Planificación Familiar: Métodos Modernos

• These notes provide general information on methods of family planning.
• They cover emergency contraceptive pills, transdermal patches, intradermal implants and intrauterine devices.

Emergency Contraceptive Pill (ECP)

• Synonyms include "morning-after pill," "postcoital pill," "Plan B," and "emergency pill.”

• Mechanism of action is mentioned, type of formulations include:

  • Special levonorgestrel
  • Ulipristal
  • Progestin pills (lng o ngt)
  • Combined oral contraceptives

• Timing for taking the pill is important.

• Effectiveness varies based on the type of ECP.

  • Without ECPs, 8 out of 100 women may become pregnant.
  • With ulipristal acetate, less than 1 out of 100 women become pregnant.
  • With progestin-only ECPs, 1 out of 100 women may become pregnant.
  • With combined estrogen and progestin ECPs, 2 out of 100 women may become pregnant

• Side effects include nausea, abdominal pain, fatigue, headache, breast tenderness, dizziness and vomiting.

• If vomiting occurs, a new dose should be taken.

• After using ECPs, initiate a continuous contraceptive method.

• ECPs help prevent pregnancy and reduce unsafe abortions.

• Counseling on the regular method of contraception used is important.

• Restarting regular contraceptive methods after ECP use requires consideration.

• Hormonal methods should be considered regarding restarting.

• Ulipristal acetate's mechanism of action is a key consideration.

• If vomiting occurs within 2 hours of taking the pill, the next steps should be taken.

• If vomiting occurs after 3 hours of taking the pill, the next steps should be taken.

• Women with contraindications to combined oral contraceptives (AOC) can use ECPs, given the brief treatment and small dose.

• A pregnancy test should be performed before taking the ECP.

• The minimum number of missed AOC doses to consider a woman for ECP prescription needs evaluation.

• When restarting AOCs, two advice points should be given: start immediately (do not wait for menstruation) and use a backup method (condom) for 7 days or 2 days if it is a progestin-only pill (AOP).

• If ulipristal acetate is used, wait 6 days before restarting.

• If a woman has unprotected sex 3 days after using a progestin-only ECP, the risk of pregnancy is the same as for a woman not using contraception (8/100).

• Perform a pregnancy test if Paola takes an ECP when the expected period is 7 or more days late.

• Frequent use of ECPs is possible but initiating a continuous-use method is advised.

Contraceptive Patch

• A small, plastic, transdermal patch.
• Contains two hormones: estrogen (EE) and progestin.
• One new patch is applied weekly for 3 weeks.
• Mechanism of action involves anovulation and changes in cervical mucus.
• Pregnancy rate in the first year of use is about 7/100.
• With correct use, pregnancy rate is less than 1/100 (3/1000).
• Weight of the woman can affect efficacy (90Kg).
• Fertility recovers after discontinuing use.
• Side effects include skin irritation, bleeding pattern changes, amenorrhea, headache, nausea/vomiting (NyV), breast pain (mastodynia), abdominal pain, flu-like symptoms or upper respiratory infection (IRA), and vaginitis.
• Benefits are noted.
• Risks are rare to very rare, including thromboembolic events (TVP and TEP).
• Application sites are noted.
• Instructions for use.
• Instructions for missed or delayed use address first week, end of week 1 or 2 and end of week 3 scenarios.
• Instructions also cover patch detachment (less than 48 hours; more than 48 hours).

Contraceptive Implants

• Small, flexible plastic rods.
• Contains a progestin.
• Trade names:
  • Jadelle (two rods, levonorgestrel)
  • Implanon NXT (one rod, etonogestrel 68 mg + barium sulfate 3%).
• Effective duration is specified.
• Mechanism of action involves 2 actions.
• Contraceptive efficacy is less than 1/100 (1 in 1000).
• Side effects include changes in bleeding patterns during the first year: scant, less frequent, prolonged, irregular, infrequent, or amenorrhea, headache, abdominal pain, acne, weight changes, breast pain, dizziness, mood changes, and nausea; may increase the size of ovarian follicles.
• Known benefits include protection against ectopic pregnancy and anemia.
• Complications include local infection, difficult removal and rarely expulsion.
• Misconceptions need to be clarified.
• Should not be used in women with systemic lupus erythematosus (SLE), severe liver disease, thrombosis, undiagnosed abnormal uterine bleeding (HUA) or breast cancer.
• Initiation:
  • During menstruation (within 7 days).
  • After hormonal method change.
  • During exclusive breastfeeding (MELA <6 months).
  • No breastfeeding after childbirth (>4 weeks).
  • Post-abortion (within 7 days).
  • Post emergency contraception (PAU).
• Placement is a factor.
• Removal is possible.
• Fertility returns after removal.
• Risk of ectopic pregnancy is 1/100,000 in implant users versus 650/100,000 in non-users.
• If the method fails, 10-17 out of 100 pregnancies may be ectopic.

Intrauterine Device (IUD) - Copper

• A copper T-shaped device (T Cu380A).
• Function: Chemical damage to sperm and/or ovum.
• Efficacy: <1/100 with perfect use; 6/1000 with typical use and 8/1000 with habitual use.
• Duration: 10 years (according to the package insert) or 12 years according to studies.
• Side effects include bleeding (3-6 months), spasms, cramps, anemia, rare pelvic inflammatory disease (PID) (<2/1000).
• Benefits include protection against endometrial cancer, cervical cancer, and reduced risk of ectopic pregnancy (12/10K with IUD; 66/10K without IUD).
• Complications include perforation.
• If pregnancy occurs: abortion, premature birth, and infection.
• Do not insert if: 48 hours to 4 weeks postpartum, pelvic inflammatory disease (PID), vaginosis, recent septic abortion, puerperal sepsis, gestational trophoblastic disease (GTD), postpartum endometritis, undiagnosed abnormal uterine bleeding (AUB), gynecological cancer, genital tuberculosis (TB), increased risk of sexually transmitted infections (STI), uterine myomatosis, patients with high risk of STI or multiple partners.
• Initiation of the method:
  • Within the first 12 days of menstruation.
  • When changing methods.
  • Postpartum.
  • During MELA (less than 6 months).
  • After 6 months postpartum.
  • After 4 weeks postpartum.
  • In the absence of menstruation.
  • Post-abortion (<12 days).
  • As emergency contraception.
  • Following emergency contraception use (EC).
• Insertion technique is key.
• Follow-up consultation is required 3-6 weeks after insertion.
• Removal is possible.
• Pelvic inflammatory disease (PID): 1/666 cases with IUD within 20 days; <2/1000.
• Ectopic Pregnancy (EP) with IUD: 12/10,000 vs 65/10,000 in non-users.
• If IUD fails, 6-8/100 pregnancies will be ectopic.

Intrauterine Device (IUD) - Hormonal (IUS)

• Contains a progestin (Mirena® or Liletta®).
• Prevents sperm from fertilizing the egg.
• Effectiveness: <1/100 or 2/1,000.
• Duration: 5 years (based on research).
• Side effects: changes in menstrual bleeding (less volume, fewer days, irregular, prolonged, amenorrhea), acne, headache, breast pain, nausea, weight gain, dizziness, mood changes and ovarian cysts.
• Benefits: protects against anemia, endometrial cancer, and cervical cancer; reduces dysmenorrhea (painful periods), heavy periods and endometriosis.
• Risks: rare PID, perforation; very rare: abortion, premature birth, infection.
• Expulsion rate is 4/100.
• Address doubts, misunderstandings and taboos.
• Considers items for the copper IUD:
  • Breast Cancer
  • Blood Clots in the legs
• Initiation process for usage