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Home , Copper IUDs

08_XXX_MM1 Departmentand ofReproductiveHealth Research Contraceptive Contraceptive Technology Training Research Health andReproductive Sexual in Course Promoting Family PlanningFamilyPromoting Updates Updates on Kirsten Mario Mario Part 2 Geneva Geneva Vogelsong Festin 2016 100 women 100 in one women year Less 1pregnancyper than More effective 100 women 100 in one women year 30 per About Less effective 08_XXX_MM2 Comparing Effectiveness of Methods correctly every time time youcorrectlyeveryhave sex Withdrawal, : Patch,ring: Pills: months): LactationalMethod Amenorrhea Injectables: 3 months : After procedure, littleor nothing to do or remember Implants, IUD, female : more effectivemethod toHow your make Two on days. fertile Standard Method andDays awareness methods: youhave sex Condoms,diaphragm: - Day MethodDay maybe easier touse. Take Take at a pill the same time each day Breastfeed Breastfeed often, dayand night Get Get repeat injections on time Keep in place, change on time Use another method for first Use correctly every time everytime correctlyUse Use Abstain or use (for 6 6 (for 08_XXX_MM3 Description of the method Interventions for associated effects Benefits and side effects Eligibilitycriteria Effectiveness Mechanism of action Outline andObjectives 08_XXX_MM4 Progestin only pills only Progestin oral contraceptives Combined Other Other methods Tubal libation and vasectomy contraception Emergency , Other barrier methods condoms and Male female LNG IUS bearing) IUDs ( implants Hormonal combined contraceptives, Injectable progestin contraceptives, Injectable Methods - only 08_XXX_MM5 Contraceptive Devices Copper (IUDs or IUCDs) (IUDs Copper T 380A Intrauterine Intrauterine 08_XXX_MM6 What isaCopperIUD? the the into and vagina the through it, inserted around wire or sleeves copper with device plastic Small – – – – insert and remove insert Require trained provider to years) acting 12 Long (up to Highly effective Safe 08_XXX_MM7 Copper T Copper Multiload 375 Multiload - 380A Copper TCu Multiload 375 widely used copper IUD - 380A, “Copper T” is most - bearing bearing IUD 08_XXX_MM8 Prevents fertilization by: fertilization Prevents Source: Ortiz, 1996 Ortiz,Source: movement of the sperm the of movement with Interfering sperm the of viability the Impairing Copper Mechanism T: of Action 08_XXX_MM9 Source: CCP 2011Source: WHO, and Other health benefits Other health No systemic effects fertility Rapid return to years) 12 Long action Require user no effective highly Safe and Copper IUDs: Characteristics Copper - acting (up to Rare Rare complications STIs/HIV against protect Do not insertion discomfort during or Possible pain remove and insert to needed Trained provider Require pelvic exam effects side Potential 08_XXX_MM10 menstruation experience: may women Some periods bleeding menstrual Programme of Research Development and Research Training in Human Reproduction, 1997. TrainingResearch Reproduction, and Humanin Development Research of Programme Source: first first 3−6 months. Side effects most are during common the Bleeding between menstrual menstrual between Bleeding prolonged or Increased during pain and cramps More Copper IUDs: Possible CopperIUDs: Side Effects CCP and WHO, 2011; Larsson, 1993; DeMaeyer, 1989; WHO, 2004, updated 2008; WHO Special WHO 2008; CCP 2011;WHO, updated DeMaeyer, and 2004, 1993; WHO, 1989; Larsson, 08_XXX_MM11 IUDs are known to: Source: CCPSource: 2011;WHO, and 1991.Sivin, Help protect against endometrial cancer endometrial against protect Help of ectopic risk Reduce – – 10,000 inwomen Rate contraception in is65 using no for Copper T380A users) inall Rate IUD (2in in10,000 users is 12 Copper Copper IUDs: HealthBenefits 08_XXX_MM12 factors age and parity of woman and insertion Expulsions at time of insertion PID insertions Perforations – – Reduced Reduced through supervised training Linked to and skill experience of provider — Potential Complications Rare, most due to or — — Related to provider skill, Very rare, 1 in 1,000 Copper IUDs Copper 08_XXX_MM13 Source: Chi, et al, 1985. al, et Chi, Source: (more (more than 6 weeks after delivery) Interval (48 (48 hours to 4 weeks) Late Postpartum (between 10 minutes and 48 hours) Early postpartum (within 10 minutes) Immediate postpartum Expulsion Rates Are Higher Postpartumfor Timingof Insertion Insertion recommended recommended High higher Moderately Slightly higher (3% for provider) skilled Low Expulsion Rates Expulsion - Generally Generally not 08_XXX_MM14 Source: