Yasmin Adam Department of Obstetrics amp Gynaecology October 2021 Outline WHO medical eligibility criteria Some examples HIV Womens Participation Counselling Which method Combined Hormonal Contraception ID: 1044235
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1. Contraception- a simple guideYasmin AdamDepartment of Obstetrics & GynaecologyOctober 2021
2. OutlineWHO medical eligibility criteriaSome examplesHIVWomens’ ParticipationCounsellingWhich methodCombined Hormonal ContraceptionProgestogen only ContractionIUCDBarrier methodsEmergency Contraception
3. MEC categories for contraceptive eligibility1No restriction to the use of the method2The advantages of using the method outweigh the risks3The risks outweigh the advantages to the use of the method4An unacceptable risk if the contraceptive method is used
4. AgePostpartumBreastfeedingPuerperal SepsisPast ectopic pregnancyCVDDyslipidemiasVTESuperficial venous disordersCYP3A 4 InducersMigraineLiver diseaseECPRapeSTI”sRisk of HIV, LW HIV,ART
5. CHC- Postpartum< 21 days PP and no other risks for VTE3< 21 days and other risk factors for VTE4> 21 days- 42 days with no other risks for VTE2> 21- 42 days with risks for VTE3> 42 days 1
6. LG-IUD postpartum/ breast feeding< 48 hours postpartum 2≥ 48 hours to < 4 weeks postpartum 3≥ 4 weeks postpartum 1≥ Puerperal sepsis 4
7. Methods where there is no effect on a medical conditionFertility AwarenessCalendar methodSymptom basedCoitus InterruptusLactational AmenorrheoaSterilization (mle/ female)A- AcceptC- CautionD DelayS Special
8. Women at risk/ Living with HIVHC-increase the risk of HIV acquisition?22 prospective observational studies7 studies COC showed no effect – 1 (Kenyan study)NET-EN – 6 studies no effect – 1 did show an effectDMPA – 5 studies no effect – 3 showed and effect – 1 dependent on the model usedHC- increase the risk of progression?7 observational studies showed no association with COC1 RCT showed an increaseDoes HC increase transmission of HIV?2 Prospective studies with CHC and 2 with POI- no effectIndirect studies- measuring VL
9. Participation in the choice “Voluntary use of contraception by women is critical for upholding their reproductive rights. All women have the right to evidence-based, comprehensive contraceptive information, education and counselling to ensure informed choice. Women’s contraceptive choices are made in a particular time, societal and cultural context; choices are complex, multifactorial and subject to change.Decision- making for contraceptive methods usually requires the need to make trade-offs among the different methods, with advantages and disadvantages of specific contraceptive methods varying according to individual circumstances, perceptions and interpretations.”
10. CounsellingThe effectiveness of the method Correct usage of the methodHow it worksSide EffectsHealth risks and benefits of the methodSigns & symptoms- seek medical helpReturn to fertilityDiscontinuing the methodInformation on STI protection
11. CounsellingMethodTypical Use (%)Perfect Use (%)FAM24Female Condom215Male condom182Withdrawal224COC and POP90.3Depo Provera60.2IUCD0.80.6Mirena0.20.2Implanon0.050.05Female Sterilization0.50.5Male Sterilization0.150.1
12. Shopping BasketCombined Hormonal ContraceptionProgestogen only ContraceptionIntra-uterine methodsBarrier MethodsPermanent methods
13. Combined Hormonal MethodsInjectableOralPatchesVaginal ring
14. Combined Hormonal ContraceptionDecide on the Estrogen
15. Combined Hormonal ContraceptionDecide on the dose15ug20 ug30 ug50 ug
16. Combined Hormonal ContraceptionLevonorgestrel/ Norgestrel3rd Generation ProgestogensGestodeneDesogestrelNorgestimateOtherCyproterone AcetateSpironolactone –type progestogen - DrosperinoneDienogest
17. Combined Hormonal ContraceptionDecide on length of cycle21 day28 day30 day12 month
18. Progestogen only contraceptionInjectablesDMPA – SC/ IMINorethisteroneProgestogen only pillImplantsVaginal ring
19. Emergency ContraceptionHigh dose Progestogens750 BD/ 1500 stat – up to 96 hoursYuzpe RegimeHigh dose CHCProgesterone Receptor ModulatorUlipristal 30 mg stat – 120 hoursMifepristone -25-50IUCD – 5 – 7 days
20. Thank you