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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 & carbohydrate 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[ 2006;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 2006
DMPA: Injection
NET TERMINATION RATES PER 100 WOMEN IN WHO COMPARATIVE STUDY OF DMPA
Net Cumulative Event Rates |
Reason | 1-Year | 2-Year |
Pregnancy | 0,1 | 0,4 |
Amenorrhea | 11,9 | 24,2 |
Bleeding | 15.0 | 18.8 |
Medical | 11.8 | 15.0 |
Personal | 20,7 | 38,8 |
Total | 51,5 | 73,5 |
IN CONCLUSION
DMPA has
· Minimal metabolic impact -- Mild glucose impairment -- No coagulation changes
-- Decreased HDL-cholesterol |
IUD: ADVANTAGES
MISCONCEPTIONS SURROUNDING THE IUD