Contraception

The way to evidence

A 42 year‑old woman P5+1 was

wearing an IUD for 6

months ,that was removed 2

months ago because of partial

expulsion(2nd expulsion)

She is diabetic for 21 years Husbanded refuses condom, coitus

interrupts or vaginal tablet

She is seeking for another effective contraceptive method

What is the best advice ??

What Is The Best Advice ?? The most suitable& effective?

A- E/P vaginal ring: Nuva Ring

B- Progestagen implant: Implanon

C:Levonorgestrel IUD: Mirena

D: Depoprovera

E: Progesagen only pills

B

Contraceptive Choice above the age of 40 years

Choice is influenced by :

1. Frequency of intercourse

2. Natural decline in fertility

3. Menstrual dysfunction

4. Concurrent medical disorders

5. Wish for non-contraceptive

benefits

6. Acceptance of the couple.

7. Age of the couple.

No contraceptive method is contraindicated

by age alone.

RCOG FFPRHC Guidance Grade C 2005

Women aged over 40 years can be advised that:

Women should be counseled for the risks and non-

contraceptive benefits of all contraceptive methods.

Medical eligibility criteria for contraceptive ( MECC ) WHO 2004

The WHO Medical Eligibility Criteria

The WHO Medical Eligibility Criteria for Contraceptive Use

provides evidence-based recommendations to ensure that

women can select the most appropriate method of

contraception without unnecessary medical barriers.

RCOG FFPRHC Guidance Grade C 2005

WHO Medical Eligibility Criteria for Contraceptive Use

(WHOMEC )2004 / 2008

Eligibility rather than ineligibility )or contraindication( :

4 Categories

Category 1: The use is unrestricted )Used in any circumstances(

Category 2: The advantages outweigh the theoretical or proven risks.) Generally can be used(

Category 3: The risks outweigh the benefit. )Not used unless other appropriate methods are not available or acceptable(

Category 4: The use an unacceptable health risk )Method not to be used(

A. E/P vaginal ring: Nuva Ring

Review 12 RCTs

• Superior cycle control than COC

• Lower incidence of nausea and breast tenderness

Roumen. Contraception, 2007

• May be more effective than proper COC use.

• Long-term studies is limited: but expected that benefits

and risks are similar to COC.

Evidence-based guidance A WHO Family Planning Cornerstone 2007

B. Progestagen Implants: Implanon

Norplant and Implanon

The Implanon rod

• Core: 40% EVA Copolymer

60% Etonogestryl

• Membrane: 100% EVA

EVA: Ethylene Vinyl Acetate

ApplicatorApplicator

ObturatorObturator

cannulacannula

• Alleviate menorrhagia, dysmenorrhea & PMT

• Reduce the size of fibroid

• Regression of endometriosis

• Regression of endometrial hyperplasia

• Endometrial protection in HRT.

• Prevention of PID

• Can be left up to 7 years )Normal = 5 y(

Particularly useful for the perimenopausal woman

C. Mirena®

D. Injectables

NET-EN and DMPA

C. Progestin only pills )POP(

E+P

P - I - R

POPPO

Injectable

PO

Implant

IUD

Mirena

History of G. Diabetes 11111

Uncomplicated Diabetes 22222

Diabetes + other Risk factor32222

1-Vascular Diabetes )Nephropathy, Retinopathy, Neuropathy(

2-Diabetes >20 years42322

WHO Medical Eligibility Criteria: Diabetes

What Is The Best Advice ??

A- E/P vaginal ring: Nuva Ring : Eligibility 4

B- Implanon Eligibility 2.& FR 0.0-0.05HWY C:Levonorgestrel IUD: Mirena Previous 2 expulsions

D: Depoprovera Eligibility 3

E: Progesagen only pills Eligibility2& FR:0.5-5HWY

B