WHO MEC: Special situations
WHO MEC: Special situations
MAR-2011-AP-(IN)-3627-SS 30-Aug-2012 MAR-2011-AP-(IN)-3627-SS 30-Aug-2012
Efficacy of methods
Medical eligibility criteria for contraceptive use. (ed 4). A WHO Family planning cornerstone. 2009
Percentage of women experiencing an unintended pregnancy during the first year of typical use and the first year of perfect use of contraception and the percentage continuing use at the end of the first year. United States of America.Percentage of women experiencing an unintended pregnancy during the first year of typical use and the first year of perfect use of contraception and the percentage continuing use at the end of the first year. United States of America.
Contraceptive revolution – reversible methods
WHO medical eligibility criteriafor contraceptive use: classification
Condition: Category
For which there is no restriction on use of the method 1
Where the advantages generally outweigh the theoretical or proven risks
2
Where the theoretical or proven risks usually outweigh the advantages of using the method
3
Represents an unacceptable health risk of the contraceptive method if used
4
Medical eligibility criteria for contraceptive use. (ed 4). A WHO Family planning cornerstone. 2009
WHO medical eligibility criteriafor contraceptive use: classification
Category With clinical judgement With limited clinical
judgement
1 use method in any circumstances Yes
(use the method)2 generally use the method
3 use of method not usually recommended unless other more
appropriate methods are not available or not acceptable
No
(do not use the method)
4 method not to be used
Medical eligibility criteria for contraceptive use. (ed 4). A WHO Family planning cornerstone. 2009
Contraceptive Methods Available in India.Contraceptive Methods Available in India.Abbreviations mentioned in WHO MECAbbreviations mentioned in WHO MECContraceptive Methods Available in India.Contraceptive Methods Available in India.Abbreviations mentioned in WHO MECAbbreviations mentioned in WHO MEC
Low-dose combined oral contraceptives: COCs
Progestogen-only Pills: POPs
Intrauterine devices IUDs
Depot medroxyprogesterone acetate : DMPANorethisterone enantate : NET-NE
Copper-bearing IUD: Cu-IUDs
Levonorgestrel-releasing IUD (20 g/24hours): LNG-IUD
Combined contraceptive Vaginal Ring: R
Implant IMP
Medical eligibility criteria for contraceptive use. (ed 4). A WHO Family planning cornerstone. 2009
Case 1
A 18 year old unmarried woman, seeking contraception advice
She also c/o; constant pelvic pain worsening during menses
Medical History: None
Family History: No reports of bleeding disorder Obstetrical History: G0P0A0
Investigations: USG-NAD
WHO Guidelines
Condition Category
COC
Dysmenorrhea 1
Evidence: There was no increased risk of side-effects with COC use among women with dysmenorrhoea compared with women notusing COCs. Some COC users had a reduction in pain and bleeding1
1. Medical eligibility criteria for contraceptive use. (ed 4). A WHO Family planning cornerstone. 2009
Case-2
A 24 year old married woman, seeking contraception advice
She also C/O: constant pelvic pain worsening during menses
Medical History: None
Family History: No reports of bleeding disorder
Obstetrical History: G0P0A0
Investigations: USG- free fluid in the cul-de-sac
WHO Guidelines
Condition Category
COC
Endometriosis 1Evidence: A Cochrane Collaboration Review identified one randomized controlled trial evaluating the effectiveness of COC use compared with a GnRH analogue in treating the symptoms of endometriosis. Women with endometriosis did not report worsening of the condition or any adverse events related to COC use1.
1. Medical eligibility criteria for contraceptive use. (ed 4). A WHO Family planning cornerstone. 2009 2. Vercellini P, Trespidi L, Colombo A, Vendola N, Marchini M, Crosignani PG. A gonadotrophin-releasing hormone agonist versus a low-dose oral contraceptive for
pelvic pain associated with endometriosis. Fertility and Sterility 1993;60(1):75–9.
Case 3
A 35 year old female patient seeking advice on contraception
C/O: heavy menses
Family history: Mother underwent surgery for hysterectomy at the age of 45 due to uterine fibroids
Obs/Gyn History: G1P1A0
Investigations: USG- 4 heterogeneous structures, in the muscular layer without distortion of uterine cavity suggestive of leiomayomata.
