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4. Long term FP methods family planning use
- 1. Long term FP methods Introduction to Implants 1 3/29/2024 By Addis E
- 2. Overview of implants • Implants are matchstick sized flexible progestin-filled rods or capsules that are placed just under the skin of the upper arm. • An excellent option for women at all phases of their reproductive lives, to delay, space, or limit births. 2 3/29/2024 By Addis E
- 3. Common types of implants sinoplant • 150 mg levonorgestrel • In 2 rods • Insertion: 2 min • Removal: 4.9 min • 4 years • Disposable Implanon • 68 mg etonogestrel • In 1 rod • Insertion: 1.1 min • Removal: 2.6 min • 3 years • Pre-loaded disposable Jaddel • 150 mg levonorgestrel • In 2 rods • Insertion: 2 min • Removal: 4.9 min • 5 years • Autoclavable / Disposable 3 3/29/2024 By Addis E
- 4. Type…. Norplant • 6 rode • The rode are 34 mm long • Each contains 36 mg of levonorgestrel • Used for 5 years 3/29/2024 By Addis E 4
- 5. Mechanism of action • Implants continually release a small amount of progestin steadily into the blood. • The primary mechanisms are: • Increased cervical mucus viscosity (within 48-72 hrs). • Inhibition of ovulation- in about 50% of menstrual cycles. • Alters endometrium, making it less conducive for implantation 5 3/29/2024 By Addis E
- 6. Effectiveness of Implants • Are one of the most effective methods • <1 preg. per 100 women over the first year (5 per 10,000 women). 6 3/29/2024 By Addis E
- 7. Drug interaction effect on implants effectiveness • Its effectiveness may be reduced when co- administered with some:- • Antibiotics. • Anticonvulsants, and • Anti-HIV Protease Inhibitors: ritonavir • NNRTIs: efavirenz 7 3/29/2024 By Addis E
- 8. Characteristics of Implants • Are safe • Easy to use/ Convenient • Highly effective • Not motivation dependent • Long acting • Rapidly reversible/No delay in return of fertility after removal • Do not increase frequency of ectopic pregnancy. 8 3/29/2024 By Addis E
- 9. Characteristics of Implants … • Contain no estrogen • Safe for Breast feeding mother (after 6 wks PP), • May cause irregular bleeding • Does not protect from STIs • Require minor surgical procedure for insertion /removal 9 3/29/2024 By Addis E
- 10. Characteristics of Implants … • Non-contraceptive health benefits include:- • Help prevent ectopic pregnancy, • Help protect against pelvic inflammatory disease • May prevent endometrial cancer 10 3/29/2024 By Addis E
- 11. Who Can Use Implants? • Suitable for nearly all women; including women who: • Prefers a long-acting method • Is breastfeeding (starting 6 wks after childbirth) • Cannot take estrogen-containing contraceptives • Is post-abortion 11 3/29/2024 By Addis E
- 12. Who can not use Implants ? • Implants may not be appropriate for some women • Generally avoid in case of • Serious liver disease • Current DVT • Unexplained vaginal bleeding • Breast cancer (current or history) 12 3/29/2024 By Addis E
- 13. Timing of insertion • A woman can start using implants any time if she is not pregnant. • Recommended times for insertion when changing from another contraceptive • Natural FP or barrier method: before day 7 of cycle • COC: within 7 days of last active pill • Implant: when Implant is removed • Progestogen-only pill: on the day the last pill is taken • Injectable hormones: any time before next injection • IUD: any time 13 3/29/2024 By Addis E
- 14. Timing of implant removal • At anytime during the menstrual cycle. • At 5 years of use for Jadelle and 3 years for Implanon. • Anytime client requests removal, after adequate counseling. 14 3/29/2024 By Addis E
- 15. Jadelle® implant • Two thin, flexible rods, each rod containing 75mg LNG • Prevent pregnancy for up to 5years. • Packaged in a sealed, sterile plastic pouch • Store away from excessive heat (>300º C) & moisture. • Currently provided with a sterile, single-use disposable trocar. • Effectiveness • 0.1 pregnancies per 100 women in the first year of use. 15 3/29/2024 By Addis E
- 16. Implanon® implant • A single rod etonogestrel-containing, reversible, implant • 40 mm in length and 2 mm in diameter • One of the most effective methods: Over 3 years of use • Less than 1 preg. Per 100 women (1/1,000 women) • Pre-loaded inserter • Easier insertion and removal • Store at 25°C (15°-30°C) and avoid direct sunlight. 16 3/29/2024 By Addis E
- 18. THANK YOU! 3/29/2024 By Addis E 18
- 20. Introduction • An intrauterine device is a small, often T-shaped birth control device that is inserted into the uterus to prevent pregnancy. • IUDs are one form of long-acting reversible birth control. 3/29/2024 By Addis E 20
- 21. Type of IUCD • Types of IUCDs available world wide are:- • Copper – bearing: which include the Cu-T 380A, Cu-T 200C, Multilaod (MLCu 250 and 375), and the Nova T. • Medicated: with a steroid hormone, such as the levonorgestrel containing Mirena IUS 21 21 3/29/2024 By Addis E
- 22. Copper T 380A (CuT 380A): • The CuT 380A is T-Shaped, with:- • Polyethylene with barium sulfate. • 314 mm of copper wire wound around the vertical stem. • Each of the two arms of the T has a sleeve of copper measuring 33 mm. • Duration 12 yrs 22 22 3/29/2024 By Addis E
- 23. 23 Parts of IUCDs (Tcu 380A) Arms (Rt./Lt.) Stem String/Thread Copper sleeve (33mm×2=66mm2 ) Copper wire (314mm2 ) Main frame: T shaped, flexible & containing barium sulfate 23 3/29/2024 By Addis E
