Podcast
Questions and Answers
What is the method used to determine the pregnancy rate among 100 women using a contraceptive method for 12 months?
What is the method used to determine the pregnancy rate among 100 women using a contraceptive method for 12 months?
Pearl index
What are some side effects associated with progestin-only injectables?
What are some side effects associated with progestin-only injectables?
Menstrual irregularities, weight gain, delayed return to fertility, decreased bone density, no STI/HIV protection
Which contraceptive methods are categorized as the most effective?
Which contraceptive methods are categorized as the most effective?
What is the mode of action of progestin-only injectables?
What is the mode of action of progestin-only injectables?
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Progestin-only injectables can lead to bone loss that is reversible especially in older women. True or False?
Progestin-only injectables can lead to bone loss that is reversible especially in older women. True or False?
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Ideal contraceptive should be reversible as soon as its discontinuation and have __________ non-contraceptive benefits.
Ideal contraceptive should be reversible as soon as its discontinuation and have __________ non-contraceptive benefits.
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What is the failure rate of combined injectables, like Cyclofem and Mesigyna? Failure rate = _ / HWY
What is the failure rate of combined injectables, like Cyclofem and Mesigyna? Failure rate = _ / HWY
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The effectiveness of the lactational amenorrhea method decreases after 6 months.
The effectiveness of the lactational amenorrhea method decreases after 6 months.
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Match the contraceptive method with its action:
Match the contraceptive method with its action:
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What is the recommended type of IUD to use if the patient prefers using IUD to induce endometrial atrophic changes with 70% reduction in menstrual blood loss?
What is the recommended type of IUD to use if the patient prefers using IUD to induce endometrial atrophic changes with 70% reduction in menstrual blood loss?
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What are some predisposing factors for IUD expulsion?
What are some predisposing factors for IUD expulsion?
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Counseling the patient about the type & duration of IUCD, failure rate, and warning signs is recommended before IUD use.
Counseling the patient about the type & duration of IUCD, failure rate, and warning signs is recommended before IUD use.
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Intra-uterine pregnancy due to IUD may present as ____________.
Intra-uterine pregnancy due to IUD may present as ____________.
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Match the generation of progestagen with its example:
Match the generation of progestagen with its example:
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Study Notes
Services of Family Planning Units
• Pregnancy spacing (reversible or permanent) • Management of infertility • Management of recurrent fetal loss and genetic counseling
Classification of Contraceptives
• Hormonal contraceptives + Combined (Estrogen and Progesterone): OCP, monthly injectable, vaginal ring, skin patch + Progesterone only: POP, injectable (DMPA), implants, hormone releasing IUCD • Non-hormonal contraceptives + Physiological + Barrier + Chemical + IUCD + Surgical
Short Acting vs. Long Acting Contraceptives
• Short acting: physiological, barrier, chemical, OCPs • Long acting: implants, injectables, IUCD, surgical
Irreversible vs. Reversible Contraceptives
• Irreversible: surgical • Reversible: all others
Measuring Effectiveness (Pearl Index)
• Method used to determine pregnancy (failure) rate among 100 women using a contraceptive method for 12 months • Perfect use rate: represents the theoretical efficacy • Typical use rate: represents the actual users' experience
Effectiveness of Contraceptives
• Most effective: IUCD, contraceptive implants, sterilization • Effective: injectables, OCP, transdermal patches, vaginal ring • Least effective: diaphragm, cervical caps, condoms, spermicides, withdrawal, and periodic abstinence
Ideal Contraceptive
• Available • Affordable • Easily administered • Does not interfere with coitus • Has other non-contraceptive benefits • Has the least adverse effects • Effectiveness is immediate • Reversible as soon as discontinued
Eligibility for Contraceptive Use
• Conditions with no restriction for use (Category 1) • Conditions where advantages outweigh risks (Category 2) • Conditions where risks usually outweigh advantages (Category 3) • Conditions with unacceptable health risk (Category 4)
