Assisting Families With Reproductive Life Planning PDF

ASSISTING THE FAMILY WITH REPRODUCTIVE LIFE PLANNING OBJECTIVES After mastering the contents of this chapter, you should be able to: 1. Describe common methods of reproductive life planning and the advantages, disadvantages, and risk factors associated with each. 2. Use critical thinking to an...

ASSISTING THE FAMILY WITH REPRODUCTIVE LIFE PLANNING OBJECTIVES After mastering the contents of this chapter, you should be able to: 1. Describe common methods of reproductive life planning and the advantages, disadvantages, and risk factors associated with each. 2. Use critical thinking to analyze ways that family-centered reproduc- tive life planning can be accomplished. 3. Assess clients for reproductive life planning needs. 4. Plan nursing care related to reproductive life planning, such as helping a client select a suitable reproductive planning method. 5. Implement nursing care related to reproductive life planning, such as educating adolescents about the use of condoms as a safer sex practice as well as to prevent unwanted pregnancy. NURSING PROCESS OVERVIEW FOR REPRODUCTIVE HEALTH Assessment: 1. A Pap smear, pregnancy test, gonococcal and chlamydial screening, perhaps hemoglobin for detection of anemia or a mammogram to rule out breast disease. 2. Obstetric history, including sexually transmitted infections (STIs), past pregnancies, previous elective abortions, failure of previously used methods, and compliance record 3. Subjective assessment of the client’s desires, needs, feelings, and understanding of conception (teens, for example, may believe that they are too young to get pregnant; many women in the immediate postpartum period may believe that they cannot conceive immediately, especially if they are breastfeeding) 4. Sexual practices, such as frequency, number of partners, feelings about sex and body image, or latex allergy. Nursing Diagnosis: 1. Health-seeking behaviors regarding contraception options related to desire to prevent pregnancy 2. Deficient knowledge related to the use of diaphragm. 3. Spiritual distress related to partner’s preferences for contraception 4. Decisional conflict regarding choice of birth control because of health concerns. 5. Decisional conflict related to unwanted pregnancy 6. Powerlessness related to failure of chosen contraceptive 7. Ineffective sexuality pattern related to fear of pregnancy 8. Risk for ineffective health maintenance related to lack of knowledge about natural family planning method Planning and Implementation: When establishing expected outcomes for care in this area, be certain that they are realistic for the individual. Women’s decisions are influenced by many factors; a nurse’s role is to educate about contraceptives and support a woman about her contraceptive decision. If a woman has a history of poor compliance with medication, for instance, it might not be realistic for her to plan to take an oral contraceptive every day. Be certain to be sensitive to a couple’s religious, cultural, and moral beliefs before suggesting possible methods. Clients are required to provide informed consent for surgical contraceptive methods or procedures. The risks, benefits, alternatives, and proper use of the method and the client’s understanding of his or her rights and responsibilities should be included in the consent form. Outcome Evaluation: Client voices correct technique for using chosen method Client voices confidence in chosen method by next visit Client expresses satisfaction with chosen method at follow-up visit Client consistently uses chosen method without pregnancy for 1 year’s time Important things to consider in helping couples to choose a method: § Personal values § Ability to use a method correctly § If the method will affect sexual enjoyment § Financial factors § If a couple’s relationship is short term or long term § Prior experiences with contraception § Future plans Major Benefits of Contraception uDecrease in unintended adolescent pregnancies uDecrease in the need for “morning after”, a post coital medications uDecrease elective termination of pregnancy Successful Counselling uBenefits & disadvantages uSafe sex practices uCondom = protection against STD or HIV uLifestyle & overall health uAbstinence – the only 100% protection An ideal contraceptive should be: ü Safe ü Effective ü Compatible with