Transcript
Contraception
The way to evidence
A 42 year‑old woman P5+1 was
wearing an IUD for 6
months ,that was removed 2
months ago because of partial
expulsion(2nd expulsion)
She is diabetic for 21 years Husbanded refuses condom, coitus
interrupts or vaginal tablet
She is seeking for another effective contraceptive method
What is the best advice ??
What Is The Best Advice ?? The most suitable& effective?
A- E/P vaginal ring: Nuva Ring
B- Progestagen implant: Implanon
C:Levonorgestrel IUD: Mirena
D: Depoprovera
E: Progesagen only pills
B
Contraceptive Choice above the age of 40 years
Choice is influenced by :
1. Frequency of intercourse
2. Natural decline in fertility
3. Menstrual dysfunction
4. Concurrent medical disorders
5. Wish for non-contraceptive
benefits
6. Acceptance of the couple.
7. Age of the couple.
No contraceptive method is contraindicated
by age alone.
RCOG FFPRHC Guidance Grade C 2005
Women aged over 40 years can be advised that:
Women should be counseled for the risks and non-
contraceptive benefits of all contraceptive methods.
Medical eligibility criteria for contraceptive ( MECC ) WHO 2004
The WHO Medical Eligibility Criteria
The WHO Medical Eligibility Criteria for Contraceptive Use
provides evidence-based recommendations to ensure that
women can select the most appropriate method of
contraception without unnecessary medical barriers.
RCOG FFPRHC Guidance Grade C 2005
WHO Medical Eligibility Criteria for Contraceptive Use
(WHOMEC )2004 / 2008
Eligibility rather than ineligibility )or contraindication( :
4 Categories
Category 1: The use is unrestricted )Used in any circumstances(
Category 2: The advantages outweigh the theoretical or proven risks.) Generally can be used(
Category 3: The risks outweigh the benefit. )Not used unless other appropriate methods are not available or acceptable(
Category 4: The use an unacceptable health risk )Method not to be used(
A. E/P vaginal ring: Nuva Ring
Review 12 RCTs
• Superior cycle control than COC
• Lower incidence of nausea and breast tenderness
Roumen. Contraception, 2007
• May be more effective than proper COC use.
• Long-term studies is limited: but expected that benefits
and risks are similar to COC.
Evidence-based guidance A WHO Family Planning Cornerstone 2007
B. Progestagen Implants: Implanon
Norplant and Implanon
The Implanon rod
• Core: 40% EVA Copolymer
60% Etonogestryl
• Membrane: 100% EVA
EVA: Ethylene Vinyl Acetate
ApplicatorApplicator
ObturatorObturator
cannulacannula
• Alleviate menorrhagia, dysmenorrhea & PMT
• Reduce the size of fibroid
• Regression of endometriosis
• Regression of endometrial hyperplasia
• Endometrial protection in HRT.
• Prevention of PID
• Can be left up to 7 years )Normal = 5 y(
Particularly useful for the perimenopausal woman
C. Mirena®
D. Injectables
NET-EN and DMPA
C. Progestin only pills )POP(
E+P
P - I - R
POPPO
Injectable
PO
Implant
IUD
Mirena
History of G. Diabetes 11111
Uncomplicated Diabetes 22222
Diabetes + other Risk factor32222
1-Vascular Diabetes )Nephropathy, Retinopathy, Neuropathy(
2-Diabetes >20 years42322
WHO Medical Eligibility Criteria: Diabetes
What Is The Best Advice ??
A- E/P vaginal ring: Nuva Ring : Eligibility 4
B- Implanon Eligibility 2.& FR 0.0-0.05HWY C:Levonorgestrel IUD: Mirena Previous 2 expulsions
D: Depoprovera Eligibility 3
E: Progesagen only pills Eligibility2& FR:0.5-5HWY
B
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