Hormonal Contraception : Female Family Planning

8/3/2019 Hormonal Contraception : Female Family Planning

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FEMALE FAMILYFEMALE FAMILY

PLANNINGPLANNING

Dr. A A N. Anantasika SpOG(K)Dr. A A N. Anantasika SpOG(K)


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TO BE PREGNANTTO BE PREGNANT


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GOOD RELATION


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CONTRACEPTIONCONTRACEPTION

Tubal ligationTubal ligation

HormonalHormonal

IUCDIUCD AbstinenceAbstinence


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- SAFE

- CASE


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PREGNANT

??


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FAMILY PLANNING VICTIM


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Hormonal contraceptionHormonal contraception

EstrogenEstrogen

ProgestinProgestin

LevonogestrelLevonogestrelNoretindronNoretindron

NorgestrelNorgestrel

MPAMPA

Pills, InjectablePills, Injectable


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MECHANISM OF ACTION :MECHANISM OF ACTION :


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MECHANISM OFMECHANISM OFACTION:ACTION:

--PREVENTPREVENTOVULATIONOVULATION

-- IMPEDEIMPEDEIMPLANTATIONIMPLANTATION

-- THICKENINGTHICKENING

CERVICAL MUCOUSCERVICAL MUCOUS

-- TUBAL MOVEMENTTUBAL MOVEMENT


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cervix

UTERUS

Fallopian tube

OVARIUM

VAGINA MECH. ACTION


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CONTRAINDICATION :CONTRAINDICATION :

-- PregnancyPregnancy

-- Breast feeding< 6 mos (E)Breast feeding< 6 mos (E)

-- Vaginal bleedingVaginal bleeding

-- HepatitisHepatitis

-- Smokers > 35 yr( E )Smokers > 35 yr( E )-- Cardiovaskular ds, BP > 180/110mmHgCardiovaskular ds, BP > 180/110mmHg

-- Impaired hemostasis factor/ DM > 20yrImpaired hemostasis factor/ DM > 20yr

-- Breast carcinomaBreast carcinoma-- Migraine /epileptiMigraine /epilepti

-- Can not take pill everydayCan not take pill everyday


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LATE NIGHTTEALATE NIGHTTEA

CONTRACEPTIONCONTRACEPTION


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CombCombination Pillination Pill


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EfectiveEfective reversiblereversible-- 11 (1 year) (1 year)

LimitationLimitation-- ExpensiveExpensive -- boringboring-- NauseaNausea-- Intermenstrual spottingIntermenstrual spotting

-- DizzinessDizziness-- Breast discomfortBreast discomfort-- BW BW

-- Amenorrhea (rare)Amenorrhea (rare)

-- Mood swingMood swing-- Blood pressure, waterretentionBlood pressure, waterretention

-- Cant prevent STDs,HBV,HIV/AIDSCant prevent STDs,HBV,HIV/AIDS


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STARTING :STARTING :

-- Day IDay I VII of the cycleVII of the cycle

-- D8 + contraception ( 8D8 + contraception ( 8 14ds )14ds )

-- After deliveryAfter delivery

* After 6 mos ( eksclusive breast feeding)* After 6 mos ( eksclusive breast feeding)

* After 3wks, in no lactation* After 3wks, in no lactation

* Post Abortion.* Post Abortion.

-- InjectableInjectable Pill , on the injection schedulePill , on the injection schedule


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INSTRUCTIONINSTRUCTION

-- Take pill everydayTake pill everyday

-- 1 week free pill ( 21 pill), continuous1 week free pill ( 21 pill), continuous( 28 pil )( 28 pil )

-- Forgetting 1 pilForgetting 1 pil take asa remembertake asa remember

+take the next pill as usuall.+take the next pill as usuall.

-- Forgetting >Forgetting > 2 pil2 pil take 2 pil/day +take 2 pil/day +other contraceptionother contraception

-- Special condition :Special condition :

vomitingvomiting

DiarhheaDiarhhea


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Special PrecautionSpecial Precaution

BPBP > 160/90> 160/90 --

DMDM Without KXWithout KX ++

MigraineMigraine Without neuroWithout neurologic defectlogic defect ++

Phenitoin ,Phenitoin ,barbiturate,barbiturate,

RifampisinRifampisin

EE 50 mcgEE 50 mcg

Sickle CellSickle CellAnemiaAnemia

--


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COMBINATION INJECTABLESCOMBINATION INJECTABLES

-- 25 mg depot MPA25 mg depot MPA

5 mg estradiol sipionate5 mg estradiol sipionate

-- 50 mg norethindrone50 mg norethindroneenantateenantate

5 mg estradiol valerate5 mg estradiol valerate


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SUNTIKAN KOMBINASISUNTIKAN KOMBINASI