spiritual & cultural beliefs and personal preferences of both the user and sexual partner ü Free of bothersome side effects ü Convenient to use and easily obtainable ü Affordable & needing few instructions for effective use ü Free of effects (after discontinuation) on future pregnancies Natural Family Planning and Fertility Awareness uPeriodic abstinence methods – methods that involve no introduction of chemical or foreign material into the body. Abstinence Refraining from sexual relations. Periodic Abstinence – a method to avoid pregnancy by avoiding sexon the days a woman may conceive. LAM (Lactation Amenorrhea Method) uDuring breastfeeding – there is a natural suppression of both ovulation & menses. LAM is a safe birth control method if: u Aninfant is: uUnder 6 months of age uBeing totally breastfed at least every four hours during the day and every 6 hours at night uReceives no supplementary feeding uMenses has not returned Coitus Interruptus (Withdrawal) u The couple proceeds with coitus until the moment of ejaculation. u The man withdraws & the spermatozoa are emitted outside the vagina u There may be few spermatozoa present in the pre- ejaculation fluid. Postcoital Douching u Douching following intercourse u No matter what solution is used, it is not effective method u Sperm may be present at the cervical mucus as quickly as 90 sec. after ejaculation Fertility Awareness Method uCalendar u“Cycle Beads” uBasal Body Temperature (BBT) uCervical mucus uCombination of these methods CALENDAR (Rhythm) Method u A record of at least 6 menstrual cycle to calculate safe days u Subtract 18 from the shortest cycle u First fertile day u Subtract 11 from the longest cycle u Last fertile day u Cycle ranging from 25 to 29 days u Fertile period = from 7’th day to 18’th day Basal Body Temperature Method u Before day of ovulation – temp. Falls 0.5 F u Time of ovulation – rises 0.2 C u Rise of progesterone u Use of oral thermometer or tympanic each morning immediately after waking u Avoid coitus for the next 3 days u The sperm survives 3 to 5 days (combine method recommended) Cervical Mucus Method (Billings Method) Changes in the cervical mucus that occur naturally u with ovulation u Before ovulation – thick, does not stretch u Just before ovulation – mucus increases u On the day (peak day) – mucus becomes copious, thin, watery & transparent u Feels slippery like egg white u Stretch like 1 inch before the strands breaks (spinnbarkeit) Two Day Method u Assess for vaginal secretion daily u Secretions for two days in a row – avoid coitus that day and the following day – secretions suggest fertility u Requires conscientious daily assessment and results in about 12 days per month in which she should avoid coitus Symptothermal Method u Combines the cervical mucus & BBT methods u Taking of temperature daily u Analyzes the cervical mucus daily u Observe for other signs of ovulation u Mittelschmerz (midcycle abdominal pain) u if the cervix feels softer than usual u Abstain from intercourse 3 days after the rise of temperature or the 4th day after the peak of mucus change. Standard Days Method: CycleBeads u Designed for women who have menstrual cycle between 26 and 32 days. u If she reaches the dark brown bead (appears on the 27’th day) before she begins her next menses – cycle is too short for the method to be reliable u If she reaches the end of the end of the string of beads (32 days) before menses, cycle is too long for the method to be reliable Ovulation Detection u The use of over the counter ovulation detection kit. u Detects midcycle surge of LH in urine 12 to 24 hours before ovulation u Can be used as an aid combining with the cervical mucus assessment u An ovulation detector – help with the future plan for conception when the couple is ready Marquette Model u Combines the use of ovulation detection with other signs of ovulation u Cervical mucus u BBT u Cervix position and softness v to avoid pregnancy during a woman’s fertile period v Developed in the late 1990’s by doctors and nurses at Marquette University in Wisconsin Barrier Methods of Contraception u Forms of birth control that place a chemical or latex barrier between the cervix and advancing sperm so sperm cannot reach and fertilize the ovum. 1. Spermicides uAn agent that causes the death of spermatozoa before they can enter the cervix uChanged the vaginal pH to a strong