Transcript DISEASE OF THE OVARY AND FALLOPAIN TUBE

Family Planning
DI WEN
M.D., Ph.D.
Professor & Chairman
Department Of Obstetrics & Gynecology
Renji Hospital Affiliated to SJTU School of Medicine
Birth Control,
Pregnancy,
and Childbirth:
Managing Your
Fertility
Methods of Fertility Management
Hormonal methods
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Oral contraceptives
Pills
Depo-Provera
Ortho-Evra
Nuva ring
Lunelle and Norplant
(currently off the market)
Methods of Fertility Management
Surgical methods of sterilization
– Female
– Tubal ligation
– Male
– Vasectomy
Methods of Fertility Management
Other methods of contraception
– IUDs
– Progestasert
– ParaGuard
– Withdrawal
– Emergency contraceptive pills
– Emergency minipills
– Abstinence and “Outercourse”
Contraceptive Variables
• Effectiveness
• Compliance and desire to avoid pregnancy
• Frequency of intercourse
• Patient’s age
• Cost of method
• Side effects
• Patient’s perceptions and misperceptions
• Patient’s concomitant drug use
• Patient’s health status and habits
Oral Contraceptives
Hormonal Methods
• Oral contraceptive:
– Combined oestrogen/progestogen
– Progestogen only
• Depot progestogen:
– Injections(Progestogen)
– Subcutaneous silicone implants
– Vaginal: Silicone rings releasing oestrogen
– and progestogen
Oral Contraception
• Prevents ovulation.
• FSH secretion is depressed
• LH peak is abolished.
• Urinary androgen
much increased.
excretion
is
• Changes in cervical mucus make
sperm penetration less likely.
OC Formulations & Mechanism of Action
• Formulations
– Monophasics
– Biphasics
– Triphasics
• Mechanism of action
– Suppress ovulation
– Alter cervical mucus and endometrium
OC Health Risks-breast Cancer
• No significant increased risk
among current or former users
• Small increased risk of breast
cancer diagnosis
• Link to earlier diagnosis of breast
cancer
OC Health Risks-cervical Cancer
• Numerous studies have linked OC
use and cervical neoplasia
• Findings are difficult to interpret
OC Health Risks
• Nonfatal venous thromboembolism
– Similar low risk of VTE associated with all lowdose OCs
• Myocardial infarction
– No increase in risk
– Further studies may prove OCs protective
• Stroke
– No increase in risk
OC Noncontraceptive Benefits
• Reduced risk of ovarian and endometrial
cancer
• Menstrual benefits
• Improvement in benign breast conditions
and ovarian cysts
• Improvement in acne
• Reduced incidence and severity of PID
• Protection against ectopic pregnancy
• Maintenance of bone density
OC Contraindications
• Thrombophlebitis or thromboembolic disorders
• Past history of DVT or thromboembolic disorders
• Cerebral vascular disease or coronary artery
disease
• Known or suspected carcinoma of the breast
• Carcinoma of the endometrium
• Undiagnosed abnormal genital bleeding
• Jaundice
• Hepatic adenomas or carcinomas
• Known or suspected pregnancy
• Smoker over age 35
OC Side Effects
• Nausea
• Breast tenderness
• Menstrual changes
• Weight gain
• Headache
Progestin-Only Pills
• Formulation:
– Contains norethindrone or nogestrel
– 28 days of active hormones
• Candidates:
– Women who cannot or will not take
estrogen
– Postpartum and lactating women
Long-Acting Contraceptives
Currently available:
– Injectable DMPA (Depo-Provera)
– Copper IUD (Paragard)
– Progestin IUD (Mirena)
DMPA Injections
DMPA Side Effects
• Menstrual changes
• Delayed return of fertility
• Alopecia
• Reduced libido
• Weight gain?
• Depression?
DMPA Health Risks & Benefits
• Loss of bone mineral density?
