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WHO MEC: Special situations

WHO MEC: Special situations

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WHO MEC: Special situations

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  1. WHO MEC: Special situations MAR-2011-AP-(IN)-3627-SS 30-Aug-2012

  2. Efficacy of methods Percentage of women experiencing an unintended pregnancy during the first year of typical use and the first year of perfect use of contraception and the percentage continuing use at the end of the first year. United States of America. Medical eligibility criteria for contraceptive use. (ed 4). A WHO Family planning cornerstone. 2009

  3. Contraceptive revolution – reversible methods

  4. WHO medical eligibility criteriafor contraceptive use: classification Medical eligibility criteria for contraceptive use. (ed 4). A WHO Family planning cornerstone. 2009

  5. WHO medical eligibility criteriafor contraceptive use: classification Medical eligibility criteria for contraceptive use. (ed 4). A WHO Family planning cornerstone. 2009

  6. Contraceptive Methods Available in India.Abbreviations mentioned in WHO MEC Low-dose combined oral contraceptives: COCs Combined contraceptive Vaginal Ring: R Progestogen-only Pills: POPs Depot medroxyprogesterone acetate : DMPA Norethisterone enantate : NET-NE Intrauterine devices IUDs Levonorgestrel-releasing IUD (20 g/24hours): LNG-IUD Copper-bearing IUD: Cu-IUDs Implant IMP Medical eligibility criteria for contraceptive use. (ed 4). A WHO Family planning cornerstone. 2009

  7. Case 1 • A 18 year old unmarried woman, seeking contraception advice • She also c/o; constant pelvic pain worsening during menses • Medical History: None • Family History: No reports of bleeding disorder • Obstetrical History: G0P0A0 • Investigations: USG-NAD

  8. WHO Guidelines Evidence: There was no increased risk of side-effects with COC use among women with dysmenorrhoea compared with women not using COCs. Some COC users had a reduction in pain and bleeding1 • Medical eligibility criteria for contraceptive use. (ed 4). A WHO Family planning cornerstone. 2009

  9. Case-2 • A 24 year old married woman, seeking contraception advice • She also C/O: constant pelvic pain worsening during menses • Medical History: None • Family History: No reports of bleeding disorder • Obstetrical History: G0P0A0 • Investigations: USG- free fluid in the cul-de-sac

  10. WHO Guidelines Evidence: A Cochrane Collaboration Reviewidentifiedone randomized controlled trial evaluating the effectiveness of COC use compared with a GnRH analogue in treating the symptoms of endometriosis. Women with endometriosis did not report worsening of the condition or any adverse events related to COC use1. • Medical eligibility criteria for contraceptive use. (ed 4). A WHO Family planning cornerstone. 2009 • Vercellini P, Trespidi L, Colombo A, Vendola N, Marchini M, Crosignani PG. A gonadotrophin-releasing hormone agonist versus a low-dose oral contraceptive for pelvic pain associated with endometriosis. Fertility and Sterility 1993;60(1):75–9.

  11. Case 3 • A 35 year old female patient seeking advice on contraception • C/O: heavy menses • Family history: Mother underwent surgery for hysterectomy at the age of 45 due to uterine fibroids • Obs/Gyn History: G1P1A0 • Investigations: USG- 4 heterogeneous structures, in the muscular layer without distortion of uterine cavity suggestive of leiomayomata.

  12. WHO Guidelines Comments: COCs do not appear to cause growth of uterine fibroids Medical eligibility criteria for contraceptive use. (ed 4). A WHO Family planning cornerstone. 2009

  13. Case 3 • A 30 year old female patient complaining about irregular bleeding pattern seeks advice on contraception • Family history: unknown • Physical examinations: mild acne lesions on face and hirsutism on face and limbs • Obs/Gyn History: G1P0A1

  14. WHO Guidelines Medical eligibility criteria for contraceptive use. (ed 4). A WHO Family planning cornerstone. 2009

  15. MEC use in women with different patterns of vaginal bleeding (WHO MEC 2009) • Medical Eligibility criteria (MEC)  • 1: A condition for which there is no restriction for the use of the contraceptive method • 2: A condition for which the advantages of using the methodgenerally outweigh the theoretical or proven risks • 3: A condition where the theoretical or proven risks usually outweigh the advantages of using the method • 4: A condition that represents an unacceptable health risk if the contraceptive method is used.

  16. DSG+EE Vs LNG+EE: Which one has better affect on acne hirsutism and weight change • Sanam and Ziba, Saudi Med J 32:23-26, 2011

  17. Design and Method Women ranging from 18-35 years with no contraindication to OCs and have not used hormonal contraception in past 6 months Amir hospital & Family Planning Clinic Health Centers, Samnan, Iran n=100 Baseline analysis: weight, acne, number of leisions, hirsutism evaluation, SHBG levels and free testosterone Randomization DSG+EE Grp n=50 LNG+EE Grp n=50 0 months 1months 2 months 3 months 4 months 6 months 5 months Outcome analysis: weight, acne, number of leisions, hirsutism evaluation, SHBG levels and free testosterone

  18. Parameters • LNG+EE • DSG+EE • P-Value • Weight • Base Weight (Kg) • 63.2±15.6 • 65.3±10.6 • 0.576 • Terminal Weight (Kg) • 65.8±15.6 • 65.3±11.0 • 0.902 • Weight Changes (Kg) • 3.3±3.6 • 0.0±2.5 • 0.000 • Acne • Base number of acne • 4.3±7.0 • 4.8±8.2 • 0.758 • Terminal number of acne • 4.7±6.7 • 1.8±3.6 • 0.011 • Number of acne changes • 0.4±3.3 • -3.0±6.2 • 0.001 • Hirsutism • Base hirsutism severity • 2.5±4.3 • 2.7±4.4 • 0.836 • Terminal hirsutism severity • 2.8±4.2 • 1.0±2.0 • 0.012 • Hirsutism severity changes • 0.3±1.8 • -1.7±2.9 • 0.000 The effect of the pill on weight, hirsutism and acne Sanam and Ziba, Saudi Med J 32:23-26, 2011

  19. Case 4 • A 28 year old female patient seeking advice on contraception • C/O: constant lower abdominal pain and lower back pain • Obs/Gyn History: G0P0A1 . (Surgical abortion of an unplanned pregnancy at a local clinic, two months ago.) • Investigations: USG- Relevant findings in transvaginal sonogram shows normal ovary close to thickened fallopian tube in right adnexa

  20. WHO Guidelines Comments: COCs may reduce the risk of PID. Medical eligibility criteria for contraceptive use. (ed 4). A WHO Family planning cornerstone. 2009

  21. A summary of a few more situations where COC are favorable… Medical eligibility criteria for contraceptive use. (ed 4). A WHO Family planning cornerstone. 2009 MAR-2011-AP-(IN)-3627-SS 30-Aug-2012