acid level uDoes not protect against STI’s Benefits & Advantages of Spermicides u Can be bought over the counter at a lower cost u When used in conjunction with another contraceptive, they increase the other method’s effectiveness u Various preparations available: u Gels u Creams u Sponges u Films u Foams u Vaginal suppositories Gels or Creams uEasily inserted into the vagina before coitus with a provided applicator uShould be inserted 1 hour before coitus Film of glycerin u Impregnated with a spermicidal agent that is folded & inserted vaginally u On contact with vaginal secretions or pre coital penile emissions, the film dissolves & a carbon foam forms to protect the cervix against invading spermatozoa. Other vaginal products u Cocoa butter & glycerin based vaginal suppositories containing a spermicide u Should be inserted 15 minutes before coitus (dissolved in 15 minutes) Foam-impregnated synthetic sponges u Moistened to activate the impregnated spermicide and then inserted vaginally to block sperm access. v Heath Education Caution women that feminine wash are not spermicidal and thus, it is not used as contraceptives  Side Effects & Contraindications of Spermicides u Women with acute cervicitis, it might further irritate the cervix. u Vaginal leakage after use of the product (cocoa butter, or glycerin base) is bothersome. Effect on Sexual Enjoyment u Although spermicidal products must be inserted fairly close to the time of coitus, they also are so easily purchased over the counter that many couples find the inconvenience of insertion only a minor problem. If a couple is concerned that the method does not offer enough protection, worry about becoming pregnant may interfere with sexual enjoyment. Some couples find the foam or moisture irritating to vaginal and penile tissue during coitus and therefore are unable to use them. Effect on Pregnancy u If conception should occur, there is no reason to think that the fetus will be affected by a spermicide. Some women worry that a sperm that survived the spermicide must have been weakened by migrating through it and therefore will produce a defective child. They can be assured that conception occurred most likely because the product did not completely cover the cervical os, so the sperm that reached the uterus was free of the product and unharmed. u Use by the Perimenopausal Woman. The use of vaginal film or suppositories is not recommended for women near menopause as this is a time in life when vaginal secretions are lessening so the film or suppository might not dissolve completely. Spermicide foam can help lubricate the vagina and so increase sexual enjoyment. u Use by the Postpartal Woman. Vaginal spermicides are appealing to postpartal women as these can be purchased over the counter and used in the time period before a postpartal checkup when a more permanent form of contraception will be prescribed. They have no effect on breastfeeding. Male & Female Condoms Male Condoms – a latex, rubber or synthetic sheath that is placed over the erect penis before coitus to trap sperm § Breakage or spillage may occur in up to 15% of uses thus causing failure rate. § Big advantage = one of the few “male- responsibility” birth control measures available. § No health care visit or prescription is needed Male Condom u Protection against spread of the following diseases: u Human papillomavirus (HPV) u Syphilis u Genital herpes u STI’s (gonorrhea & chlamydia) u Their use has become a major part of the fight to prevent infection from HIV Male Condom u Must be applied before any penile- vulvar contact as even pre- ejaculation fluid may contain some sperm. u Positioned loose enough at the penis tip to collect the ejaculate u The penis must be withdrawn before it begins to become flaccid after ejaculation  Female Condom u Sheaths made of latex or polyurethane, pre- lubricated with a spermicide u Protection against conception, STI’s & HIV u The inner ring (closed end) – covers the cervix u The outer ring (open end) – rest against the vaginal opening u Inserted anytime before any sexual activity begins & removed after ejaculation.  