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WHO contraceptives

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Information about WHO contraceptives
Education

Published on March 4, 2009

Author: mitoztip

Source: authorstream.com

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WHO MEDICAL ELIGIBILITY CRITERIA FOR CONTRACEPTIVES : WHO MEDICAL ELIGIBILITY CRITERIA FOR CONTRACEPTIVES Op.Dr.Kenan Ertopçu SB IZMIR EGE DOGUMEVI VE KADIN HASTALIKLARI EGITIM VE ARASTIRMA HASTANESI Slide 3: Although many types of contraceptive services are currently present, but still many families with no desire for children or postpone the desire do not use effective contraceptive methods, which may be the result of side effects of the method and anxieties due to health risks. Slide 4: Data regarding the appropriateness of the contraceptive methods to the families can be observed under different titles in different literatures. “Indications”, “who can use?”, “contraindications”, “who can’t use?”, “precautions”, “relative contrindications” and “emergency conditions” are some of the examples for foresaid different titles. The main objective of appropriateness / inappropriateness lists followed by family planning programmes is to establish reliable use of the method, no matter placed under which title. Any condition could be accepted in different categories in different family planning programmes. But this can be natural for countries with different reproductive characteristics. Slide 5: Appropriate update of used lists in accordance with the developing technology is a very important phenomenon. If not updated in appropriate period, lists proposed to be used for reliable use of any method will become a medical barrier for themselves, so that the programme will be affected negatively. Slide 6: At this point, it will be appropriate to speak about an international study evaluating appropriateness criterias of contraceptive use in order to support family planning programmes and strengthen the services of high quality. This study was initiated by WHO in 1994 with two different scientific groups composed of specialists from 21 countries. “ Development Chronology of WHO Appropriateness Criterias of Contraceptive : Development Chronology of WHO Appropriateness Criterias of Contraceptive 1994 ; Study was initiated by WHO in 1994 with two different scientific groups composed of specialists from 21 countries. 1996 ; Data regarding first studies were published. 2000 ; 1996 publication was updated after review of studies largely about contraceptive use in selected cases October 2003 ; More than 35 specialists developed contraceptive appropriateness criterias guide-book in WHO center at Switzerland. Specialist Study Group used the following sources while developing contraceptive appropriateness criterias: : Specialist Study Group used the following sources while developing contraceptive appropriateness criterias: 1-Medline, Premedline, Popline and / or similar bibliographic databases 2-Published and reviewed publications in between 1966 and 2003 3-Systematic reviews and/or metaanalysis of reported studies (meta-analysis of women with specific health conditions and change with these conditions after use of contraceptive method) Slide 9: Appropriateness of contraceptives to individuals who will begin to use or continue to use, together with probable health benefit or risks of individuals with specific disease conditions were evaluated in WHO classification Factors which could affect the appropriateness of the individual to the method were classified in one of the four categories. Although no limit about the use was defined in the first category, use of the method was not permitted in the fourth category. WHO CATEGORIES : WHO CATEGORIES Category 1: Reliable use – No restriction for method use Category 2: Usable – Positive aspects of method use are generally more than the theoretical and proved risks (presence of other method choices or follow-up period must be taken into consideration) Category 3: Not first choice – Theoretical and proved risks are generally more than the positive aspects of the method (presence / availability of other methods, close follow-up possibility and severity of the condition must be taken into consideration) Category 4: No use – Unaccepted health risk WHO CATEGORIES FOR SURGICAL STERILIZATION AND VASECTOMY : WHO CATEGORIES FOR SURGICAL STERILIZATION AND VASECTOMY A (Accept) : Reliable use – no restriction of method use C (Caution) : Applicable – Required measures must be taken prior to the application D (Delay) : Application must be delayed – Temporary methods must be proposed until the condition is recovered R (Refer) : Referral may be needed – If experienced personnel, anesthesia specialist and appropriate equipment are not present, then the case must be referred to another center NEW MAIN TOPICS IN WHO 2003 GUIDE-BOOK : NEW MAIN TOPICS IN WHO 2003 GUIDE-BOOK WHO has issued new family planning guidance, including the following: HIV, AIDS : WHO has issued new family planning guidance, including the following: HIV, AIDS Most women with HIV infection generally can use IUDs. Women generally can take hormonal contraceptives while on antiretroviral (ARV) therapy for HIV infection, although there are interactions between contraceptive hormones and certain ARV drugs. Intrauterine devices may not be removed during management of sexually transmitted diseases or pelvic inflamatory diseases : Intrauterine devices may not be removed during management of sexually transmitted diseases or pelvic inflamatory diseases If management is successive, removal or not of IUDs will not affect the progress. IUDs can be applicated to the cases with STIs even with ulcerative diseases like syphilis and herpes IUDs cannot be applicated only to the cases with chlamydia and gonorrhoea or purulent cervicitis. Other conditions related with IUDS : Other conditions related with IUDS Leiomyomas not causing distortion of uterine cavity are not impede use of IUDs ALL OF THESE CRITERIAS ARE VALID FOR HORMONE PLATED IUDs Obesity ,IUD and progesterone containing methods : Obesity ,IUD and progesterone containing methods IUDs, DMPA and Levonorgestrel containing IUDs decreased from category 2 to category 1 in obesity (can be used safely in any condition) Studies about weight gain or