LONGACTING REVERSIBLE CONTRACEPTION

1
LONG-ACTING REVERSIBLE CONTRACEPTION
2
LONG-ACTING REVERSIBLE CONTRACEPTION

• INJECTABLE
• IMPLANT (4)
• IUD (4) / IUS (1)
• (16-49y.o. women, 2004/5)

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INJECTABLE (1)

• Options
• Medroxyprogesterone acetate (Depot Provera)
• Norethisterone oernanthate (Noristerat)
• Efficacy
• 0 -1
• 0.4 2
• Mode of action
• Ovarian suppression
• Cervical mucus endometrial effect

4
INJECTABLE (2)

• ADVANTAGES
• Effective
• No user error/ convenient
• ? menstrual disorders
• ? endometriosis
• ? PID / endometrial Ca
• ?ectopics / ovarian cysts

• DISADVANTAGES
• Reversibility
• Delayed return of fertility
• Menstrual disturbance
• Wt gain ( other)
• Enzyme inducers
• ? BMD

5
INJECTABLE (3)

• Starting
• Day 1-5 ? immediate protection
• Other ? 7d extra precautions
• Follow-up
• 12 (14) or 8 (10) weeks
• Managing problems
• Late injection
• Persistent bleeding

6
IMPLANTS (1)

• Composition
• Subdermal implant of etonorgestrel (Implanon)
• Efficacy
• 0 1
• Mode of action
• Ovarian suppression
• Cervical mucus endometrial effects

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IMPLANT (2)

• ADVANTAGES
• Effective
• No user error/ convenient
• Lasts 3 years
• Rapid reversal
• ? menstrual disorders cf. Depo
• No BMD effect

• DISADVANTAGES
• Altered bleeding
• Wt gain? ( other)
• Enzyme inducers
• Invasive
• Expensive?

8
IMPLANTS (3)

• Starting
• Day 1-5 ? immediate protection
• Other ? 7d extra precautions
• Switching
• Post TOP / delivery
• Managing problems
• Irregular bleeding (as for injectables)

9
IUD / IUS (1)

• Composition
• IUD - copper plastic (5/10yrs)
• IUS plastic levonorgestrel Mirena (5yrs)
• Efficacy
• IUD - max 1
• IUS - lt1
• Mode of action
• Prevents fertilisation implantation
• IUS progestogen effects (?inc ovulation)

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IUD / IUS (2)

• ADVANTAGES
• Effective immediately
• Immediately reversible
• No user error/ convenient
• Long term
• ? bleeding dysmenorrhea (IUS)
• IUS as part of HRT

• DISADVANTAGES
• Insertion
• Bleeding pain
• Less effective against extrauterine pregnancy
• Problems
• Infection
• Perforation (110 000)
• Expulsion
• Threads

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IUD / IUS (3)

• Contraindications (WHO 4)
• Possible pregnancy
• Current / recent PID
• Undiagnosed bleeding / endometrial or cervical Ca
• Distortion of uterine cavity
• Trophoblastic disease
• Allergy
• H/o bacterial endocarditis (or post valve
  replacement)
• Wilsons disease (IUD)

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IUD / IUS (4)

• Insertion
• IUD day 1-14
• IUS if after day 7 (with 7d barrier method)
• gt4/52 post TOP/delivery
• Exchange / removal
• Early in cycle / after 7d barrier or abstinence
• Managing problems
• Bleeding / pain
• Lost threads
• Infection

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NICE Guidelines on LARC methods (2005)

• More cost-effective than COC
• IUD / IUS / Implant more cost-effective than
  injectables
• Increased uptake ? less unintended pregnancies