WHO, 2004; updated 2008. updated 2004;WHO, Source: Category 1 Category Category 2 Category WHO MEC Category Who Can Initiate CopperIUDs Who CanInitiate WHO MEC category 1 and 2 examples and 1 category WHO MEC breastfeeding > 6 weeks,of PIDbreastfeeding history heavywithout bleeding, bleeding irregular withoutdistortion ofthe uterine cavity, ectopy,≥20 years, cervical fibroids uterine withor without ARVtherapy HIV/AIDS infection, anemia, dysmenorrhea, severebleeding,heavyor prolonged to <20 years,nulliparous,Menarche Conditions (selected examples)(selected 08_XXX_MM15 Source: WHO, 2004; updated 2008. updated 2004;WHO, Source: Category 3 Category Category 4 Category WHO MEC Category WhoShouldInitiate CopperNot IUDs initiating use initiating cancer/if or cervical infection,endometrial (prior to evaluation),current PID or cervical pregnancy,bleedingvaginal unexplained STI/ use if initiating cancer/ifrisk of use, initiatingindividual high postpartum, 48 hoursto <4 weeksovarian WHO MEC category 3 and 4 examples 3 and category MEC WHO Conditions (selected examples) 08_XXX_MM16 Source: WHO, 2004; updated 2008. updated 2004;WHO, Source: Interval insertion Interval Postabortion insertion insertion Postabortion insertion Postpartum Within the first 12 days of of menstrual days 12 first the Within Immediately or within 12 days if no infection if no days 12 within or Immediately 4 weeks least at delay or hours 48 Within complications bleeding or infection no if delivery cesarean or vaginal after Immediately pregnant is not if woman time other Any Timing of IUD Insertion of Timing 08_XXX_MM17 Side effects: Side effects: side Common – – – – – months 3 first the within less become Usually of illness signs Are not periods between Spotting cramping Menstrual bleeding menstrual prolonged and/or Heavier Side Effects – 6 08_XXX_MM18 IUDs: Source: Source: CCP and WHO, 2011. • • • • • • • • Significantly reduce Significantly reduce risk of sex Do pain partnerduring cause for either not Do birth defects cause not or Do heart move tothe brain not Do make women not infertile Do work by not causing Do increase not risk STIs, of including HIV Rarely PID tolead Correcting Correcting Misconceptions 08_XXX_MM19 • • Source: CCPSource: 2011.WHO, and • • Signs ofPossibleIUDComplications pain pain Fever, abdominal low discharge, vaginal unusual pregnancy period missed strings, IUD Missing cycle every pain or bleeding Irregular post days few a within cramping abdominal severe and Bleeding partial expulsion, perforation expulsion, partial infection - insertion insertion perforation expulsion, 08_XXX_MM20 Source: CCP 2011.Source: WHO, and Heavy or Heavy Problem bleeding Irregular bleeding prolonged Heavy, Prolonged or Irregular Bleeding Counseling and reassurance are key are reassurance and Counseling Managing IUD Side Effects or Complications: Effects or IUD Side Managing Action/Management days 5 for meals after daily 2 times indomethacin short For client Reassure tablets iron Provide aspirin) NSAIDs (not acid or tranexamic short For few months after diminishes usually harmful, and not iscommon this that client Reassure - - term relief offer ibuprofen or offerrelief ibuprofen term offerrelief 5 term - day course of course day 08_XXX_MM21 Source: Source: CCP and 2011. WHO, pain mild and Cramping Problem Counseling and reassurance are key are reassurance and Counseling Managing IUD Side Effects or Complications: Complications: Effects or IUD Side Managing Action/Management Cramping Cramping and Pain Mild discuss discuss removing the IUD If cramping is severe but underlying no condition, menstruation, evaluate, treat or refer If cramping continues, occurs outside of if she also has heavy bleeding) Suggest ibuprofen, other pain reliever (not aspirin months, not harmful, usually decreases over time Reassure client that this common is in first 3 after insertion can She expect cramping and pain in first 1 – – 2 days 6 08_XXX_MM22 Source: Source: CCP and 2011. WHO, Rule out PID, ectopic pregnancy or pregnancy ectopicout PID, Rule immediately. refer suspected, is pregnancy ectopic If IUD. the to remove need no is There infection. bacterial anaerobic and chlamydia gonorrhea,for antibiotics appropriate with treat suspected, PID is If perforation. Severe Pain in Lower Abdomen (Rare) Managing IUD Side Effects or Complications: Complications: Effects or IUD Side Managing 08_XXX_MM23 Source: Source: CCP and 2011. WHO, Stop procedure immediately, remove IUD Follow Provide alternative contraception signs of bleeding vital anhour; checkfor signs Observe