WHO Guidelines
Condition Category
COC
Uterine Fibroids(With or without distortion of uterine cavity)
1
Comments: COCs do not appear to cause growth of uterine fibroids
Medical eligibility criteria for contraceptive use. (ed 4). A WHO Family planning cornerstone. 2009
Case 3
A 30 year old female patient complaining about irregular bleeding pattern seeks advice on contraception
Family history: unknown
Physical examinations: mild acne lesions on face and hirsutism on face and limbs
Obs/Gyn History: G1P0A1
WHO Guidelines
Condition Category
COCIrregular pattern without
heavy bleeding Heavy or prolonged bleeding
(includes regular and irregular patterns)
1
Medical eligibility criteria for contraceptive use. (ed 4). A WHO Family planning cornerstone. 2009
MEC use in women with different patterns of vaginal bleeding (WHO MEC 2009)
Vaginal Bleeding patterns Hormonal
contraceptivesProgesterone
only PillsProgesterone only
injections
Irregular bleeding without heavy bleeding 1 2 2
Heavy or prolonged bleeding (includes
regular or irregular)1 2 2
Unexplained vaginal bleeding (suspicious
of serious pathology) before evaluation
2 2 3
Medical Eligibility criteria (MEC)
• 1: A condition for which there is no restriction for the use of the contraceptive method• 2: A condition for which the advantages of using the method generally outweigh the theoretical or proven risks• 3: A condition where the theoretical or proven risks usually outweigh the advantages of using the method• 4: A condition that represents an unacceptable health risk if the contraceptive method is used.
DSG+EE Vs LNG+EE: Which one has better affect on acne
hirsutism and weight change
Sanam and Ziba, Saudi Med J 32:23-26, 2011
Design and Method
Amir hospital &Family Planning
Clinic
Health Centers, Samnan, Iran
Women ranging from 18-35 years with no contraindication to OCs and have not used hormonal contraception in past 6 months
Baseline analysis: weight, acne, number of leisions, hirsutism evaluation, SHBG
levels and free testosterone
DSG+EE Grpn=50
LNG+EE Grpn=50
n=100
Outcome analysis: weight, acne, number of leisions, hirsutism evaluation,
SHBG levels and free testosterone
0 months
1months
2 months
3 months
4 months
5 months6 months
Randomization
The effect of the pill on weight, hirsutism and acne
Sanam and Ziba, Saudi Med J 32:23-26, 2011
0.0121.0±2.02.8±4.2Terminal hirsutism severity
0.000-1.7±2.90.3±1.8Hirsutism severity changes
0.8362.7±4.42.5±4.3Base hirsutism severity
Hirsutism
0.001-3.0±6.20.4±3.3Number of acne changes
0.0111.8±3.64.7±6.7Terminal number of acne
0.7584.8±8.24.3±7.0Base number of acne
Acne
0.0000.0±2.53.3±3.6Weight Changes (Kg)
0.90265.3±11.065.8±15.6Terminal Weight (Kg)
0.57665.3±10.663.2±15.6Base Weight (Kg)
Weight
P-ValueDSG+EELNG+EEParameters
Case 4
A 28 year old female patient seeking advice on contraception
C/O: constant lower abdominal pain and lower back pain
Obs/Gyn History: G0P0A1 . (Surgical abortion of an unplanned pregnancy at a local clinic, two months ago.)
Investigations: USG- Relevant findings in transvaginal sonogram shows normal ovary close to thickened fallopian tube in right adnexa
WHO Guidelines
Condition Category
COC
Pelvic Inflammatory Disease(PID-Current)
1
Comments: COCs may reduce the risk of PID.
Medical eligibility criteria for contraceptive use. (ed 4). A WHO Family planning cornerstone. 2009
A summary of a few more situations where COC are favorable…
Condition Category Additional Notes
(Evidence/Comments)COC
Gestational Trophoblastic Disease
(decreasing or undetectable levels of β-HCG/ persistently
elevated β-HCG levels or malignant disease)
1 Evidence found COC use did not increase the risk of postmolar trophoblastic disease and some COC users experienced a more rapid regression in hCG levels, compared with non-users.
Endometrial Cancer 1 COC use reduces the risk of developing endometrial cancer. While awaiting treatment, women may use COCs. In general, treatment of this condition renders a woman sterile.
Ovarian Cancer 1 COC use reduces the risk of developing ovarian cancer. While awaiting treatment, women may use COCs. In general, treatment of this condition renders a woman sterile.
Cervical Ectropion 1 Cervical ectropion is not a risk factor for cervical cancer, and there is no need for restriction of combined hormonal contraceptive use
Medical eligibility criteria for contraceptive use. (ed 4). A WHO Family planning cornerstone. 2009MAR-2011-AP-(IN)-3627-SS 30-Aug-2012 MAR-2011-AP-(IN)-3627-SS 30-Aug-2012
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