Family planning

Family Planning-Part 2

By: Ismah Haron

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Injections

Implant

Patch IUD

Surgical

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INJECTIONS

Progestin only

DMPA NET-EN

Monthly

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Progestin only injectable

• Mechanism: preventing ovulation

• Efficacy: 3 per 100 women

• Benefits:- Don’t require daily action- Cause no monthly bleeding- Can be used throughout breastfeeding- Help protect against endometrial ca, uterine fibroids, IDA- May help to gain weight

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• Method: - IM - Repeat in 3 months (DMPA) and 2 months (NET-EN)

• Side effects:- Bleeding changes- Headaches- Dizziness- Increased blood pressure- Mood changes- Loss of bone density

• Return of fertility: DMPA 4 months longer, NET-EN 1 month longer

Picture from: Family Planning; A Global Handbook For Providers WHO 2011 Update

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• Contraindications:- Serious active liver disease- High blood pressure (≥160/100 mmHg)- Diabetes more than 20 years or with complications

(arteries, vision, kidneys, nervous system)- Stroke, DVT, heart attack- Breast ca- Migraine aura

• Can come 2 weeks early for injections • DMPA: can come up to 4 weeks late• NET-EN: can come up to 2 weeks late

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Monthly injectable

• Contains progestin + estrogen



• Benefits:- Don’t require daily action- Cause no monthly bleeding- May help to gain weight

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• Method: - IM - Repeat every 4 weeks

• Side effects:- Bleeding changes- Headaches- Dizziness- Increase blood pressure- Breast tenderness

• Return of fertility: about 1 month longer


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• Contraindications:- Serious active liver disease- High blood pressure (≥140/90 mmHg)- Diabetes more than 20 years or with complications (arteries,

vision, kidneys, nervous system)- Stroke, DVT, heart attack- Breast ca- Migraine aura- Fully breastfeeding- ≥ 35 years old and smokes >15 cigarettes/day- Taking lamotrigine/ritonavir

• Can come 7 days early or late for injections

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Combined patch

• Contains progestin + estrogen


• Method: - Worn on body every day and night- Can be worn on arm, back, abdomen or buttock- New patch every week for 3 weeks followed by a

week with no patch

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• Side effects:- Bleeding changes- Headaches- Dizziness- Skin irritation- URTI

• Return of fertility: immediately

• Can apply it up to 48 hours late

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Implants • Small plastic rods/capsule that contains progestin

• Mechanism:- Thickening cervical mucus- Preventing ovulation

• Efficacy: 5 per 10 000 women

• Benefits:- Don’t require daily action- Can be used during breastfeeding- Cause no monthly bleeding- Protect against PID, IDA

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TYPES OF IMPLANTS

Implanon – 3 years

Jadelle – 5 years

Norplant – 7 years

The effectiveness will be lose

earlier in heavier women

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• Method: - Minor surgical procedure- Placed under the skin


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• Side effects:- Bleeding changes- Headaches- Dizziness- Weight gain- Breast tenderness- Abdominal pain- Can either improve/worsen acne- Infections at site of implant- Expulsion of the implant- Enlarged ovarian follicles


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• Contraindications:- Serious active liver disease- DVT- Breast ca


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IUDCopper bearing

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Copper-bearing IUD

• Mechanism: causing chemical change damage sperm

• Efficacy: 6 to 8 per 1000 women

• Benefits:- Don’t require daily action- Can be used throughout breastfeeding- Help protect against endometrial ca- Long lasting

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• Method: - Effective up to 12 years- Determine the uterus size and anatomical position

• Side effects:- Bleeding changes- More cramps and pain during monthly bleeding - Perforation of the IUD

• Return of fertility: immediately Picture from: Family Planning; A Global Handbook For Providers WHO 2011 Update

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• Contraindications:- Gynecological/obstetric problems e.g.

cervical ca- AIDS- STD- Pregnant - Anatomical abnormality of uterine cavity

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Levonorgestrel IUD

• Contains progestin

• Mechanism: suppress endometrium growth


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• Benefits:- Don’t require daily action- No monthly bleeding- Can be used throughout breastfeeding- Protect against IDA, PID- Reduces menstrual cramps

• Method: - Effective up to 5 years- Determine the uterus size and

anatomical position Picture from: Family Planning; A Global Handbook For Providers WHO 2011 Update

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• Side effects:- Bleeding changes- Acne- Headaches- Breast tenderness- Ovarian cyst- Perforation


• Contraindications:

- DVT, severe liver disease, breast ca

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STERILIZATION

Male

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Vasectomy

• Mechanism: closing off vas deferens


• Benefits:- Permanent- Fewer side effects and complications

Picture from: Decision-making tool for family planning clients and providers WHO 2005

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• Complication (rare):- Severe scrotal/testicular pain- Infections at the incision sit

• 3 months delay in taking effect

• Return of fertility: None

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Caution, delay & special arrangement for vasectomy

CAUTION DELAY SPECIAL ARRANGEMEN

TPrevious scrotal injury

Active STD Hernia in groin

Large varicocele/hydrocele

Both sides undescended testicle

One side undescended testicle

AIDS

Diabetes, depression Coagulations disorder

Young age

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Female sterilization

• Mechanism: blocked fallopian tubes


• Benefits:- No side effects- Easy to use- Protect against PID, ovarian ca

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• Method: - Tubal ligation- Minilaparotomy or laparoscopy

• Return of fertility: none

Picture from: Decision-making tool for family planning clients and providers WHO 2005

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Caution, delay & special arrangement for female sterilization

CAUTION DELAY SPECIAL ARRANGEMEN

TBreast ca Currently pregnant AIDS

Uterine fibroids PID Endometriosis

Previous abdominal/pelvic surgery

STD Abdominal wall/ umbilical hernia

Controlled hypertension

DVT ≥ 160/100 mmHg

Kidney disease Severe IDA (Hb <7 g/dL)

Hyperthyroidism

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Comparing methods

Source: Decision-making tool for family planning clients and providers WHO 2005

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THANK YOU

References:

1. Family Planning; A Global Handbook For Providers WHO 2011 Update

2. Medical Eligibility Criteria For Contraceptive Use 4th Edition WHO 2009

3. Selected Practice Recommendation For Contraceptive Use WHO 2008 Update

4. Decision-making Tool For Family Planning Clients And Providers WHO 2005

Family planning

Health & Medicine

Transcript of Family planning