for – – Advise Advise sex for 2weeks avoid increased pain: refer If falling rapid pulse, blood pressure, or - up in a week or asneeded Managing IUD Side Effects or Complications: Complications: Effects or IUD Side Managing Suspected Perforation 08_XXX_MM24 Source: Source: CCP and 2011. WHO, Determine risk ofpregnancy risk Determine Insert another IUD if expulsion is confirmed and confirmed is if expulsion IUD another Insert method contraceptive another of choice Give refer or ultrasound, X consider strings, locate If cannot canal cervical in strings for probe exam, pelvic Perform – – SheIUD wantsto use still an Woman isnot pregnant Managing IUD Side Effects or Complications: Complications: Effects or IUD Side Managing Missing Missing Strings - ray or or ray 08_XXX_MM25 Source: Source: CCP 2011. and WHO, pregnancy forAssess pregnancy, including ectopic continue the pregnancy: the client Ifis pregnant andwishes to – – – up for signs of septic of septic signs for up follow close advise remove, to If not possible IUD the remove If possible, miscarriage or delivery ofpreterm risk the increases pregnancy during IUD an using that Explain Managing IUD Side Effects or Complications: Complications: Effects or IUD Side Managing Suspected PregnancySuspected - 08_XXX_MM26 Hormonal intrauterine intrauterine Hormonal device LNG - IUS 08_XXX_MM27 LNG - IUS Hormonal Hormonal IUDs Effective for 5 years 5 Effective for reversible Immediately (LNG system LNG as known Also IUD hormonal common most IUD (LNG progestin a release Steadily - IUS) - intrauterine intrauterine - IUD) 08_XXX_MM28 of thelininguterus Works primarily by suppressing the growth breast tenderness or pain, acne Also infrequent reports of headaches, bleeding days Some report lighter, fewer or even absent trained health care provider Needs to be inserted into auterus by a Other features oftheLNG IUS 08_XXX_MM29 Male andFemale Condoms 08_XXX_MM30 man’s erect peniserect man’s that a A sheath fitsover synthetics synthetics various skin and natural include Other materials rubber latex of thin aremade Most What Is a Male ?a Male Is What 08_XXX_MM31 • • • available in some countries Natural latex female condoms thin, soft, synthetic rubber film Most common type is FC2 inside a woman’s vagina A transparent sheath that fits loosely – What Is aFemale Condom? Has flexible rings at both ends at both rings flexible Has — made of 08_XXX_MM32 may be difficult toachieve difficult be may In real Source: Hatcher,Source: 2007 Comparing Comparing Effectiveness of Male and Pregnancyrates: typical use typical useperfect - life situations, correct and consistent use consistent and correct situations, life . Female Condoms 15% Male 2% Female 21% 5% 08_XXX_MM33 Create a barrier that including HIV including against STIs barrier forma Also pregnancy preventing thus vagina, the entering keeps from sperm Condoms: Condoms: Mechanism of Action 08_XXX_MM34 Condoms are the other STIs between partners Protection from transmission of HIVand Protection from pregnancy provides dual protection: Dual Protection Male and Female Condoms Female and Male only FP method that and 08_XXX_MM35 Source: WHO/RHR and JHU/CCP, and WHO/RHR Source: 2011 Effectiveness for Preventing HIV and STIs and Preventing HIV for Effectiveness herpes herpes and warts transmitted by skin Condoms are less effective for preventing STIs fluids such as gonorrhea and chlamydia Condoms prevent STIs transmitted through body HIV infection 80% are condoms of sex, act every with correctly used When women and men in of HIVinfection risk the reduces significantly of condoms use correct consistent, The Male and Female Condoms Female and Male ; American Foundation for AIDS Research, 2005; Carey,2005; for AIDS Research, Lytle,1997. Foundation 1992; American – - 95% effective in preventing preventing in effective 95% to - skin contact, such as 08_XXX_MM36 Widely Widely available Safe and easy touse effects hormonal No side protection Provide dual correctly consistently and used Effective when Characteristics of Male Condoms of Characteristics STIs conditions caused by Protect women from method temporary backup Can be used as provider’s help Do not require premature ejaculation Can help men with 08_XXX_MM37 Can interrupt sex May reduce sensation lubricants, heat, humidity or light Can be damaged by oil cooperation Require partner communication and many other methods As typically used, less effective than Characteristics of Male Condoms of Characteristics - based 08_XXX_MM38 condoms, All men and women can safely use male allergic reaction to