Transcript Bez tytułu slajdu - UMS Student Government

Failure rates
Method
Chance
Withdrawal
Calendar
Symptothermal
Condom
Spermicides
Diaphragm
Cap
% women experiencing
an acciden. pregnancy/year
typical
85
19
20
18
14
26
20
20/40
perfect
85
4
9
2
3
6
6
9/20
Failure rates
Method
IUD (Copper T)
IUD (LNG)
Pill (E + P)
Pill (P only)
MPA inj
Norplant I & II
Sterilization
% women experiencing
an acciden. pregnancy/year
typical
0.8
0.1
2
5
0.5
0.05
0.15/0.4
perfect
0.6
0.1
0.1
0.5
0.3
0.05
0.1/0.4
Contraceptive use - USA
•
•
•
•
•
•
•
•
•
Female sterilization
OC
Male condom
Male sterilization
Withdrawal
Injectable (MPA)
Diaphragm
Implants
IUD
27%
26%
20%
10%
3%
3%
2%
2%
1%
Natural family planning
• identification of potentially fertile days +
periodic abstinence
• calendar - assumption:
–
–
–
–
ovulation on day 14 (± 2) of menstrual cycle
sperm viability 5 days
oocyte viability 24 hours
abstinence days 9-15 (7-17)
• failures even with regular cycles, does not
account for additional factors (stress,
illness, travel)
• does not work well for women with
irregular cycles, chronic cervicitis/vaginitis
Natural family planning
• BBT method: daily temperature readings;
temperature rise by 0.4 C/F after ovulation
• Cervical mucus (Billings) method:
observation of the cervical secretions:
fertile days - increase in secretions that are
clear , strechy and slippery
• Symptothermal method: combination of the
fertility indicators (cervical mucus, BBT
and/or calendar)
Home ovulation detection kits (urinary LH)
Lactational amenorrhoea
method
• Baby less than 6 months
• Amenorrhoea since lochia ceased
• Fully or nearly fully breastfeeding
2% chance of pregnancy
Barrier methods
• Male condom (latex, polyurethane)
• Female condom (polyurethane Reality)
• Diaphragm (6h/6h, not longer than 24h
TSS, UTI)
• Cervical cap (up to 48h, spermicide
necessary, Prentif cap)
• Spermicides (films, gels, foams,
suppositories; nonoxynol-9 2-12%surfactant that destroys cell membrane;
protective against STI)
IUD
• With copper (Copper T380):
– sterile, inflammatory, hostile endometrial
environment
– inhibits sperm migration
– inhibits fertilization and oocyte transport
• With LNG (Mirena): as above PLUS
– thickens cervical mucus
– augments atrophic decidualization of
endometrium
– ? may inhibit ovulation
IUD
• Appropriate selection
• Contraindications:
– acute PID / history of PID
– genital bleeding of unknown etiology
– known/suspected uterine or cervical
malignancy
– decreased immunoresistance (leukemia,
AIDS)
– allergy to copper
– distortion of the uterine cavity
– multiple sex partners
IUD
• NOT an abortifacient
• DOES NOT increase the risk of ectopic
(actually decreases the risk)
• DOES NOT increase the risk of PID
• DOES NOT increase the risk of
subsequent infertility
• DOES NOT increase the risk of cervical
and uterine cancer
DMPA injections
• IM injection every 3 months (150mg
of DMPA)
• blocks LH surge and prevents
ovulation
• side-effects: menstrual changes
(irregular bleeding , amenorrhoea)
Subdermal implants
• Norplant I : 5 year LNG implant
system (six tubes; 85ug of LNG daily,
by year 5 30ug)
• Norplant II (Jadelle) : 3 year 2 rod
system
• Implanon : (single implant with 3keto-desogestrel, 3 year)
• side-effects + difficulties with
removal
Combined oral contraceptives COC
• 20-50 ug of EE
• progestin:
– desogestrel, norgestimate, gestodene
– LNG, Norethisterone (NET, NETA)
• monophasic : constant dose of E and P
• biphasic and triphasic : mainly variation
of P dose (also E dose possible)
• used by 30-40% of reproductive age
women in Western Europe
Combined oral contraceptives COC
• prevent ovulation by suppression of
pituitary LH/FSH secretion
• additional P effects:
– changes in the cervical mucus hindering
sperm transport
– changes in the endometrium: prevention of
implantation
– decreased tubal motility : delayed oocyte
transport
COC - health benefits
•
•
•
•
•
•
•
Ovarian cancer: risk reduction by 40-80%
Endometrial cancer: risk reduction by 50%
Benign breast conditions ( risk)
PID ( risk)
Ectopic pregnancies ( risk)
Functional ovarian cysts ( risk)
Menstrual effects: improvement in
regularity + anemia + dysmenorrhea
• Bone density
• Acne
COC - health risks
• Breast cancer: small or no increase
• Cervical neoplasia: increase in cervical
adenocarcinoma, does not increase the
risk of invasive cervical cancer
• VTE: 2-3 fold increased risk (0.4 to 1.0 per
10.000 women, but in pregnancy 6 per
10.000)
• MI: no increase in the risk (only for the
smokers > 35 years)
• stroke: no increase in the risk with low
dose COC in nonsmoking women
COC - contraindications
• Appropriate selection
• Contraindications:
– thromboembolic disorder (active or past)
– coronary artery/ cerebral vascular disease
– carcinoma of the breast
– carcinoma of the endometrium or other
estrogen-dependent neoplasia
– active hepatic disease
– pregnancy
– smoking after 35 years of age
COC - side effects
•
•
•
•
•
•
nausea
bloating
menstrual changes
breast tenderness
?? headache
?? weight gain
Progestin only pills (POP)
• Indications - can not tolerate E or
contraindications:
– breastfeeding women
– postpartum women
– older women with CVD
– women at increased risk for VTE
• NET or LNG
• no delay (even hours not allowed) in
administration
Emergency contraception
• Immediate IUD
• Yuzpe method: 72h, efficacy max. 24h; 2
pills 250ug LNG + 50ug EE (Ovran)
followed by further two tablets 12 hours
later
• LNG alone (POEC): 750ug LNG stat and
750ug LNG 12h later; 72h, efficacy max.
24h; more effective than Yuzpe, fewer
side effects (nausea+vomiting)