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REPRODUCTIVE ENDOCRINOLOGY . . . CONT.

Notes

CONTRACEPTION

Table 3. Classification of Contraceptive Methods

Type

Surgical

Sterilization (tubal ligation) Vasectomy

Barrier Methods Condom Alone Condom with Spermicide Spermicide Alone Sponge Diaphragm with spermicide

Hormonal Oral contraceptives Norplant (levonorgestrel)

Depo-Provera (medroxyprogesterone)

IUD

Physiological Withdrawal Rhythm method Chance – No method used

Description

  • See below

  • Six capsules inserted subdermally in arm

  • Provides protection for up to 5 years

  • S/E: severe irregular menstrual bleeding, scar in arm

  • 150mg injection q3mths

  • restoration of fertility may take up to 1-2 yrs

  • S/E – irregular menstrual bleeding

  • See below

Effectiveness

    • 99.9

      %

    • 99.9

      %

90.0% 95.0% 82.0% 90.0% 81.0%

98.0-99.5% (depending on compliance) 99.9%(per year), 96.0%(over 5 years)

99%

95.0%-97.0%

77.0% 76.0% 10.0%

Intrauterine device (IUD) • absolute contraindications • current pregnancy • undiagnosed vaginal bleeding • acute or chronic PID • suspected gynecologic malignancy • relative contraindications • prior ectopic pregnancy • menorrhagia, dysmenorrhea • congenital abnormalities of uterus or fibroids • valvular heart disease • side effects • pregnancy: ectopic or septic abortion • increased blood loss and duration of menses • increased risk of PID especially in nulliparous women • dysmenorrhea • expulsion (5% in the first year) • uterine wall perforation (1/5000)

Oral Contraceptives absolute contraindications • current pregnancy • undiagnosed vaginal bleeding • cardiovascular disorders • thromboembolic events • cerebrovascular disease • coronary artery disease • moderate-severe hypertension • estrogen-dependent tumours • breast • uterus • liver • impaired liver function • congenital hyperlipidemia • age > 35 and smoking • obstructive jaundice in pregnancy • Wilson disease

Gynecology 18

MCCQE 2000 Review Notes and Lecture Series

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