latex – – countries Non women and men both among rare Extremely Who CanUseMale Condoms - latex condoms are available in some some in available are condoms latex except those with severe 08_XXX_MM39 • • • • Suggest adding another method another adding Suggest work will that approaches choose her to use partner Difficulty persuading errors correct demonstrate, If difficulty on putting behaviors practices, breaking or If slipping contraception used not If condom Managing ProblemsManaging Male Condoms Male — — Offer emergency — Ask client to to Ask client Ask about about Ask — Help Help 08_XXX_MM40 swelling condom Mild irritation or mild allergic reaction to • • • • possible vaginal infection or STI or infection vaginal possible for refer or assess continue, If symptoms condom the on water or Put lubricant Try of condoms brand another If no infection, may have allergy to latex allergy have may infection, If no — Itching, redness, rash and/or Managing ProblemsManaging Male Condoms Male 08_XXX_MM41 What Women Like: Female provider’s help provider’s require not Do stimulation provides ring Outer protection STI/HIVOffer condoms male latex than natural more feels Texture What Menand Women Like - Characteristics of Characteristics controlled Female Female Condoms What Men Like: immediately immediately removed be to have not Do sensation dull not Do constricting or tight Are not advance in inserted be Can 08_XXX_MM42 Limitations: Less available than male condoms male than availableLess condoms male than expensive More methods otheras effective as Not practice require at first, to insert difficult be May What Men and Women Don’t Like Characteristics of Characteristics Female Condoms Female 08_XXX_MM43 Latex female condoms: Severe allergic All men and women can use FC2 prevents use reaction to latex is the only condition that – Extremely rare Extremely Who Can Use Female Condoms Who CanUse 08_XXX_MM44 • • • • • choose approaches that will work Difficulty persuading partner: Help her contraception correctly: Offer emergency If condoms slips or is not used If condom squeaks: Use more lubricant If uncomfortable: Reinsert or reposition demonstrate If having trouble inserting: Ask her to Managing Problems Managing Female Condoms Female 08_XXX_MM45 (Continued) Mild irritation in or around the vagina or the around in or irritation Mild penis (itching, redness, rash) redness, penis (itching, – – – possible possible vaginal infection or STI symptomsIfpersist, assess and treatfor on penis Suggest added lubricant inside condom or Usually goes away on its own Managing Managing Problems Female Condoms Female 08_XXX_MM46 Male condoms: Female Female condoms: prevent prevent semen from entering the body Do not cause illness in women because they be learned Are not difficult to use, but correct use needs to “backs Do not cause illness in men because sperm sex drive Do not make men impotent, weak, or decrease Responding to Myths andFears Respondingto Myths - up” 08_XXX_MM47 Both Both male and female condoms: (continued) marriage, marriage, but also used by married couples Are not intended only for use outside of Do not have holes that HIV can pass through Cannot get lost in woman’s body Responding to Myths andFears Respondingto Myths 08_XXX_MM48 vagina before sex, covering the the covering sex, before vagina Diaphragm per 100 women in the first first year. the in women 100 per pregnancies 20 with effective, as Not barrier. a as cervix the covering sex, before vagina the in caps Cervical year. first the over diaphragm the using women 100 per 6pregnancies of sex, act every with correctly used When a with used usually barrier, a as cervix Other barriermethods – is placed deep in the the in deep placed is – is also placed deep deep placed is also 08_XXX_MM49 vagina before every act ofsex act every before vagina Spermicide alone or dual protection) dual or alone anti (either Microbicide – – – be aprimaryorback upmethod. One of least methods, effective may movement. slowing them or to break, killingsperm cells Work by causingthe membrane of availablealsosubstances 9, but other NonoxynolUsually Other barriermethods – applied deep in the the in deep applied - infective infective 08_XXX_MM50 with a commitment to abstain or use Requires the cooperation of both partners, No side effects. the specific methods. keep track of days, according to rules of Must be aware of the body changes or another method on fertile days – – family Natural abstinence Periodic Fertility awareness Fertility awareness methods 08_XXX_MM51 Calendar based methods based