Female Condom u Prevents skin-to-skin contact STI’s – the only woman controlled safer sex method available. v Contraindication & Side Effects § None, except for sensitivity or allergy to latex § In case of allergy – polyurethane or natural membrane types can be used. § But should be cautioned that these types of condoms do not offer the same level of protection against STI’s Diaphragm & Cervical Caps Diaphragm u A circular rubber disk u Placed over the cervix before intercourse to mechanically halt the passage of sperms u Can be used along with the spermicidal gel to increase its effectiveness. u A woman should have the fit of the diaphragm first by the health care provider u Cervix can change shape with pregnancy, miscarriage, cervical surgery (D&C) or elective termination of pregnancy Diaphragm u A woman should have the diaphragm checked if she gains or loses more than 15 lbs. u Because this could change her pelvic & vaginal contours u The diaphragm should remain in place up to 6 hours after coitus – spermatozoa remains viable in the vagina in that span of time  Diaphragm u Maybe left in place as long as 24 hours, but not more than that to prevent: u cervical inflammation (erosion) or u urethral irritation from the pressure against the vaginal walls u if coitus is repeated before 6 hours, it should not be removed & replaced. u More spermicidal gel should be added to the vagina  Diaphragm u After use, a diaphragm should be: u washed with mild soap and water u Dried gently u Stored in its protective case v With this care, it will last for 2 years, after which it should be replaced. Diaphragm Side Effects and Contraindications: 1. Diaphragm is not effective If: § Uterus is prolapsed § Uterus is retroflex § Uterus is anteflexed § Intrusion on the vagina by a cystocele or rectocele – the walls of the vagina is displaced by bladder or bowel  Diaphragm Side Effect and Contraindications: 2. UTI’s due to a pressure on the urethra 3. May further aggravate irritation if used with acute cervicitis, herpes virus infection, papilloma virus infection - due to close contact with the rubber and spermicides Diaphragm Other Contraindications Include: § History of toxic shock syndrome (TSS: a staphylococcal infection introduced through the vagina § Allergy to rubber & spermicides § History of recurrent UTI’s Diaphragm To prevent TSS while using a diaphragm or cervical cap advice women to: u Wash their hands thoroughly before insertion and removal. u Do not use diaphragm during menstrual period u Do not leave a diaphragm in place longer than 24 hours. u Be aware of symptoms of TSS u If symptoms of TSS should occur, immediately remove the diaphragm and call a health care provider. Symptoms of TSS: Elevated temperature Diarrhea Vomiting Muscle aches sun burn-like rush Effect on Sexual Enjoyment. Some women dislike using diaphragms because they must be inserted before coitus (al- though they may be inserted up to 2 hours beforehand, minimizing this problem) and they should be left in place for 6 hours afterward. Use of a vibrator as a part of foreplay, frequent penile insertion, or the woman-superior position during coitus may dislodge a diaphragm; therefore, this may not be the contraceptive of choice for some couples. Diaphragm u Use by the Adolescent. Adolescents may be fitted for diaphragms. However, because an adolescent girl’s vagina will change in size as she matures and begins sexual relations, the device may not remain as effective as it does with older women. Adolescents may need to be reminded that pelvic examinations will be necessary to ensure that a diaphragm continues to fit properly. u Use by the Perimenopausal Woman. Women over age 35 have a higher incidence of cystocele or rectocele than younger women so diaphragms may not be the ideal contraceptive for them. u Use by the Postpartal Woman. As the cervix changes considerably with childbirth, women must be refitted for diaphragms and cervical caps after childbirth. This is usually done at a 4- or 6-week checkup. Cervical Cap u Made of soft rubber shaped like a thimble, which fits snugly over the uterine cervix u Less effective than the diaphragm because caps tend to dislodge more readily than diaphragm during coitus u Can be placed longer up to 48 hours – they do not put pressure on the vaginal walls or urethra. Cervical Cap u Must also be fitted individually by the healthcare provider u They include a small strap that can be grasped for easy removal Cervical Cap Contraindicated in women who have: 1. An abnormally short or long cervix 2. A history of TSS 3. An allergy to latex & spermicides 4. A history of cervicitis or cervical