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LONG ACTING REVERSIBLE CONTRACEPTIVES (LARC).pptx
- 1.
- 2. Introduction Whocan use LARC? Effectiveness of LARC Main types of LARC:Implants and IUDs content 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 2
- 3. LARC isa Long-Acting Reversible Contraceptive, meaning that once it is inserted it will provide continuous protection against unwanted pregnancy until it is removed. There are two types of LARCs, implants or IUDs (Intrauterine Devices) and further subdivided into hormonal and non-hormonal. Both forms can be placed during a short in-office procedure and are more than 99 percent effective in preventing unwanted pregnancy. They last for several years and are easy to use. INTRODUCTION 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 3
- 4. LARC methods area safe and effective birth control choice for women of all ages. Teenagers, women who have given birth, and women who have never given birth can use these methods. They also are good methods for women to use immediately after child birth. WHO CAN USE LARC? 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 4
- 5. LARC methods (Implantsand IUDs) are 20 times more effective than oral contraceptive pills, the patch, or the vaginal ring. The IUD and the implant are the most effective forms of reversible birth control available. During the first year of use, fewer than 1 in 100 women using an IUD or implant will get pregnant. EFFECTIVENESS OF LARC 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 5
- 6. The IUD andthe implant do not protect against sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). A male or female condom should be used to provide STI protection if one is at risk of getting an STI. NOTE 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 6
- 7. 3/6/2023 NDUBUISI, I.C. SOM,UDUTH SOKOTO 7 MAJOR TYPES OF LARC
- 8. Implants are smallplastic rods, each about the size of a matchstick, that release a progestin like the natural hormone progesterone in a woman’s body. A specifically trained provider performs a minor surgical procedure to place one or 2 rods under the skin on the inside of a woman’s upper arm. Do not contain estrogen, and so can be used throughout breastfeeding and by women who cannot use methods with estrogen. IMPLANTS 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 8
- 9. 3/6/2023 NDUBUISI, I.C. SOM,UDUTH SOKOTO 9 TYPES
- 10. Uniplant: 1 rodcontaining 55mg of nomogestrol, effective for 1 year. Implanon/implanon NXT (Nexplanon): 1 rod containing 68mg of etonogestrel, labeled for up to 3 years of use. Jadelle: 2 rods containing 75mg of levonorgestrel, highly effective for 5 years Zarin/Levoplant (Sino-Implant (II)), 2 rods containing 75mg of levonorgestrel. Labeled for up to 4 years of use. 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 10 TYPES OF IMPLANT
- 11. Implants work primarilyby: Preventing the release of eggs from the ovaries (ovulation) Thickening cervical mucus (this blocks sperm from reaching an egg) 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 11 MODE OF ACTION
- 12. Jadelle Annual0.2 pregnancies/100 women 5-year cumulative 1.1 /100 women Zarin 0.3 – 1.1 pregnancies/100 in the first year of use Implanon Less than 1 pregnancy/100 women for over 3 years of use 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 12 EFFECTIVENESS
- 13. Safe to useimmediately postpartum if not breastfeeding Safe to use after 6th week postpartum if breastfeeding Safe for women of any age and parity Safe to use immediately after an abortion 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 13 HOW SAFE IS IMPLANT?
- 14. An implantcan be placed in the provider’s office with a short procedure. Before placement, the provider will clean the client’s arm and then numb the spot where the device will be inserted with 2ml of 1% xylocaine. The device comes in its own applicator-syringe, which is used to inject the implant under the skin. The whole procedure takes around 10 minutes and is followed by dressing with a pressure bandage. 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 14 INSERTION OF IMPLANT
- 15. Effective immediately ifinserted within the first 7 days of menstrual cycle (5 days for Implanon). Very effective in preventing pregnancy and safe for majority of women They are long-acting Do not interfere with intercourse Do not affect breastfeeding (Contain no oestrogen) No supplies required by the client No frequently repeated visits to the clinic required 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 15 BENEFITS
- 16. No increased riskof cardiovascular complications No delayed return to fertility Decrease ectopic pregnancy May decrease menstrual pain and menstrual bleeding May help prevent iron deficiency anemia Protect against endometrial cancer and symptomatic pelvic inflammatory disease 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 16 BENEFITS
- 17. May causemenstrual changes – spotting, irregular bleeding, amenorrhea May cause weight gain, breast tenderness, dizziness, nausea, mood change, acne Some women may develop enlarged ovarian follicles Do not protect against STIs/HIV/AIDs Insertion and removal procedures may be associated with bruising, infection or bleeding The client cannot discontinue the method on her own Outline of the rods may be visible under the skin of some women, especially when the skin is stretched 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 17 LIMITATIONS
