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Family planning

Family planning. Clinic of Reproduction and Gynecology PAM. Met hods of family planning. Periodic abstinence Barrier contraceptives Oral contraceptives Progestin injections Subdermal implants Emergency contraception Intrauterine device (IUD) Sterilization Induced abortion.

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Family planning

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  1. Family planning Clinic of Reproduction and Gynecology PAM

  2. Methods of family planning • Periodic abstinence • Barrier contraceptives • Oral contraceptives • Progestin injections • Subdermal implants • Emergency contraception • Intrauterine device (IUD) • Sterilization • Induced abortion

  3. Physiological infertility • “Shortly” after menarche (first menstrual bleeding) • After newborn delivery and during breastfeeding • “Shortly” before menopause • The highest chance to become pregnant – sex 1 or 2 days before ovulation (28% - 30%) • Fecundability 20% per cycle

  4. Factors affecting negative effect of breastfeeding on fertility • Time lapsed from delivery • Duration and frequency of breastfeeding • Nutrition • Social and cultural determinants • To sum up – breastfeeding does not protect against unwanted pregnancy

  5. Efficacy(Pearl index) • IUD 0,1 (0 –1) • OC 0,2 (0 –3) • Progestin injection 0,1 (0 –1) • Morning after pill 3 (2 – 5) • Condom 4 (1 – 7) • Periodic abstinence 10 (3 – 15)

  6. OC Action of oral contraceptives • Inhibition of GnRH release • Inhibition of ovulation • Changes in the fallopian tubes – motility, epithelial structure, oviductal fluid – impaired transport of sperm, oocytes and embryos • Changes in the endometrium – endometrium becomes thin – impaired implantation • Changes in the cervix – mucous becomes thick – sperm hardly penetrates

  7. Benefits of OC • Lower incidence of ovarian cysts • Lower incidence of ovarian malignancies • Lower incidence of endometrial malignancies • Lower incidence of anemia • Lower incidence of endometriosis, osteoporosis and RA • Lower incidence of ectopic pregnancies • Lower incidence of PID

  8. OC as a treatment modality • Dysfunctional uterine bleeding • Irregular cycles, hypermenorrhoe • PMS • Ovarian hyperandrogenism • Acne • Hirsutism

  9. Minor adverse effects of OC • Breakthrough bleeding • Amenorrhea and oligomenorrhea • Nausea and vomiting • Breast tenderness • Mood disorders • Weight gain (fluid retention) • Altered sexual drive

  10. Major adverse effects of OC • Impaired thyroid function • Deep vein thrombosis and thromboembolism • Hypertension • Altered glucose metabolism • Cholelithiasis • (?) breast malignancies (?)

  11. ABSOLUTE Smoking after 35yr Acute liver disease Uncontrolled hypertension DM with vascular changes History of thromboembolic event Pregnancy Undiagnosed vaginal bleeding Estrogen-dependent malignancy RELATIVE Depression Migraine headache Smoking before 35yr More than 35 yr Varicose veins Planned surgery Contraindications to OC

  12. STOP OC immediately in case of: • Calf pain • Chest pain • Migraine • Cholelithiasis • Prolonged immobilization (e.g. bone fractures)

  13. Drug interaactions of OC • anticonvulsants • antibiotics • penicillin • tetracyclin • cephalosporin • sulfonamides

  14. Emergency contraception • Up to 1 h • LNG 0,75 mg (1 tabl.) orally (Postinor) • Up to 72 h • LNG 0,25 mg + EE 0,5 mg „2x2x2” orally (Gravistat 250, Stediril 50) • IUD

  15. OC (two components) synthetic estrogen and progestin) Monophasic • Gravistat 50μg EE + 0,25 mg levonorgestrel • Cilest 35μg EE + 0,25 mg norgestimate • Marvelon 30μg EE + 0,15 mg desogestrel • Minisiston 30μg EE + 0,125 mg levonorgestrel • Femoden 30μg EE + 0,075 mg gestoden • Logest 20μg EE + 0,075 mg gestoden • Mercilon 20μg EE + 0,150 mg desogestrel • Diane-35 35μgEE + 2 mg cyproterone acetate

  16. OC (two components) synthetic estrogen and progestin) Sequential Biphasic • Anteovin 50μg EE + 11 tabl. 0,05 mg LNG 50μg EE + 10 tabl. 0,125 mg LNG Triphasic • Triquilar, Tri- Regol, Trisiston 30μg EE + 6 tabl. 0,05 mg LNG 40μg EE + 5 tabl. 0,075 mg LNG 30μg EE + 10 tabl. 0,05 mg LNG

  17. Long-acting formulations • Progestin injections (MP 0,15 i.m. q 3mo) • Subdermal implants • IUD + progestin (LNG)

  18. Barrier methods For males: • Condom For women: • Diaphragm • Cervical cap • Vagninal foam, cream, suppositories (contain nonoxynol-9 – kills and immobilizes sperm)

  19. Condom • PROTECTIONagainst STDs (AIDS included) • Easy to use • Cheap • Almost no side-effects (minor local allergic reactions to latex) • Prevention malignancies of the cervix

  20. Disadvantages of condoms • Impaired sexual satisfaction • Allergy • Not comfortable in use

  21. Physiological bases for periodic abstinence The first probable day of expected ovulation 14 – 2 = 12 day The last possible day of expected ovulation 14 + 2 = 16 day Sperm survival(48 h) 12 – 2 = 10 day Oocyte capability of being fertilized(24 h) 16 + 1 = 17 day Fertile span of time 10 - 17 day of the cycle The “tuned” method is called SYMPTOTHERMAL (+ BBT, cervical mucous)

  22. IUD Benefits • Does not affect the natural cycle • Effective • Makes women being controlled regularly Adverse effects • Bleeding and pain • PID • Perforation of uterus • Expulsion

  23. Contraindications to IUD • PID • Pregnancy • Vaginal bleeding of unknown origin • Planned pregnacy

  24. IUD candidate • 34 yo and over • Smoker • 2 children and no further reproductive plans

  25. OC candidate • Less then 30 yo • No children • Single sexual partner • Planes to become pregnant in the future • Dysfunctional uterine bleeding

  26. Condom and spermicide candidate • Less then 20 yo • No children • Irregular sexual activity

  27. Progestin injections • Breastfeeding • Plans further pregnancies

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