infection 5. A history of cervical cancer 6. Undiagnosed vaginal bleeding  HORMONAL CONTRACEPTION u Hormones that when taken orally , transdermally, intravaginally, or intramuscularly, cause such fluctuations in a normal menstrual cycle that ovulation or sperm transport does not occur. Oral Contraceptives u Pill u OC’s – Oral contraceptives u COC’s – combined oral contraceptives u Composed of varying amounts of synthetic estrogen u Combined with small amount of synthetic progesterone (Progestin) v The estrogen acts to suppress FSH and LH to suppress ovulation v The progesterone action causes a decrease in the permiability of cervical mucus & so limits sperm motility & access to ova Oral Contraceptives v Progesterone also interferes with tubal transport and endometrial proliferation § To an extent that possibility of implantation is significantly decreased Combination Oral Contraceptives Popular COC’s prescribed: u Monophasic pills- contains fixed doses of both estrogen & progestin throughout a 21-day cycle u Biphasic – preparation that deliver a constant amount of estrogen throughout the cycle but varying amounts of progestin u Triphasic and tetraphasic preparations – vary in both estrogen & progestin content throughout the cycle u Triphasic types more closely mimic a natural cycle, thereby reducing breakthrough bleeding (bleeding outside the normal menstrual flow). Combination Oral Contraceptives u COC’s must be prescribed by the health care provider after screening the eligibility u women over age 21 u Routine exam u Pap smear v Cause of failure is for the women who tend to forget to regularly take them. Oral Contraceptives Combination Oral Contraceptives Benefits of Oral Contraceptives are decreasing incidences of: 1. Dysmenorrhea, because of lack of ovulation 2. Premenstrual dysphoric syndrome& acne because of the increase in progesterone levels 3. Iron deficiency anemia because of the reduce amount of blood flow Benefits of Oral Contraceptives are decreasing incidences of: 4. Acute pelvic inflammatory disease (PID) & resulting tubal scarring 5. Endometrial & ovarian cancer, ovarian cysts & ectopic pregnancies 6. Fibrocystic breast disease 7. Colon cancer ü Lower concentration of LDL and increase HDL – estrogen interferes with lipid metabolism Oral contraceptives possibly decreases incidence of the following: uOsteoporosis uEndometriosis uUterine myomata (fibroid uterine tumors) uRheumatoid arthritis Ways to start a cycle pill u Sunday start u Quick start u First day start u After childbirth v Advice to use a second form of contraception during the initial 7 days of taking the pills Combination Oral Contraceptives Ø Menstrual flow – 7 days with placebo tablets Ø No menstrual flows – take the pill continuously without taking the placebo. Ø Extended use – taking 84 days § Menstrual flow every 3 months (4x/yr.) Combination Oral Contraceptives Ø Taking 365 days/ yr without placebo (low dose combination estrogen & progestin) § Ethinyl estradiol 20 mcg § Levonorgestryl 90 mcg ü Menstrual flow is completely eliminated for 1 year (pill- free interval) Ø To be taken consistently and conscientiously Ø Caution from easy reach of children Progestin-Only Pill (Mini Pill) u Containing only progestin u Must be taken conscientiously every day u Without estrogen, ovulation may occur but because the progestins have not allowed the endometrium to develop fully or sperm to freely access the cervix, fertilization and implantation will not take place Side effect and Contraindication of all OralNausea u Contraceptives: u Weight gain u Headache u Breast tenderness u Breakthrough bleeding (spotting outside the menstrual period) u Monilial vaginal infections u Mild hypertension u Depression § COC’s are not routinely prescribed for women with history of: § Thromboembolic disease § Family Hx of cerebral or cardiovascular accident § Migraine § Smoking (tendency toward clotting as an effect of increase estrogen) Symptoms of myocardial & thromboembolic complications to watch out: u Chest pain (pulmonary embolus or myocardial infarction) u Shortness of breath (pulmonary embolus) u Severe headache (CVA) u Severe leg pain (thrombophlebitis) u Blurred vision (hypertension, CVA) Women with the following cases should avoid the use of COC’s: § DM, Hx of liver disease, hepatitis – COC’s can interfere with glucose metabolism § Migraine with an