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Family Planning-Part 2
By: Ismah Haron
10/04/2023 2
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
• Mechanism: preventing ovulation
• Efficacy: 3 per 100 women
• 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
Picture from: Family Planning; A Global Handbook For Providers WHO 2011 Update
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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
• Mechanism: preventing ovulation
• 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
Picture from: Family Planning; A Global Handbook For Providers WHO 2011 Update
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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
• Return of fertility: immediately
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• Contraindications:- Serious active liver disease- DVT- Breast ca
Picture from: Family Planning; A Global Handbook For Providers WHO 2011 Update
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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
• Efficacy: 2 per 1000 women
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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
• Return of fertility: immediately
• Contraindications:
- DVT, severe liver disease, breast ca
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STERILIZATION
Male
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Vasectomy
• Mechanism: closing off vas deferens
• Efficacy: 2 per 1000 women
• 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
• Efficacy: 5 per 1000 women
• 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