5. clinical practice in contraception-bus

7/25/2019 5. Clinical Practice in Contraception-BUS

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! "

Budi Santoso

Departement of Obstetry Ginecology

RSUD Dr. Soetomo Surabaya Airlangga University


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GREET :

Warm greetings

Fiendly meet

Keep secrets

HELP :

Choosing methods

Screening methods

ASK :

Age, parity, marriage

Number of childrens

History of contraception

EXPLAIN :

Mechanism of contraception

TELL :

Appropriate contraception

Contraception methods

Show the contraception device

RETURN :

When to comeback evaluation

Side effects

3


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# Describe side effects of various methods, their frequency &duration

# Reassure re safety of methods

# Emphasize client satisfaction with methods in general

# Elicit & answer questions; correct misinformation courteously


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# Elicit and respond to client concerns

# Be concise & clear

# Be honest re frequency or severity of side effects

# Provide support material


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# Conventional/ Natural Method :

o

Calendar

o Coitus interruptus

o Lactational Amenorrhea

Method

# Barrier Methods:

o

Condoms (!and !)

o Diaphragms

o Spermicides

o

Foams , jelly ,tissue

# Progestin-Only Contraceptives:

o Norplant Implants

o Injectable

o Pills

# Combined Contraceptives:

o CICs

o COCs

# IUD :

o

CuT380A , Nova T ,

Lippes Loop . Multiload

#

Operative :

o Vasectomy

o Tubectomy

To AVOID sperm meets ovum


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# Diaphragm: High Failure Rates

Must Remain in ~6 Hrs post-coitus

Best if Combined with Spermicide

UTI Potential# Condom: STD Protection, Inconsistent Use by Men

# Female Condom

# Today Sponge


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# Cyclofem

25 mg depo-medroxyprogesterone acetate and 5 mg

estradiol cypionate injectable (IM) once a month

# Mesigyna

50 mg norethindrone enanthate and 5 mg estradiol

valerate injected (IM) once a month


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Mechanism of Action CICs


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# Anytime you can reasonably sure the client is not pregnant

# Days 1 7 of the menstrual cycle

# Postpartum:

after 6 months if using LAM

After 3 weeks if not breastfeeding

# Postabortion (immediately or within 7 days)


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NoncontraceptivesBenefits


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# Contain Synthetic Estrogen/Progestin

# Modern E2Dosage !50 Mcg

# Despite Diversity, Side Effects and Efficacies Similar

# Requires Patient Compliance

# May Be Monophasic or Triphasic


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Suppress ovulation

Reduce sperm

transport in upper

genital tract (fallopian

tubes)

Change endometrium

making implantation

less likely

Thicken cervical mucus

(preventing sperm

penetration)


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# Menstrual Regulation

# Decreased Risk of Anemia

#

Ovarian, Endometrial CA: Risk# Lower PID Risk

# Prevention of Benign Breast Disease


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# Breakthrough Bleeding (!

25%)

#

Amenorrhea

# Breast Tenderness,

Nausea

#

?Weight Gain


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# Thromboembolism (#35 yo, Smoker)

# MI (Smokers Only):

o < 15 cig/day: 3X Risk

o

> 15 cig/day : 21X Risk

# Liver Adenomas (Very Rare)


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Injectable

# Inhibits Ovulation

# 150 mg 3 months (14 day grace period)

#

Delayed Ovulation After Discontinuation# Main Side-Effects:

o Amenorrhea

o AUB

o

Weight Gaino Hair Loss


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Pills

$ Unlike the combined pill, the progestin-only pill

(sometimes called the mini-pill) only has one

hormone, progestin, instead of both estrogenand progestin.

$ It is prescribed by a doctor. It is taken at the

same time each day. It may be a good option forwomen who cant take estrogen.

$

Typical use failure rate: 9%.


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# Implantable for !5 Years

# Similar Side Effects as Depo-Provera

# Avg. Yearly Failure Rate: 0.8/100 (Increases : > 2/100 after

5 years)

# Occasionally Difficult to Remove


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# ParaGard (CuT380A), Progestasert

# Very Effective (~ TL), Reversable

# Risks OVERBLOWN

# Monogamy Essential, However

#

Does Not Protect Against STDs

# Can Remain for !10 Years

Types


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# IUD, OCPs

# Specific OCP Regimens Given !72 Hours After Unprotected

Intercourse

~ 75% Effective

#Yuzpe Method: Ovral 2 tabs po now and 2 tabs 120later

# May Cause Nausea

# Consider Dispensing at Yearly Visit


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FemalePrevents pregnancy by

preventing sperm from

reaching the egg

Prevents pregnancy by preventing

sperm from entering the semen; semen

is ejaculated without sperm

Male


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Sterilization is appropriate for people who:

# Do not want any more children

# Want highly effective contraception

#

Want permanent protection

# Have difficulty with temporary methods requiring

compliance or resupply

There are no medical restrictions for age or parity.

Source: WHO, 2004; updated 2008.


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It is IMPORTANT to distinguish side effects from rumors or

misinformation

o

Challenge: Clients believe that certain methods will render awoman sterile

o Solution: Always discuss returning to fertility as a significant

issue


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Reasons

#Too Busy

# Worried that clients may

reject method(s)

Possible Solutions

#Reassure that counseling

can be brief. Provide

literature.

#Reassure that side effect

counseling increases use

continuation.


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Reasons

#Unaware of frequency of

sides effects

# Lack of support material

Possible Solutions

# Give providers training on

common side effects.

# Provide simple written AV

materials for providers


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# All Methods have Risks and May Not be

Appropriate for all Patients

# Give enough counceling


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