dysfunctional uterine bleedings to be more in obese cases than lean cases didnot resulted. Decrease in efficacy of norplant in more than 4 years in women with more than 70 kgs was observed Hormonal methods are valid for women with depression : Hormonal methods are valid for women with depression Different studies revealed that depression symptoms donot increase with oral contraceptive, minipill, DMPA, implant use One study revealed that Fluoxetine (Prozac) use do not decrease efficacy of oral contraceptives and minipills. THERE IS NOT ENOUGH EVIDENCE YET FOR USE IN POSTPARTUM DEPRESSION OR BIPOLAR DISEASE No restriction with wide-spectrum antibiotics : No restriction with wide-spectrum antibiotics Studies revealed that wide-spectrum antibiotics didnot decrease hormone levels and ovulation was not observed Griseofulvin can be used safely with hormonal contraceptives During rifampisin use, OC, minipill, implant, contraceptive patch and vaginal ring are not first choice :  Women with known thrombogenic mutation(e.g. Factor V Leiden; Prothrombin mutation; Protein S, Protein C and Antithrombin deficiencies) can not use COCs and CICs. 1-Hormonal patch, vaginal ring and etonogestrel implants : 1-Hormonal patch, vaginal ring and etonogestrel implants Three new methods (patch, ring and etonogestrel implants) were added. The patch and ring are grouped with CICs but are given the same category ratings as COCs. The etonogestrel implants are grouped with, and are given the same category ratings as, the levonorgestrel implants. The patch and ring are grouped with CICs but are given the same category ratings as COCs. : The patch and ring are grouped with CICs but are given the same category ratings as COCs. The etonogestrel implants are grouped with, and are given the same category ratings as, the levonorgestrel implants : The etonogestrel implants are grouped with, and are given the same category ratings as, the levonorgestrel implants 2- Barrier methods : 2- Barrier methods For the conditions of high risk of HIV, HIV-infected, and AIDS, spermicide use is a Category 4. For the conditions of high risk of HIV, HIV-infected, and AIDS, diaphragm (with spermicide) and cervical cap are Category 3. Spermicides are not appropriate in high risk of HIV : Spermicides are not appropriate in high risk of HIV Metaanalysis of 5 studies about nonoxinol 9 performed in 2001 revealed that women with frequent daily use of spermicide showed more frequent development of HIV infection. Abrasion of vaginal walls with spermicide use will cause HIV to easily penetrate the vaginal tissue. 3. Female surgical sterilization : 3. Female surgical sterilization The condition of known thrombogenic mutations (e.g. Factor V Leiden; Prothrombin mutation; Protein S, Protein C, and Antithrombin deficiencies) has been added for female surgical sterilization and is Category A. The condition of depressive disorders has been added for female surgical sterilization and is a Category C. For the condition of other STIs (excluding HIV and hepatitis), female surgical sterilization is Category A. For the condition of previous abdominal or pelvic surgery, female surgical sterilization is Category C. 4. Male surgical sterilization : 4. Male surgical sterilization The condition of young age has been added for male surgical sterilization and is Category C. The condition of depressive disorders has been added for male surgical sterilization and is Category C. Hormonal methods can be generally used with cervical lesions : Hormonal methods can be generally used with cervical lesions According to the metaanalysis of 30 studies in 2002, risk of development of invasive cervical cancer from CIN has been increased especially with use of OC and DMPA more than 5 years But there is not sufficient evidence for effect of hormonal contraception in CIN development And studies about progression of CIN 1 lesions in OC using women revealed contradictory results Progesterone-only methods can be initiated 6 weeks later in lactating women : Progesterone-only methods can be initiated 6 weeks later in lactating women Studies, even limited, revealed that initiation of progesterone-only contraceptives before 6 weeks in lactating women didnot affect growth, development and health of the baby Data about the effect of progestine in maternal milk to the baby’s brain and liver functions are not sufficient WHO study group didnot cancel the 6 week limitation in 2003. Answers to the frequently asked questions in clinics : Answers to the frequently asked questions in clinics Hormone use in cases with varices; Answer: All methods are category 1 Hormone use in cases with hypo- or hyperthyroid conditions; Answer: All methods are category 1 Hormone use in cases with epilepsy; Answer: All methods are category 1 Hormone use in cases with Hepatitis carrier; Answer: All methods are category 1 Hormone use in cases with obesity; Answer: All methods are category 1 WHO Family PlanningGuidance on the Internet Latest MEC : WHO Family PlanningGuidance on the Internet Latest MEC http://www.who.int/reproductive-health/publications/RHR_00_2_medical_eligibility_criteria_3rd/index.htm Related guidance from WHO, the Selected Practice Recommendations for Contraceptive Use (SPR), appears at http://www.who.int/reproductive-health/publications/rhr_02_7/index.htm. Keep up on new evidence related to the MEC. The online system CIRE—Continuous Identification of Research Evidence—identifies new research articles whose study objectives concern a topic addressed by WHO’s MEC or SPR. CIRE screens emerging scientific literature so that WHO guidance can be updated. Any updates to current guidance appear in WHO’s postings of the MEC or SPR on the World Wide Web (see above). Changes to classifications of the MEC or to the SPR are ordinarily made only following expert group meetings such as the October 2003 MEC meeting. Records of all articles that CIRE has identified can be searched at http://www.infoforhealth.org/cire/cire_pub.pl.Visitors to this web page can sign up for e-mail notification when CIRE posts new records. Also, The Pop Reporter e-zine, at http://www.infoforhealth.org/popreporter/ current.shtml, notifies its readers of new postings. Free subscription available at http://prds.infoforhealth.org/signup.php. Slide 40: THANK YOU

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