- 24. Mechanisms of Action Principal mechanism: Prevent or interfere fertilization by affecting sperm motility. Effect of progesterone, • Thickening of cervical mucus, 24 24 • Prevents fertilization by Impairing the viability sperm and interfering with movement of the sperm 3/29/2024 By Addis E
- 25. Effectiveness • Is one of the most effective contraceptive methods. • Efficacy – pregnancy rate < 1% woman years. • 0.8 pregnancies per 100 women year in the first year of use. • Continuation Rates and Client Satisfaction: • Continuation rates are also high. • Approximately 70- 90% of women use their IUCDs one year after insertion. 25 25 3/29/2024 By Addis E
- 26. Effectiveness … 26 Implants Female Sterilization DMPA COCs Male Condoms Standard Days Method Female Condoms Spermicides Less effective More effective In this progression of effectiveness, where would you place IUDs? 3/29/2024 By Addis E
- 27. Effectiveness … 27 Implants Female Sterilization DMPA COCs Male Condoms Standard Days Method Female Condoms Spermicides Less effective More effective IUDs 3/29/2024 By Addis E
- 28. Characteristics of IUCDs • Safe for most women. • Immediate effectiveness and reversible • May be safely used by lactating and postpartum women. • Good choice for older women with COC precautions. • Long duration of use. • Can be inserted on the day of visit. 28 28 3/29/2024 By Addis E
- 29. Characteristics of IUCDs ... • Nothing is required during sexual intercourse • Does not interact with medications. • Can be removed whenever the client chooses. • Does not protect against STIs/HIV. • Trained provider needed to insert and remove • Complications are rare, but may occur 29 29 3/29/2024 By Addis E
- 30. Who Can Use IUCDs? Most women can use the Copper T IUD safely, including women who: • Have or have not had children • Are of any age • Post abortion • Are breastfeeding • Have had PID • Have vaginal infections • Are infected with HIV or have AIDS and on ARVs 30 30 3/29/2024 By Addis E
- 31. Who can not use IUCDs? • Generally not appropriate for women:- • With pregnancy (known or suspected) • With unexplained vaginal bleeding • Who is post partum between 48hrs-4wks • With current pelvic infection • With GTD or cervical/endometrial cancer • With uterine cavity distortion (myoma or congenital) • With AIDS cases (clinically not well) 31 31 3/29/2024 By Addis E
- 32. Timing of insertion A woman can start using IUCDs any time if she is not pregnant. • Optimal times for insertion are • Within 12 days from onset of menstrual bleeding • Immediately or within 12 days after abortion (if no infection is present) • If <48 hours post partum or > 4 weeks 32 32 3/29/2024 By Addis E
- 33. Timing for IUCD Removal • At any time during the menstrual cycle. • Anytime the client requests for any reason. • Evidence of side effects like uterine perforation, bleeding . • Partial expulsion- may be replaced with a new one. • When IUCD has been in utero for its effective life 33 33 3/29/2024 By Addis E
- 35. Summary IUDs are: • Safe, effective, convenient, reversible, long lasting, easy to use, and appropriate for the majority of women. Providers can ensure safety by: • Informative counseling • Careful screening • Appropriate infection prevention practices • Proper follow-up 35 3/29/2024 By Addis E
- 37. Female sterilization • Is operation to permanently prevent pregnancy. • Sterilization is currently the worlds most widely used contraception method. • It account for nearly half of all contraceptive use worldwide 37 3/29/2024 By Addis E
- 38. Mechanism of Action 38 By blocking the fallopian tubes (tying and cutting, rings, clips or electrocautery), sperm is prevented from reaching ova and causing fertilization. 3/29/2024 By Addis E
- 39. Characteristics • Highly effective • 0.5 pregnancies per 100 women during first year of use • Safe • Permanent: Ideal for those desiring no more children • Does not interfere with intercourse • Quick recovery: • Simple surgery usually performed under local anesthesia and as an out patient 39 3/29/2024 By Addis E
- 40. Characteristics … • Requires trained service providers • Short-term discomfort and pain following procedure • Potential risk of complications, especially if general anesthesia is used • Client may regret later (age < 35) • Does not protect against STIs (e.g. HBV, HIV) 40 3/29/2024 By Addis E
- 41. Who can use • Who want permanent protection against pregnancy • Who are certain that they have achieved their desired family size • Who understand and consent to procedure 41 3/29/2024 By Addis E
- 42. Complications •Procedural complications – Bleeding or hemorrhage – Infection – Anesthesia-related complications – Trauma – tears or perforations to abdominal organs (bladder, bowel, uterus) •Ectopic pregnancy • Failure • Risk of failure (pregnancy) ~ 2% at 10 years;) 42 3/29/2024 By Addis E
- 43. A Bilateral Tubal Ligation (BTL) • Is one type of sterilization • is a surgical procedure that involves blocking the fallopian tubes to prevent the ovum (egg) from being fertilized. 3/29/2024 By Addis E 43
- 44. Bilateral tubal ligation … 3/29/2024 By Addis E 44
- 46. Vasectomy • Male sterilization • Surgical cutting and sealing of vas deferens • A very safe, convenient, highly effective, and simple surgery 46 3/29/2024 By Addis E