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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)
[object Object],[object Object],[object Object],[object Object]
What Is  The Best  Advice ??   The most suitable& effective?  ,[object Object],[object Object],[object Object],[object Object],[object Object],B
Contraceptive Choice above the age of 40 years ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
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 ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
B. Progestagen Implants: Implanon Norplant and Implanon
The Implanon rod ,[object Object],[object Object],[object Object],[object Object]
Applicator Obturator cannula
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],C. MirenaÂź
D. Injectables NET-EN and DMPA
C. Progestin only pills (POP)
WHO Medical Eligibility Criteria: Diabetes IUD Mirena PO Implant PO Injectable POP E+P P - I - R 1 1 1 1 1 History of G. Diabetes  2 2 2 2 2 Uncomplicated Diabetes  2 2 2 2 3 Diabetes + other Risk factor 2 2 3 2 4 1-Vascular Diabetes  (Nephropathy, Retinopathy, Neuropathy)   2-Diabetes >20 years
What Is  The Best  Advice ??   ,[object Object],[object Object],[object Object],[object Object],[object Object],B

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Contraception

  • 1. Contraception The way to evidence
  • 2. 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)
  • 3.
  • 4.
  • 5.
  • 6. No contraceptive method is contraindicated by age alone. RCOG FFPRHC Guidance Grade C 2005 Women aged over 40 years can be advised that:
  • 7. Women should be counseled for the risks and non-contraceptive benefits of all contraceptive methods. Medical eligibility criteria for contraceptive ( MECC ) WHO 2004
  • 8. 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
  • 9. WHO Medical Eligibility Criteria for Contraceptive Use (WHOMEC) 2004 / 2008 Eligibility rather than ineligibility (or contraindication) : 4 Categories
  • 10. 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)
  • 11.
  • 12.
  • 13. B. Progestagen Implants: Implanon Norplant and Implanon
  • 14.
  • 16.
  • 18. C. Progestin only pills (POP)
  • 19. WHO Medical Eligibility Criteria: Diabetes IUD Mirena PO Implant PO Injectable POP E+P P - I - R 1 1 1 1 1 History of G. Diabetes 2 2 2 2 2 Uncomplicated Diabetes 2 2 2 2 3 Diabetes + other Risk factor 2 2 3 2 4 1-Vascular Diabetes (Nephropathy, Retinopathy, Neuropathy) 2-Diabetes >20 years
  • 20.