aura; those who are taking drugs for seizures- increase risk for CVA § Oral contraceptives do not increase risk of breast cancer § Decreases the incidence of ovarian & uterine cancer § COC’s increases or strengthens the action of some drugs: § Caffeine § Corticosteroids uCOC’s drug interaction: uAcetaminophen uAnticoagulants uSome anticonvulsants Ø Reduces their therapeutic effects Ø Women should be advised to temporarily change their method of birth control while prescribed by these drugs. § Drugs that decreases the effectiveness of COC’s: § Barbiturates § Griseofulvin § Isoniazid § Penicillin § Tetracycline Ø Woman should change temporarily her method of contraception while taking these drugs u Assessment - woman’s ability to pay COC & ability to follow instructions faithfully u Should return for a yearly follow up visit for: u Pelvic examination u Pap smear u Breast examination u Without risk factors, woman may continue to take low-dose OC’s until they reach menopause Progestin-only Pill Progestin-only pill § Disadvantage of causing more breakthrough bleeding than combination pills § Do not pose a danger of thromboembolism § Should be taken every day even through the menstrual flow. § Maybe taken during breastfeeding – do not interfere with milk production u Effect on Sexual Enjoyment. For the most part, not having to worry about pregnancy because the contraceptive being used is so reliable makes sexual relations more enjoyable for couples. Some women appear to lose interest in coitus after taking the pill for about 18 months, possibly because of the long-term effect of altered hormones in their body. Sexual interest increases again after they change to another form of contraception. u Effect on Pregnancy. If a woman taking an estrogen/progestin combination COC suspects that she is pregnant, she should discontinue taking any more pills if she intends to continue the pregnancy. High levels of estrogen or progesterone might be teratogenic to a growing fetus, although the actual risk is thought to be no higher than normally occurs u Use by the Adolescent. It is usually recommended that adolescent girls have well-established menstrual cycles for at least 2 years before beginning COCs. This reduces the chance that the estrogen content will cause permanent suppression of pituitary-regulating activity. Estrogen has the side effect of causing the epiphyses of long bones to close and growth to halt; therefore, waiting at least 2 years also ensures that the preadolescent growth spurt will not be halted. COCs have side benefits of improving facial acne in some girls because of the increased estrogen/androgen ratio created and of decreasing dysmenorrhea. These effects are appealing to adolescents so increase the COC compliance rate. The pill may be prescribed to some adolescents specifically to decrease dysmenorrhea, especially if endometriosis is present u Use by the Perimenopausal Woman. As women near menopause, they are likely over age 35 so are less likely to be candidates for COCs than when they were younger. Help women in this age group to find an alternative method that will meet their personal preferences as well as still be maximally effective for them. u Use by the Postpartal Woman. It is not recommended that women who are lactating take estrogen-based contraceptives as a small amount of the hormone will be excreted in breastmilk. Women are, therefore, usually prescribed “mini-pills” or OCs that contain only progestin until they are no longer breastfeeding. u Discontinuing Use. After women stop taking COCs, they may not be able to become pregnant for 1 or 2 months, and possibly 6 to 8 months, because the pituitary gland requires a recovery period to begin cyclic gonadotropin stimulation again. If ovulation does not return spontaneously after this time, it can be stimulated by clomiphene citrate (Clomid)therapy to restore fertility. ESTROGEN/PROGESTERONE TRANSDERMAL PATCH u Patches that slowly but continuously release a combination of estrogen & progesterone u Applied each week for three weeks u No patch is applied on fourth wk – menstrual flow u Less effective in women who are obese u Also have a risk of thromboembolic symptoms ESTROGEN/PROGESTERONE TRANSDERMAL PATCH Estrogen/Progesterone Transdermal Patch u Patches may be applied to one of four areas: u Upper outer arm u Upper torso (front or back, excluding the