourse and who are highly motivated to avoid pregnancy. • Offers some protection against STDs (e.g., HIV/AIDS).
  21. 21. Voluntary Sterilization (tubal occlusion and vasectomy) • Appropriate for clients/couples who are certain about desire for permanent contraception.
  22. 22. The Seven Contraceptive Ages of Women Age Life -event Suggested method 0 Birth to puberty No method required. Responsible sex education is essential. 1 Puberty to marriage •Abstinence until life-partner is found •Barrier method/COC 2 Marriage to first child •First choice – pill •Barrier •Fertility awareness method LAM, POP, Barrier, IUCD, Injectable, Implant 3 During breastfeeding 4 Family spacing after breastfeeding Continue with the above / COC 5 After the (probable) last child IUCD (First choice),COC, POP, Injectable, Implants 6 Family complete – family growing up Vasectomy, female sterilization, LNG-IUS 7 Perimenopausal Contraceptive HRT ( No sterilization) LNG-IUS, Implant

×