Prevention and management of side effects

Found that too early, frequent and late childbirth and abortion is one of the major causes of maternal and perinatal mortality. Often this is the result of contraceptive failure, and in most cases, lack of access to reproductive health services. For forming healthy families and improve the reproductive health needs to rational use of modern contraceptives in view of individual selection.

Progestin-only pills containing progestin only (POC) Types: • Progestin-Only Pills (POP, the "mini-pill" esklyuton) Pack of 35 tablets: 300mcgs or 350 mcg

levonorgestrelnorethindrone Pack of 28 tablets 75 mg nopgestrel • Progestogen injection (POIC) DMPA (Depo-Provera): 150 mg of depot-medroxyprogesterone

acetate, is injected every 3 months NET-EN (Noristerat): 200 mg norethindroneenantant,

injected every 2 months • Subcutaneous implants: Norplant 6 thin flexible capsules

filled with levonorgestrel, Implanon 1 capsule for 3 years. • IUD: releasing progesterone and levonorgestrel

Mechanism of action of POCs• Amendment to the endometrium, making it

difficult for implantation (severity appears as duration of use of the drug)

• thickening of the cervical mucus, preventing sperm penetration

• suppression of ovulation (POIC)POC Rules of admission• At any time when there is confidence in the

absence of pregnancy;• C1-th to the 7 th day of the menstrual cycle;

• After the birth: - After 6 months, if it uses the lactational

amenorrhea method (LAM) - After 6 weeks if breastfeeding, but should not

be LAM - Immediately or within 6 weeks if not

breastfeeding• Post-abortion (immediately or within 7 days)• Packaging POP contains 28 active pills of the same

color, they must be used every day, regardless of onset of menstruation (ie not recommended weekly intervals, as in the COC).

Explains how to use pocIMPORTANT: every day take one pill every day

continuously. If a woman is not breastfeeding, it is best to take one pill every day at the same time. Even if a woman takes a pill a few hours later than usual time, it increases the risk of pregnancy. Pass two or more pills in a row greatly increases the risk of pregnancy.

• Start a new package:After over a package, strictly for the next day to

take the first pill from a new package. All tablets are active, ie hormonal. Tablet-free interval between packages is not done.

Instructions in case if a woman forgets to take one or more pills:

• It should take one tablet as soon as you remember, and then continue taking one tablet every day, as usual, and for the next 2 days to use a backup method of contraception.

• breast-feeding woman using POP as a backup method, will remain protected against pregnancy, even if she misses a pill.

• If it has been more than 3 hours from the time when a woman had to take a pill, and yet she is not breastfeeding or breast-feeding, but it resumed menstruation, in the next 48 hours to either abstain from sex or use condoms or spermicide. It should take the missed tablet as soon as possible and then continue one tablet every day, as usual

How to inject Necessary medical equipment and supplies:

• One dose of DMPA (150 mg)• antiseptic solution and cotton wool• Injection of 2 or 5 ml and a needle for

intramuscular injection 21-23 size.

Sequencing 1. Wash your hands and wash your hands and put on clean gloves 2. If necessary, clean the suspected injection with soap and water and

wipe it with antiseptic (if any) in a circular motion in the direction of the injection to the periphery.

3. Slightly (but not too much so as not to form foam) Shake with DMPA use, wipe the top of the cork and antiseptic syringe and dial the desired dose.

4. Deeply enter a sterile needle into the top of the shoulder (deltoid) or buttock (in the upper outer square of the gluteus maximus), pull back the Porsche syringe to make sure that did not get into the vessel, it may lead to a too rapid absorption of DMPA. If caught in a vessel puncture to do elsewhere. Enter the contents of the syringe.

5. Do not massage the injection site. Tell the patient that you can not massage or rub the injection site. Explain that this can result in too rapid absorption of DMPA.

Requiring the use of POCs: • Women of any reproductive age and with any number of pregnancies in the history

who wish to avoid pregnancy • nursing mothers; • Patients after abortion • Women over 35 years who are at risk of cardiovascular disease in the absence of

estrogen component; • Women who want a highly effective method of oral contraception, but can not

tolerate the side effects of COCs; • patients with a history of anemia. • Women with moderate to severe menstrual pain • Women smokers • Women with a high BP • Women with cerebrovascular disease; • with long flowing diabetes; Advantages POC: • Effective immediately (<24 hours), if taken at the same time every day (POP); • Before using the pelvic examination is not required (except for the progestin IUD) • Do not interfere with intercourse • Return of fertility after discontinuation of the drug - POP; • convenience and ease of use; • the patient can independently control pills • does not reduce the amount of breast milk during • Lack of estrogen component (does not cause nausea, headaches, increased blood

pressure)

Noncontraceptive benefits• reduces the amount of blood lost at the

time of• Reduce spasms of smooth muscles of

the uterus.• Prevents endometrial cancer• Reduces the risk of benign breast

disease

POP disadvantages: • The effectiveness of drugs depends on the organization of the patient -

requires constant motivation and daily use (POP);   There may be intermenstrual bleeding due to the constant changes in

the level of serum progestins, slowing exclusion layer of the endometrium;

• Do not protect against STIs, HIV, AIDS, and reproductive tract infections.

• Perhaps some weight gain (POIC) or loss Side effects most commonly reported: • Amenorrhea: occurs in up to 40% used DMPA, with 20-30% of the IUD -

does not require treatment to the exclusion of Pathology • Violation of the menstrual function while using POIC as spotting bleeding (especially in the first few months). This is explained by

supporting level of progestin in the blood serum, which leads to a slower rejection of the uterine lining. Typically, such a pattern is observed in the first months of use of the drug;

• The addition or loss of weight (change in appetite) • Acne • Pain in the lower abdomen / pelvis

Depo-Provera may be introduced or Noresterat nurses.

Injectable contraceptives, as well as other hormonal methods have noncontraseptive effects, which are to reduce the risk of endometrial cancer, ectopic pregnancy, inflammatory diseases of the pelvic organs. Using Depo-Provera and Noresterata a positive trend of anemia, endometriosis, ovarian cysts, prevention of growth miomatous node cancer and benign tumors of the breast.

For forming healthy families and improve the reproductive health needs to rational use of modern contraceptives in view of individual selection.