breast u Abdomen or buttocks u Should not be placed on areas where make up, lotion or cream will be applied u Wrist were bending might loosen the patch u Anywhere the skin is red, irritated or has an open lesions u Patch can be worn while bathing or swimming u If becomes loosen, remove and replace at once with a new one for less than 24 hours. u If not sure of when it becomes loosen, replace and start a new 4- week cycle but she needs to use a backup contraception method. u Can cause mild discomfort & irritation at the application site VAGINAL ESTROGEN/ PROGESTIN RINGS (Nuva Ring) u An etonogestrel/ethinyl estradiolvaginal ring (Nuva Ring) – a flexible silicon vaginal ring u When placed in the vagina continually releases a combination of estrogen & progesterone u Inserted for 3 weeks and removed for 1 week for menstrual bleeding to occur VAGINAL ESTROGEN/ PROGESTIN RINGS (Nuva Ring) u The hormones released are absorbed directly by mucous membrane of the vagina u Advantage for women with liver disease – avoiding a “first pass” through the liver u Do not need to be removed for intercourse u Need to mark a calendar to remind the woman when to remove and replace the ring u May cause vaginal discomfort or infection u If taken out for more than 4 hours – should be replaced with a new ring and backup method for 7 days SUBDERMAL HORMONE IMPLANTS uA progestin-filled miniature rod no bigger than a matchstick etonogestryl implant (Nexplanon) u Can be imbedded just under the skin on the side of the upper arm, stimulating a small vein u Slowly release progestin over a period of 3 years. u Suppresses ovulation, thicken cervical mucus & change the endometrium lining SUBDERMAL HORMONE IMPLANTS Time of Insertion uDuring menses or no later than day 7 of menstrual cycle u6 weeks after the birth of the baby uImmediately after elective termination of pregnancy Side Effects of Implant uWeight gain uIrregular menstrual cycle uDepression uScarring at the insertion site uNeed for removal Contraindication of Implants u Desireto be pregnant within one year u Undiagnosed uterine bleeding Complication: u Infection at the site Intramuscular Injections u Medroxyprogestrerone acetate u DMPA (Depo-Provera) u A progesterone given every 12 weeks u Inhibits ovulation u Alters the endometrium u Thickens the cervical mucus Intrauterine Device uIUD’s can either hormonal or non- hormonal uA small plastic device that is inserted into the uterus through the vagina Side Effects and Contraindications u A woman may notice some spotting or uterine cramping the first 2 or 3 weeks after IUD insertion; as long as this is present, she should use an additional form of contraception, such as vaginal foam. Theoretically, a woman with an IUD in place has a higher-than-usual risk for pelvic inflammatory disease (PID), although this does not bear out in practice. u Some women have a heavier than usual menstrual flow for 2 or 3can cause a heavier than usual menstrual flow, women with anemia are also not usually considered to be good candidates for IUD use. Effect on Pregnancy u If a woman with an IUD in place suspects that she is pregnant, she should alert her primary health care provider.Although the IUD may be left in place during the pregnancy, it is usually removed vaginally to prevent the possibility of infection or spontaneous miscarriage during the pregnancy. The woman should receive an early ultrasound to document placement of the IUD. This can also rule out ectopic pregnancy, which has an increased incidence among IUD users who become pregnant with the IUD in place. u Use by the Adolescent. IUDs are rarely prescribed for adolescents, because teens tend to have variable sexual partners and no prior pregnancies, both contraindications to IUD use. u Use by the Perimenopausal Woman. Women who are premenopausal are, overall, good candidates for IUDs unless they have a history of any of the specific contraindications to their use such as multiple sexual partners or a history of pelvic inflammatory disease. u Use by the Postpartal Woman. Although postpartum insertion is usually done at a 6-week postpartal checkup, it can be done immediately after childbirth. An IUD inserted soon after childbirth does not affect uterine involution or its return to a pre pregnancy uterine size Surgical Methods of Reproductive Life Planning uVasectomy uTubal Ligation Vasectomy Tubal Ligation