- 18. Implant removal onlytakes a few minutes, but the process is a little longer than getting it inserted. Just like with the insertion, the provider gives the client a shot to numb a small area of the arm. Then a small cut is made and the implant is removed. If the client wants to continue using implant, the provider can get another implant inserted during the removal of the old one. 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 18 REMOVAL OF IMPLANT
- 19. IUDs areamong the most reliable and cost-effective long- acting method of contraception available to women today IUD offers a level of protection comparable to female sterilization with the added advantage of easy and rapid reversibility IUDs can be inserted: Immediately after delivery of the placenta During cesarean section Within 48 hours of childbirth If not inserted within 48 hours of delivery, insertions should be delayed for 4-6 weeks. 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 19 INTRA-UTERINE DEVICES (IUDs)
- 20. Effectiveness is comparableto female sterilization 12-13 years with Copper-T (approved) Cheaper to provide than other methods Quickly and completely reversible Very safe for most women (including: immediately postpartum, post abortion, or interval; breastfeeding; young; and nulliparas). 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 20 CHARACTERISTICS OF IUDs
- 21. Copper T380A: effective for up to 12 years LNG-IUS: effective for up to 5 years 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 21 TYPES OF IUDs
- 22. Cu-T380A The copperdecreases sperm motility and functions by altering the uterine and tubal environment, thus preventing sperm from reaching the fallopian tubes and fertilizing the eggs LNG-IUS Thickening of the cervical mucus Interfering with sperm movement Thinning the lining of the uterus 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 22 MECHANISM OF ACTION
- 23. At anytime, if reasonably sure client is not pregnant During the menstrual cycle Soon after child birth Post abortion/miscarriage For emergency contraception 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 23 TIMING OF INSERTION
- 24. No constant/ dailysupplies needed Effective immediately upon insertion No user action required Long lasting and reversible Protection from endometrial cancer and ectopic pregnancy 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 24 ADVANTAGES OF IUDs
- 25. Can be usedby postpartum and lactating women Fertility returns promptly upon removal Can be used as emergency contraception if inserted within 5 days of the first act of unprotected sexual intercourse Does not interfere with any medicines the client may be taking. Does not interfere with intercourse. 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 25 ADVANTAGES...
- 26. Trained providerneeded to insert and remove the IUD Pelvic examination before IUD insertion is mandatory May cause minor pain or discomfort during insertion and removal procedures Has side effects of changes in menstrual pattern and cramp Provide no protection from STIs including HIV Risk of expulsion 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 26 LIMITATION OF IUDs
- 27. Pain and crampingduring menstruation Prolonged and heavy menstrual bleeding Bleeding or spotting between monthly periods 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 27 SIDE EFFECTS
- 28. Perforation Infection Expulsion Pregnancy with IUDinsitu Missing thread 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 28 COMPLICATIONS OF IUDs
- 29. Does IUDincrease risk of HIV acquisition by the woman using it? NO Does use of IUD by HIV-infected women increase their other health risks? NO Does the HIV-infected IUD user increase risk to HIV negative male partner? NO 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 29 IUD USE AND HIV
- 30. 3/6/2023 NDUBUISI, I.C. SOM,UDUTH SOKOTO 30 SUMMARY
- 31. The AmericanCollege of Obstetricians and Gynecologists (2023). Long- Acting Reversible Contraception (LARC): Intrauterine Device (IUD) and Implant. https://www.acog.org/womens-health/faqs/long-acting- reversible-contraception-iud-and- implant#:~:text=What%20are%20long%2Dacting%20reversible,and%20are %20easy%20to%20use. http://www.myherhub.com/women-s-educational-videos/long-acting- reversible-contraception/ https://www.plannedparenthood.org/learn/birth-control/birth-control- implant-nexplanon/what-happens-when-the-birth-control-implant-is- removed NMCN MCPDP contraceptive technology update module. USAID/MCSP LLLong-Acting Reversible Contraceptive Learning Package :Learner version REFERENCES 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 31
- 32. THANK YOU FOR LISTENING ANYQUESTIONS? 3/6/2023 NDUBUISI, I.C. SOM, UDUTH SOKOTO 32
Editor's Notes
- #7 have more than one sexual partner; have a partner who has or has had more than one sexual partner; have sex with someone who has an STI; have a history of STIs; use intravenous drugs (injected into a vein) or have a partner who uses intravenous drugs
- #11 - Implanon NXT (a recent study shows it may be highly effective for 5 years). Replaces Implanon; Implanon NXT can be seen on X-ray and has an improved insertion device. - Jadelle/Zarin (2 rods, levonorgestrel 75mg) –Jadelle 5 yrs, Zarin 4 yrs · Women of any age and parity can use it · Safe to use immediately after an abortion
- #18 Users of Implanon and Implanon NXT are more likely to have infrequent bleeding, prolonged bleeding, or no monthly bleeding than irregular bleeding.