Counseling before Using Contraception
• Method: cost, duration, failure rate, reversibility • Technique: way of usage, missing, discontinuation, removal • Patient: advantages, disadvantages, contraindications, side effects
Natural Family Planning Methods
• Calendar method • Basal Body Temperature (BBT) method • Cervical Mucus (Billing) method • Urinary LH kits (Persona)
Lactational Amenorrhea Method
• Idea: stimulation of nipples sends nerve impulses to hypothalamus, inhibiting ovulation • Advantages: available from first day, no cost, healthy for infant • Disadvantages: not reliable, effective mainly in the first 6 months (50%)
Coitus Interruptus
• Idea: withdrawal of penis and ejaculation outside the vagina • Advantages: simple, readily available, no cost • Disadvantages: may cause pregnancy, less sexual satisfaction, may lead to pelvic congestion### Benefits of Hormonal Contraception
- Decrease incidence of fibroids, endometrial carcinoma
- Improve functional ovarian cyst and endometriosis
- Decrease benign breast lesions
- Decrease the risk for ectopic pregnancy
- Decrease the risk of PID (thick cervical mucus)
Disadvantages of Hormonal Contraception
- Incorrect use is common, increasing failure rate
- Require daily use
- Re-supply is required
- No protection against STI, including HIV
- May pose health risks for a small number of women
Types of Hormonal Contraception
Combined Oral Contraceptives (COCs)
- Choice of pills: low dose estrogen pills, monophasic pills, and pills containing new progesterone generation
- Starting pills: day 2-4 of the menstrual cycle, continued daily for 21 days, followed by a 7-day pill-free period
- Missing pills: take one as soon as possible, then continue with the next pill at the usual time
Progestin-Only Pills (POPs)
- Preparation: Microlut, Micronor, Exluton, and Cerazette
- Mode of action: mainly by rendering cervical mucus thick, and to a lesser extent, altering tubal motility and suppressing ovulation
- Use: one tablet daily from the first day of the cycle, continuously
- Indications: lactating patients, no estrogen side effects, suitable for cardiac, hepatic, over 40, and smokers
Injectables
- Forms: Depo-Provera, Depo-subQ Provera, and Norethisterone enanthate
- Mode of action: mainly by thickening cervical mucus, and to a lesser extent, suppressed ovulation
- Advantages: available, non-costly, require no action at the time of intercourse, no effect on lactation, highly effective, and offers non-contraceptive health benefits
- Disadvantages: menstrual irregularities, weight gain, delayed return to fertility, and decreased bone density
Subdermal Implants
- Method: Implanon, a single cylinder containing etonogestrel, left for 3 years
- Action: mainly by thickening cervical mucus, and to a lesser extent, suppressing ovulation
- Advantages: long-acting, rapidly reversible, and no estrogen side effects
- Disadvantages: headache, breast tenderness, weight gain, difficult insertion and removal, and menstrual irregularities
Vaginal Contraceptive Rings
- Combined vaginal ring: EE + Etonogestrel, inserted for 3 weeks and removed for 1 week
- Advantages: immediately reversible, simple introduction and removal, and fewer side effects
Combined Hormone Patches
- Evra patch: inserted for 3 weeks and removed for 1 week
- Failure rate: 1.2/HWY
Hormone-Releasing IUCD (LNG-IUS)
- Types: male and female
- Indications: permanent contraception, completed family, old couple, contraindication for pregnancy, and scarred uterus
- Complications: complications of anesthesia or surgery, pregnancy, and post-ligation syndrome
Male Contraception
- Permanent: vasectomy
- Temporary: physiological, mechanical, chemical, and hormonal
Postpartum Contraception
- Immediately: breastfeeding, barriers, and sterilization
- Lactating women at 6 weeks: progestagen-only methods, IUCD, and lactating women at 6 months: COC, combined monthly injectable, and VCR
Postcoital (Emergency) Contraception
- Hormones: given immediately or within 72 hours, inhibit ovulation, and cause early luteolysis
- Mechanical: IUCD inserted immediately or up to 120 hours, most effective method
Special Groups
- Diabetics: avoid estrogen-containing components, IUCD may be inserted with precaution
- Rheumatic heart disease: avoid estrogen-containing components, IUCD may be inserted with precaution
- Newly married: hormonal contraception (COC) is best
- Smokers: avoid estrogen-containing components, IUCD is better
- Elderly: IUCD is better, progesterone-containing contraceptives are more suitable, and permanent sterilization is considered
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Description
This quiz covers the potential side effects of taking oral contraceptive pills, including breast changes, acne, skin pigmentation, and more. Understand the possible effects of OCPs on the female body.
