The document discusses long-acting reversible contraceptives (LARCs) available in Malaysia, including intrauterine devices (IUDs) and implants. It notes that LARC usage in Malaysia is low compared to contraceptive pills. The main types of LARCs are described - copper IUDs, hormonal IUDs, and implants. Benefits include high effectiveness, reversibility, and not requiring daily adherence. Side effects like irregular bleeding are also discussed. Religious views on spotting are provided.

1. LONG ACTINGREVERSIBLE
CONTRACEPTIVES
Alia Syarmila Binti Yusuf

2. Introduction
Definition
Types
Conclusion

4. • The LARCs available in Malaysia
– contraceptive implant (IMP)
– the copper intrauterine device (IUD)
– levonorgestrel intrauterine system (IUS).
• LARC usage in Malaysia recorded in 2004 averaged about
4.5% for IUD and 0.4% for the implant as compared to
14% for contraceptive pills.

5. Definition
LARC is defined as contraceptive methods
that require administration less than once
per cycle or month.

6. WHY LARC???

7. 1. Are the most effective reversible methods
available
2. Have high rates of user satisfaction as
indicated by high continuation rates
3. Do not require daily adherence
4. Require fewer visits to health services than
many other methods
5. Are cheaper than using the pill over 12 months
6. Are easily reversible
7. Suitable for women of all ages
8. Do not affect fertility after removal

8. BARRIERS
1. A lack of familiarity with, or misperceptions about, the
methods
2. High upfront costs
3. Lack of access to insertion services
4. Health care providers’ concerns about the safety of IUD
use, especially in nulliparous ,younger women and
teenagers
5. Patient barriers, including a general lack of awareness
of LARC methods and information about their safety
and effectiveness

10. Types
Copper intrauterine devices
Progestogen-only intrauterine system
Progestogen-only injectable
contraceptives
Progestogen-only subdermal implants

12. Over 99 per cent effective.
Less than two women in 100 will get
pregnant over five years.
Older IUDs have less copper and are less
effective.

13. The modern banded
device has copper on the
stem and copper sleeves
on the arm

15. MODE OF ACTION

16. SIDE EFFECTS
• Irregular PV bleeding (IMB / spotting)
• Dysmenorrhea
• HMB
• Can introduce infection to the upper
genital tract (cervicitis) PID
• Perforation less than 1/1000
• Expulsion

19. PROGESTOGEN-ONLY INTRAUTERINE
SYSTEM
• Is a levonorgestrel-releasing intrauterine device
• T-shaped with reservoir on the vertical arm
• Releases progestin levonorgetsrel 20 ug daily
• Has 2 monofilament string attached to the
vertical arm.
• Life span is 5years

22. Risks
• 50% of pregnancy as a result of failure are ectopic preg.
• Irregular bleeding common in the initial 3-4 months of
use.
• About 25% of users become amenorrhoeic after the 2nd
year of use
Benefits
• Improvement in dysmenorrhoea.
• Used for treatment of HMB
• Reduced incidence of PID.
• Reduces risk of endometrial carcinoma

23. COPPER IUD HORMONAL IUD
Failure rate in 1 year of use 0.8% 0.1%
Mode of action Toxic effect on both sperm
& egg
endometrial gland atrophy
Thick cervical mucus
Suppress ovulation
Duration 10 y 5 y
Effect of menstrual cycle Menses more heavier and
painful
Irregular menses
Amenorrhea
Menstrual spotting More days of spotting
before and after menses
Erratic spotting
Hormonal side effect None Acne, greasier skin, breast
tenderness, mood swings
Therapeutic benefits None Help HMD & dysmenorrhea
Part of HRT
Average Malaysian cost RM 600 * RM 80 – 110 *
Average UK cost ₤10 ₤80

25. AbsoluteContraindication
i. Current STI or PID, including post-abortion &
following childbirth
ii. Malignant trophoblastic disease
iii. Unexplained PV bleed
iv. Endometrial & cervical Ca.
v. Known malformation of the uterus (fibroids)
vi. Copper allergy (use mirena)

