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Contraception - Coggle Diagram
Contraception
Assessment
Identify any relevant medical conditions or medication that could affect the choice of contraception, BMI, Hypertension, PMHx breastfeeding; menorrhagia; fibroids; previous ectopic pregnancy; diabetes mellitus; epilepsy; headache and migraine; cardiovascular disease (CVD) risk factors; obesity; smoking; hypertension; sexually transmitted infections (STIs) or pelvic inflammatory disease (PID); and venous thromboembolism (VTE). Fhx
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Discuss patients choice, rationale and understanding of method
Discuss smear hx, STI precautions, sexual partners
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Methods
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Barrier methods and spermicides- male/female condom, diaphragm or cap, plus spermicide
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Natural Family planning - Fertility awareness–based methods (FAM), Lactational amenorrhoea method (LAM)
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Emergency contraception- Oral levonorgestrel., Oral ulipristal acetate, Cu-IUD
Hypertension
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consistently elevated blood pressure (systolic is 160 mmHg or more, or diastolic is 100 mmHg or more)
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POP, progestogen-only implant, or progestogen-only injectable
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Hx of VTE
Barrier method (condom, diaphragm, or cap).
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Progestogen-only pill (POP), progestogen-only implant or progestogen-only injectable.
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Breastfeeding
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< 6 weeks postpartum
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Progestogen-only pills (POPs), progestogen-only implants, or progestogen-only injectables.
A copper intrauterine device (Cu-IUD) or the levonorgestrel intrauterine system (LNG-IUS), from 4 weeks postpartum (off-label use).
Consider the following methods before 4 weeks postpartum (off-label use), only after seeking specialist advice as the risks (uterine perforation) usually outweigh the benefits: Cu-IUD or LNG-IUS
Obesity
BMI 35 and above
Progestogen-only pill (POP), progestogen-only injectables, or progestogen-only implant
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Barrier methods (condoms, diaphragms, and caps)
Female sterilization — sterilization may be more difficult to perform, and there is an increased risk of complications such as wound infection
Consider combined hormonal contraception (pill, transdermal patch, or vaginal ring) only after seeking specialist advice.
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Smoking
smoker under 35 years of age, or ex smoker for 1 year and above and over 35 years of age
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35 years of age or older and smokes < 15 cigarettes daily, or has stopped smoking in the past 12 months:
Barrier methods (condoms, diaphragms, and caps).
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Progestogen-only pill (POP), progestogen-only injectables, and progestogen-only implants.
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Consider combined hormonal contraceptives (pill, transdermal patch and vaginal ring) only after seeking specialist advice as the risks usually outweigh the benefits.
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Adverse effects- weight gain, mood swings, bleeding patterns and dysmenorrhoea, BMD, VTE, delay in conception, cancer