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CONTRACEPTION FOR WOMEN WITH MEDICAL DISEASES

I.    Types of effective reversible contraceptives

A.    Oral Contraceptive

  1. Estrogen

          a. clotting factors

b. venous thrombosis

c. MI in smokers only

d. improve lipid panel

2. Progestin

a. adverse effects on lipids

b. peripheral insulin resistance

c. possible effect on VTE

B. Progestin implants

1.5 year failure rate 1%

2.Menstrual irregularities

3.Little changes in lipids or coronary heart disease

4.Rapidly reversible

C. Progestin injections

1.2 year failure rate 0.2%

2.Irregular bleeding, then amenorrhea

3.Long acting. Reversible

4.Minimal lipid & CHO effects

5. Endometrial cancer

D. Copper 380 T IUD

1.7 yr failure rate 1.6%

2.Low rate ectopic pregnancy

3.Acts as spermicide

4.Does not cause salpingitis

II. Coagulation Disorders

A.OCs contraindicated with familial coagulopathies

B.OCs indicated if anticoagulated

C.Screening only with family history

III. Dyslipidemias

A.OCs better than progestin only

B.IUD not contraindicated

IV. Hypertension

A.OCs can be tried

B.Progestins or IUDs better

V.Mitral Valve Prolapse

A. OCs can be used if asymptomatic

VI.Diabetes

A.all methods can be used unless vascular disease present

B.Best to use norethindrone OC

VII. Endocrinopathies

A.Thyroid disease - no restrictions

B.Prolactinemia ~ OCs can be used unless macroadenomas

C.PCOS - OCs best

VIII. Migraine Headach

A.OCs can be used unless classic

B.Injections contraindicated

IX. Epilepsy

A.Progestin best

B.Estrogen levels altered by antiepileptic drugs

CONTRACEPTION FOR THE HIGH-RISK PATIENT

 

WOMEN AT RISK OF UNINTENDED PREGNANCY

US Women aged 15-45 (57.9 million, 1988)

Relative Risk of MI in Women <45 Years of Age: 1985-1988

95%

Relative Confidence
Risk Interval
Current OC users 1.1 0.4-3.1
Smoking*/OC users 30.0 4.9-182
Smoking*/OC nonusers 8.7 5.2-15

ADJUSTED ODDS RATIOS (OR) FOR MI ACCORDING

TO USE OF LOW-DOSE OCs 1991-1993

Variable OR (95% Confidence Interval
Current use vs  
past use and no use  
  No use 1.00 (Ref)
  Current use 1/14 (0.28-4.72)
  Past use 0.60 (0.25-1.44)
  Current use vs
  non current use
  Past and no use 1.00 (ref)
  Current use 1.67 (0.48-S.8S)

Adapted from Sidney et al. Obstet Gyneco[ 2002;88:939

INCIDENCE OF MOST FREQUENT NON-MENSTRUAL MEDICAL CONDITIONS IN NORPLANT USERS Incidence

  Condition per 100 women/yr % Removal
  Leukorrhea 10.1 0.0
Headache 9.7 1.8
Vaginal Moniliasis 8.6 0.0
Pelvic Pain 9.3 0.8
Acne 9.6 0.8
Weight Increase 8.1 3.5
  Mood Change 4.0 2.0

Sivln I, summitted to Ob/Gyn 2002

DMPA: Injection