31. 1) Most people get cramps or feel a little bit of pain when
they're getting the IUD inserted, but many only have
mild discomfort. The pain can be worse for some, but
luckily it only lasts for a minute or two
2) You may have cramping and spotting after getting an
IUD, but this almost always goes away within 3-6
months. Hormonal IUDs eventually make periods lighter
and less crampy, and you might stop getting a period at
all. On the flip side, copper IUDs may make periods
heavier and cramps worse

32. PROGESTOGEN-ONLYINJECTABLE
CONTRACEPTIVES

33. Over 99 per cent
effective.
Less than four women in
1,000 will get pregnant
over two years.

34. Types: Progestin-Only
– Depo Medroxy Progesterone Acetate (DMPA)
150 mg
• Microcrystalline suspension
• 3 monthly
– Norethisterone Enanthate (Net-En) 200 mg
• In oil
• 2 monthly

36. Modeof action
• Inhibition of ovulation by suppressing
gonadotropinns.
• Thickening of cervical mucus.
• Thinning of the endometrium

37. • The risk of ectopic pregnancy is significantly lower
among users compared to women who do not use
contraception.
• The risk of endometrial cancer is reduced by as much
as 80%, an effect that is long term and increases with
duration of use.
• Studies have shown as much as a 70% reduction in the
frequency of sickle cell crises; the mechanism for this
effect is not known.
• Some women with endometriosis have improvement of
symptoms with use of DMPA.
BENEFIT

38. 1. Decrease in bone mineral density, hence,
encourage calcium intake.
2. Irregular bleeding
3. HMB
4. Amenorrhoea in prolonged users
5. Mood swing & Depression.
6. Wt gain, about 2.2kg in 1 yr of use.
7. Delayed return to fertility when discontinued,
≥10 months.
Disadvantages

39. Over 99 per cent effective.
Less than one woman in 1,000 will get
pregnant over three years.

40. Initially Six Rods, Norplant (now discarded)
Two rod Jadelle (levonorgestrel) – 5 years
One rod Implanon (etonogestrel) – 3 years
Bio-degradable (Capronor) that does not require
removal (2 years) – Developed by Research
Triangle Institute
Implants

41. [Levonorgestrel Implant]
• 1st generation of implants
• Consists of 6 rods, each measuring 34mm
in length & 2.4mm in diameter
NORPLANT

42. Jadelle Implants (2 capsules)

43. • Non biodegradable
• Single rod
• Release the progestrogen etonogestrel
25-75 mg daily (dose with time)
• Duration of action is 3 years
Implanon

44. • Effective for women who have difficulty
remembering to take pill
• For long term contraception
• Rapid return of fertility after removal

45. • Implanon is associated with a higher frequency of
– amenorrhea
– oligomenorrhea,
• And a decrease in the prevalence of
– HMB
– weight gain
– Headache
– acne.

49. It's common to experience some degree of
bruising, pain, scarring or bleeding at the
insertion site.

50. Progestrogen only contraception
• Extremely safe
• Can be used if woman has cardivascular
risk factor
• Same mode of action
– Cervical mucus thickened
– Endometrial gland atrophy
– High concentration inhibit ovulation

51. SPOTTINGIN ISLAM
• The spotting that comes at times other than the regular
monthly period does not prevent one from praying and fasting,
because Umm ‘Atiyyah (may Allah be pleased with her) said:
• “We did not regard yellowish and brownish discharge after
tuhr (becoming pure) as being of any significance.”
– Narrated by al-Bukhaari (326) and Abu Dawood (307). Classed as saheeh by al-
Albaani in Saheeh Abi Dawood.

52. SPOTTINGIN ISLAM
• If a woman has become pure from her menses, what she sees
after that of spotting is not regarded as menses. And these
secretions are pure (taahir) so she does not have to wash them
from her clothes.
– This is the view of Abu Haneefah and Ahmad, and it is one of the two
views narrated from al-Shaafa’i, and it was classed as sound by al-
Nawawi.