Contraception - PowerPoint Presentation

Slide1

Contraception

Dr

K Dissanayake

Bute

House Medical Centre

Slide2

Different Methods

Hormonal

Barrier methods

IUD

Natural methods

Sterilisation

Slide3

Things to consider

Age, consider whether Fraser competent in <16

yrs

Medical History

–

UKMEC / WHOMEC

Current medications

Menstrual cycle

Patient preference

–

previous experience, hormonal/non-hormonal,

amenorrhoea

Efficacy

Quick starting

Slide4

Slide5

Table 4: Percentage of women experiencing an unintended pregnancy within the first year of use with typical use and perfect use (modified from Trussell et al.)

Method

Typical use (%)

Perfect use (%)

Fertility awareness-based methods

24

0.4–5

Male condom

18

2

Combined hormonal contraception (CHC)

Progestogen

only pill (POP)

9

9

0.3

0.3

Implant

0.05

0.05

DMPA

6

0.2

Cu-IUD

LNG- IUS

0.8

0.2

0.6

0.2

Female

sterilisation

Vasectomy

0.5

0.15

0.5

0.1

Slide6

UKMEC criteria

Provides guidance who can use the contraceptive methods safely – related to safety not efficacy

UKMEC

Definition

1

A condition for which there is no restriction

of use of the method

2

A condition where the advantages of using the method generally outweigh the theoretical or proven risks

3

A condition where the

theoretical or proven risks usually outweigh the advantages. Expert clinical

judgement

or referral advised

4

A condition which represents and unacceptable

health risk if the method is used

Slide7

Emergency Contraception

Levonorgestrel

(

Levonelle

)

Ulipristal

(Ella One)

Copper IUD

Slide8

Considarations

Persistently elevated b-HCG levels (category4) or decreasing levels (Cat. 3) for Cu-IUD

Post partum < 4 week and distorted uterus are category 3 for Cu-IUD

Slide9

Hormonal contraception

Combined hormonal contraception

COC

First line -

Ethinylestradiol

30mcg +

levonorgestrel

or

Norethisterone

–

eg

Microgynon

,

Rigevidon

.

Higher risk of VTE if the

progestogen

is

Drospirenone

(

Yasmin

),

Gestodene

(

Femodene

) and

Desogestrel

(

Marvelon

/

Gedarel

)

Transdermal patches

–

eg

Evra

Vaginal ring -

NuvaRing

Slide10

Slide11

CHC

Mechanism of action

–

Inhibition of ovulation, some effect on the cervical mucus and endometrium.

When to start

Missed pills

One missed pill

2 or more missed pills

Diarrhoea

and vomiting

Slide12

CHC and UKMEC

Postpartum (0-<6 weeks) and breastfeeding

–

category 4

Post partum (3-6 weeks) and non breast feeding

With other risk factors for VTE

–

category 3

Without other risk factors for VTE

–

category2

Age and smoking

<35

yrs

–

category2

>35

yrs

- <15 cigarettes

–

cat. 3 and >15 cig cat. 4

Slide13

CHC and UKMEC

Obesity

BMI >= 30-34 Cat.2

BMI>= 35 Cat.3

Hx

of or current VTE

–

Cat. 4

Slide14

Progestogen only contraception

POP

Depo

injections

Subdermal

implant

UKMEC

Current breast cancer Cat 4, past breast cancer Cat 3

Check if

hx

of stroke and IHD

IUS

Slide15

POP

Mechanism of action

–

changes to cervical mucus, suppression of ovulation(

Desogestrel

>

norgeston

), suppression of

midcycle

peaks of LH and FSH, hostile endometrium, reduced activity of cilia in the fallopian tube

When to start

Delayed or missed pills

Vomiting and

diarrhoea

Slide16

LARC

Progestogen

only injections

Depot

medroxyprogesterone

acetate 150mg deep IM(

depo-provera

)

Depot

medroxyprogesterone

acetate

104mg SC (

Sayana

Press)

Norethisterone

enantate

200mg deep IM (

Noristerat

)

Subdermal

implant

IUS

IUD

Slide17

Progestogen only injectables

Slide18

Progestogen only injectables

Mechanism of Action

–

Inhibition of ovulation and thickening of cervical mucus

When to start

Depo

Provera

–

every 12 weeks and

Sayana

Presss

–

every 13 weeks

Loss of bone mineral density

Slide19

Progestogen only implant

Nexplanon – Etonogestrel 68mg

Slide20

Nexplanon

Mechanism of Action

–

Inhibition of ovulation, some changes to cervical mucus

When to start

3 years

Menstrual irregularities

Liver enzyme inducing drugs are likely to reduce efficacy

Deep implants/migration of implant

Slide21

IUS

Levonorgestrel intrauterine systems

Mirena

Levosert

Jaydess

Dose

52mg

52mg

13.5mg

Contraception

5

yrs

3

yrs

3

yrs

Endometrial protection

4yrs

-

-

Menorrhagia

5

yrs

3

yrs

-

size

32mm(h) 32mm(w)

32mm(h)

32mm(w)

30mm(h)

28mm(w)

Slide22

Mirena

Slide23

IUS

Mechanism of Action

–

prevents implantation of the

fertilised

ovum and changes to cervical mucus

When to start

Slide24

IUD

Copper containing devicesMost effective devices contain at least 380mm 2 of copper and have copper bands on the transverse arms.

Slide25

IUD

TT380

Slimline

–

10 years

MiniTT380

Slimline

–

5 years

T-Safe 380A QL

–

10 years

Slide26

IUD

Mechanism of Action

Toxic to the sperm and ovum thereby preventing

fertilisation

A

lteration in the copper content of the cervical mucus

–

inhibits penetration

Inflammatory reactions within endometrium

–

prevents implantation

When to start

Heavier and more painful periods

Slide27

IUS/IUD

Risk of Uterine Perforation

–

1/1000

Risk of PID

–

related to insertion and background risk of STI

Educate patient to feel for threads

Risk of ectopic pregnancy

Actinomyces

like organisms on smear

Slide28

Permanent methods

Sterilisation

Vasectomy

Tubal Occlusion

Slide29

Vasectomy

Minor surgical procedure

Small risk of

haematoma

and infection

Potentially

irreverisible

Need to use contraception for 12 weeks post procedure until

azoospermia

in confirmed

Risk of testicular/scrotal pain post vasectomy

–

can develop months or years later. 1-14%

Slide30

Vasectomy

Slide31

Tubal Occlusion

Surgical procedure

Potentially irreversible

If tubal occlusion fails the resulting the pregnancy might be ectopic

Filshie

clips and modified Pomeroy technique

–

contraception for 4 weeks following the procedure

Hysteroscopic

sterilisation

–

need contraception for 3 months until confirmation of occlusion

Slide32

Tubal Occlusion