• Lowered HDL level
• Protection against endometrial
cancer, no impact on risk of other
types of cancer
• Reduces PMS symptoms, irondeficiency anemia, risks of PID,
ectopic pregnancy
Levonorgestrel Implants
Implant Side Effects,
Health Risks & Benefits
Side effects & risks
• Irregular bleeding
• Amenorrhea
• Headache
• Hair loss
• Weight gain
• Functional ovarian
cysts
Benefits
• Improvement of
dysmenorrhea
• Improvement of
PMS
Intra Uterine Devices
• Inert
• Copper bearing
• Progestogen releasing
IUDs
IUD Insertion Risks
• Risks:
– Perforation of the uterus (rare)
– Infection (antibiotic prophylaxis not
needed)
• Expulsion rates:
– Copper T (Paragard) = 6%
– Progesterone-releasing IUDs = 3~8%
IUD Insertion Side Effects
• Copper T: increased menstrual
bleeding and dysmenorrhea
• Mirena: irregular bleeding and
spotting before eventual
amenorrhea
IUD: Major Contraindications
• Multiple sexual partners
• Pregnancy
• Abnormalities of the uterus
• PID
• Postpartum endometritis or septic abortion
• Uterine or cervical malignancy
• Undiagnosed genital bleeding
• Vaginitis or cervicitis
• Increased susceptibility to infection
• Previously inserted IUD still in place
Complications of IUDS
• Increased menstrual loss.
• Infection
•
Pregnancy
•
Expulsion
•
Translocation
Barrier Contraceptives
• Condoms
– Male latex, polyurethane, animal
skin
– Female polyurethane
• Diaphragms
• Cervical cap
• Spermicides
Male Condoms
How to
Use a
Condom
Figure 6.1
The Female Condom
Brand Name: Reality
The Diaphragm
The Cervical Cap
Spermicides
Spermicides
• Creams
• Films
• Foams
• Jellies
• Pessaries
• Sponges
(All of these are mainly Nonoxynol
based.)
Natural Family Planning
• Also called periodic abstinence or
fertility awareness
• Calendar (“rhythm”) method
• Cervical mucus (ovulation or
billings) method
• Basal body temperature method
• Symptothermal method
Rhythm Method(“safe Period”)
• 24 hours are allowed for ovum
survival
• 3 days are allowed fro the sperms
• Coitus must be avoided from the
9th to the 15th day
The Fertility Cycle
Figure 6.4
Billings’ Method
Identify the peri-ovulatory
phase by noting the vaginal
sensations associated with
changes in cervical mucus.
Emergency Contraception
• High doses of combined OCs
• High doses of progestin-only pills
Emergency contraceptive pills prevent
pregnancy by inhibiting or delaying ovulation.
They may also alter the endometrium, making
it inhospitable to the implantation of ova.
They may alter sperm or ovum transport.
• IUD
The mechanism of action of the IUD as
emergency contraception remains undefined.
NEW METHODS: OrthoEvra “The Patch”
Surgical Methods
1.Laparoscopic sterilisation
Rings,Clips-Bipolar
diathermy,Laser
2.Tubal ligation
Artificial Abortion
Definition:
An abortion that is brought
about intentionally(family
planning et al.), Also called an
induced or therapeutic abortion
The termination of a
pregnancy befor the 24th week.
Abortion of Methods
Vacuum aspiration – 1st trimest
Dilation and Evacuation (D&E) –
2nd trimester
Dilation and Curettage (D&C) – 2nd
trimester4)
Amniocentesis
Figure 6.7
Abortion of Methods
Prostaglandin or induction abortions – 2nd
trimester
Hysterotomy – removal of the fetus
surgically
Intact dilation and extraction (D&X) – late
term abortion
Mifepristone (RU-486) – induces abortion by
blocking progesterone used with
Misoprostil (a prostaglandin)
Complications
*Incomplete uterine evacuation
*Uterine perforation and/or
damage to abdominal viscera.
*Sepsis.
*Haemorrhage.
*Rhesus isoimmunisation
Medical Termination
Mifepristone(RU 486) 600mg orally
+
Gemeprost (PG analogue ) 1mg vaginally
(36-48 hours later)
Side effect
• Approximately 8% of these
abortions require surgical
followup
• Abdominal pain:20% requiring
opiate analgesia
• Blood loss
Late complications
• Infertility
• Effect on future pregnancies
• Psychological sequelae
• Rhesus isoimmunisation
Thanks for Your Attention
DI WEN
M.D., Ph.D.
Professor & Chairman
Department of Obstetrics & Gynecology
Renji Hospital Affiliated to SJTU School of Medicine