Calendar Symptoms based methods based Symptoms – – – – – – Sympto Two daymethod Temperature BasalBody secretions Cervical rhythm methods Calendar days methods Standard Increase Increase noted slightly after release of the egg or ovulation Fertility awareness Fertility awareness methods - thermal method 08_XXX_MM52 correct use correct and withconsistent effective 95% indicates fertile and nonfertile days. nonfertile and fertile indicates color a beads, cycle use can couple The days. fertile as considered are cycle each of 19 to 8 Days long. days 32 to 26 are periods menstrual her of if most SDM the use can A woman - coded string of beads that that ofbeads string coded Standard DaysMethods 08_XXX_MM53 How to use cycle touse How beads • • • • • • bead brownlast and brownbead comes dark between Alwayscheck yourperiod begin again. to move redbead ring to startsWhen period again pregnancyofno days BROWN beads are safe beads WHITE whenring ison Use condoms or abstain daysbleeding on everyday. even Move ring bead Move nextring to startswhenperiod Move RED ring to bead .      08_XXX_MM54 breastfeeding A family planning method based on months an ongoing method 6 for continuously Provides an opportunity to offer a woman breastfeeding. not returned and the woman is fully delivery, as long as monthly bleeding has Can be effective for up to 6 months after Lactational Lactational amenorrhea 08_XXX_MM55 consider other methods: other consider to want may following the with A woman – – – breastfeed that to a conditionmakes itdifficultwithA newborn anticoagulants)and certain drugs, lithium radioactive corticosteroids,bromocriptine, dosehigh ergotamine, anti reserpine, (mood certain medications Using Has HIVinfection breastfeeding, newly infected or has advanced disease. ifEspecially the woman is not taking ARVs, not fully Lactational Lactational amenorrhea - metabolites, cyclosporine,metabolites, - altering drugs, altering 08_XXX_MM56 situations such as such situations other sex and after unprotected up to 5days if taken pregnancy, prevent to help pills contraceptive Emergency inserted up to 7 days after unprotected sex after unprotected up to 7 days inserted when contraception, as effective emergency IUD Copper years) woman = method 8 pregnancies/100 (no Effectiveness FP method ongoing an to start using women for an opportunity Provide for Safe women all pregnancy existing an disrupt Do not – – – women women years. Combined estrogen progestin ECPs Progestin only ECPs or breakage, misplaced IUD, late for injections, etc) forced sex (rape) and contraceptive mistakes (condom slippage – 1 pregnancy per 100 women years – 2 pregnancies 2 pregnancies per 100 08_XXX_MM57 Contains a progestin alone (levonorgestrel pregnant. Does not work if the woman is already ovulation Works primarily bypreventing or delaying estrogen together or ulipristal) or a progestin and an Emergency contraception 08_XXX_MM58 FamilyPlanning Global Handbook 08_XXX_MM59 ECPs : Do not make women infertile Do not promote sexual risk taking Are not dangerous to a woman's health occurs Do not cause birth defects if pregnancy Do not cause abortion Correcting misconceptions about Emergency contraception 08_XXX_MM60 done through mini through done method, Permanent procedural regrets regrets procedural post no ensure to needed Counselling woman any by used be May women 1000 per failures 5 than less with methods effective most the of One laparoscopy or incision) (small laparotomy Female Sterilization - 08_XXX_MM61 Male Sterilization Tubes Tubes cut here Vasectomy increase risk for cancerrisk for increase provides nor performance Doesnot affect male over first year pregnancies Less than2per1000 technique May usingnonbe done (by sutures orcautery) ligated are cut deferens) (vas penisand Tubes that carry sperm tothe effect due tostorage of sperm With ataking month delayin 3 method inmen permanent surgical Simple - scalpel 08_XXX_MM62 Ring Patch – – – – – Works by preventing ovulationWorks bypreventing for weekly, 3 weeks patch withand estrogen progestins a adhesivesmall wearingRequires Prevents ovulation menstruates 4 in Keptfor woman 3 weeks,and by the bodyare absorbedwhich and estrogen progestins releases whicha ring flexiblekeepingRequires Other methods th week 08_XXX_MM63 Main Reference: Acknowledgements – – – – Acknowledgments Acknowledgments and References Institute of Reproductive Health Reproductive of Institute Health for Knowledge International Health Family Providers Planning Family ( https://www.fphandbook.org/ – A Global Handbook for for Handbook A Global )