Please enable JavaScript.
Coggle requires JavaScript to display documents.
Contraception (Intrauterine contraceptive devices and systems…
Contraception
Intrauterine contraceptive devices and systems
copper IUD
prevent fertilisation by the action of copper on sperm
effective 5-10 years depending on type
can get heavier and longer periods
hormone releasing intrauterine system
mirena
levonorgesterel
effective 5 years
effective in treating menorrhagia and dysmenorrhea
jaydess
effective 3 years
first few months persistent spotting in common
20-30% are eventually amenorrhoeic
not effective as post-coital contraception
IUD counselling
efficacy
less than 1 pregnancy per 100 women in one year
history
menstrual
STI and PID
risks
expulsion
PID
increased menstrual bleeding
lost threads
uterine perforation
benefits
don't need to remember
has to be inserted by trained practitioners
can be inserted at any point of the cycle, after miscarriage or TOP, immediately following delivery or at 6/52 check up
contraindications
pregnancy
active gonococcal or chlamydial infection
undiagnosed bleeding/malignancy
uterine fibroids or anomaly distorting the cavity
risk of bacterial endocarditis
copper allergy
hormonal contraception
contraceptive implants
jadelle
levonorgestrel
effective for 5 years
Implanon
etonogestrel
effective for 3 years
not available in NZ
inhibit ovulation
contraindications
pregnancy
recent breast cancer
relative
severe liver disease
severe arterial disease
liver adenoma
past history breast Ca
undiagnosed genital bleeding
enzyme inducers
side effects
irregular bleeding 30%
can be treated with COC
ammenorrhea 10%
efficacy
<1% chance of becoming pregnant
injectable depot medroxyprogesterone acetate (DMPA)
suppression of ovulation at HPA axis
150mg intramuscular injection
prevents pregnancy for 90 days
repeat injections every 12w
contraindications
pregnancy
recent breast cancer
relative
past history breast Ca
liver adenoma
severe liver disease
severe arterial disease
undiagnosed genital bleeding
risks
CVD
cancer
BMD
side effects
cycle disturbance
weight gain
fertility return may take up to 9mo
benefits
highly effective
reduction of menstrual cycle problems
combine oral contraceptive pill
ethyl estradiol and progestogen
prevents ovulation
21 daily hormones; 7 sugar pills
should be used in reliable pill takers
absolute contraindications
circulatory disease
strong FHx VTE
migraine with aura
past or present circulatory disease
SLE
haemolytic uraemic syndrome
pemphigoid gestationis
relative contraindications
risk factors for arterial disease
chronic systemic disease
long term interacting medication
risks
CV
increased fibrinolysis
VTE
low dose oestrogen low risk
stroke
haemorrhagic
minimal with low dose oestrogen
thrombotic
oestrogen dose related
MI
increased risk only for smokers
cancer
cervical
?
breast
little evidence
liver
low risk
benefits
decreases menstrual problems
can improve acne
efficacy
theoretical failure rate <1%
practical failure 6-12%
when to start
menstruation
start up to day 5 w no extra precautions
day 6 or later, extra precaution for 7 d
postpartum - no lactation
21d after delivery start if BMI<30
42d after delivery if BMI>30
postpartum - full lactation
recommended POP; COC 6/52 post delivery
post miscarriage or TOP
same day
changing from COC
next day (no 7d break)
interactions
anticonvulsants
antibiotics
rifampicin
vaginal ring
oestrogen + progestogen
same contraindications as COC
placed in vagina for 3-4/52
followed by 1/52 break or new ring
not subsidised
progestogen only pill
acts by thickening cervical mucus