-- 25 mg depot MPA25 mg depot MPA

5 mg estradiol sipionate5 mg estradiol sipionate

-- 50 mg norethindrone enantate50 mg norethindrone enantate

5 mg estradiol valerate5 mg estradiol valerate

-- I.M deep, every 4 weeksI.M deep, every 4 weeks

++ 7 days7 days

-- EfectiveEfective

0,10,1 0,4 /100 woman year0,4 /100 woman year


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STARTINGSTARTING

-- D1D1--D7D7

-- > D7> D7 abstinence/ condom 7daysabstinence/ condom 7days

-- AmenorheaAmenorhea

-- Post partumPost partum

* Lactating > 6 bln* Lactating > 6 bln* lactating (* lactating (--) : 3wks) : 3wks

-- Post abortionPost abortion ~menstruation~menstruation

-- Hormonal contracectionHormonal contracection comb.injcomb.inj-- Post IUCD ~menstruationPost IUCD ~menstruation


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PrecautionPrecaution

BPBP < 180/110< 180/110 +!+!

DMDM Without KX < 20Without KX < 20

yearsyears

+!+!

MigraineMigraine WithoutWithoutneurologic defectneurologic defect

++

TB

prep/TB

prep/EpileptiEpilepti--

Sickle cellSickle cellanemiaanemia

--


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Screening :Screening :

-- BP> 140/ 90, diastolic > 110BP> 140/ 90, diastolic > 110

-- Pulse > 100x/mntPulse > 100x/mnt

-- Pale , sianoticPale , sianotic

-- Difficult to breathDifficult to breath

-- IcterusIcterus-- HepatomegaliHepatomegali

-- Varices, leg painVarices, leg pain

--

Oedem extremityOedem extremity-- Breast massBreast mass

-- PregnancyPregnancy


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Progestin InjectableProgestin Injectable

-- Depot Medroksi Progesteron AsetateDepot Medroksi Progesteron Asetate( 150mg)( 150mg)

-- Depo Norethisterone Enantate ( 250 mg)Depo Norethisterone Enantate ( 250 mg)

Injeksi Norethisterone enantateInjeksi Norethisterone enantate11 II------88--------II 22 II------88------II 33 II------88------II 44 II1212II 55

Injeksi Depot MPAInjeksi Depot MPA11 II1212II 22 II1212II 33 I.I.


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EfectiveEfective

-- 0,3/100/year0,3/100/year

ContraindicationContraindication

-- PregnancyPregnancy(defect cong.7 / 100.000 )(defect cong.7 / 100.000 )

-- Vaginal bleeding E ?Vaginal bleeding E ?

-- Cant tolerate menstrualCant tolerate menstrualdisorderdisorder

-- Breast carcinomaBreast carcinoma

-- DM with complicationDM with complication


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Get startedGet started

-- D1D1--D7 ( > D7 + abstinence)D7 ( > D7 + abstinence)

-- AmenorheaAmenorhea any time+ abstinence /any time+ abstinence /condom 7daycondom 7day

-- InjectableInjectable

* Hormonal* Hormonal progestinprogestin*on the schedule*on the schedule

-- DMPA @ 90dayDMPA @ 90day

-- NoristerateNoristerate until 4until 4thth

inj @ 8wks,inj @ 8wks,followed by inj @ 12wksfollowed by inj @ 12wks


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Instruction:Instruction:

-- Amenorhea :Amenorhea : --

-- Spotting :Spotting : --/ combination pill/ combination pill

-- BW

BW :

Diet :

Diet


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Progestin Pill/ Mini pillProgestin Pill/ Mini pill

-- 35 pill of 300 mcg Levonogestrel or35 pill of 300 mcg Levonogestrel or350 mcg Norethindrone350 mcg Norethindrone

-- 28 pill of 75 mcg Norgestrel28 pill of 75 mcg Norgestrel


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EfectivityEfectivity

-- 98,5 %98,5 % missed pill (missed pill (--))

-- same timesame time

-- Safe after 3Safe after 3 20hrs20hrs

Contraindications :Contraindications :-- PregnancyPregnancy

-- Cant accept menstr disturbanceCant accept menstr disturbance

-- ForgetForget-- uterine leiomyomauterine leiomyoma


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Getting startedGetting started

-- D1D1--D5D5

-- > D5> D5 2 ds abstinence2 ds abstinence


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T H A N K Y O UT H A N K Y O U


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LEARNING TASKLEARNING TASK

Woman, 20 yr, P2, the 2Woman, 20 yr, P2, the 2ndnd child of 2child of 2month of age, exclusive breastfeeding.month of age, exclusive breastfeeding.Healthy husband, 25 years old, javaHealthy husband, 25 years old, java--BaliBali

truck driver.truck driver. Disscus about :Disscus about :

-- The time to use contraception.The time to use contraception.

--The contraception that chosen .The contraception that chosen .

-- The appropriate contraception thatThe appropriate contraception that

chosen if she want to have regularchosen if she want to have regular

period.period.


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RollingChairRollingChair

ContraceptionContraception


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ROK

MINI


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Hormonal Contraception : Female Family Planning

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