LARC Flashcards
What are some forms of LARC
Intra-uterine devices (Hormonal and copper)
Sub-dermal contraceptive implant
What are some risks of IUD?
- Perforation (0.1-0.2%)
- PID (0.5%)
- Malposition/Expulsion (5%)
What are some contraindications for IUDs
- Large submucosal fibroids causing distortion
- Uterine malformation
- PID
- Immunosuppression
- Pelvic cancer
Who may not tolerate IUD insertion
history of sexual trauma or traumatic birth experiences
What is required before insertion of IUD
NAAT if high STI risk
Bimanual examination
Speculum examination
What is required before IUD removal?
Abstinence or condom use for 7 days
What needs to be excluded if coil threads cannot be seen or palpated?
- Expulsion
- Pregnancy
- Uterine perforation
MOA of Cu-IUD
Copper is toxic to the ovum and sperm. It also alters the endometrium and makes it less accepting of implantation.
How long can Cu-IUD last?
Up to 10 years
Benefits of Cu-IUD
- Long lasting
- Only suitable method after breast cancer
- It can be inserted at any time in the menstrual cycle and is effective immediately
- It contains no hormones, so it is safe for women at risk of VTE or with a history of hormone-related cancers
- It may reduce the risk of endometrial and cervical cancer
Side effects of Cu-IUD
Heavier, longer periods with pain and bleeding, especially for the 1st 3 months
Contraindication of Cu-IUD
- Normal IUD conraindications
- Wilson’s disease
MOA for LNG-IUD
- Thickening cervical mucus
- Altering the endometrium and making it less accepting of implantation
- Inhibiting ovulation in a small number of women
What are the 5 main LNG-IUD brands and their length of time
- Mirena, Levosert, Benilexa - 8 years
- Kyleena - 5 years
- Jaydess - 3 years
What conditions is the Mirena coil licensed in>
Menorrhagia
Use with HRT
Endometriosis
Endometrial hyperplasia
How is the LNG-IUD started
inserted up to day 7 of the menstrual cycle without any need for additional contraception. If it is inserted after day 7, pregnancy needs to be reasonably excluded, and extra protection (i.e. condoms) is required for 7 days.
What may be seen on smear tests in those with LNG-IUD
Actinomyces-like organisms
Benefits of hormonal IUD
- More effective than the Cu-IUD
- 50% chance of amenorrhoea at 6 months (Mirena)
- Systemic hormone levels are low so rarely any hormonal side effects
Side effects of LNG-IUD
Irregular bleeding and PV spotting is common in the first few months
What is the sub-dermal contraceptive implant?
A progesterone releasing 4cm long flexible plastic rod placed in the upper arm beneath the skin and above the subcutaneous fat
How long does the SDI last?
3 years
MOA of SDI?
- Inhibiting ovulation
- Thickening cervical mucus
- Altering the endometrium and making it less accepting of implantation
Describe starting the SDI
Inserting the implant on day 1 to 5 of the menstrual cycle provides immediate protection. Insertion after day 5 of the menstrual cycle requires seven days of extra contraception (e.g. condoms), similar to the injection.
How is the SDI inserted?
It is inserted one-third the way up the upper arm, on the medial side. Local anaesthetic (lidocaine) is used prior to inserting the implant. A specially designed device is used to insert the implant horizontally, beneath the skin and above the subcutaneous fat. It should be palpable immediately after insertion. Pressing on one end of the implant should make the other end pop upwards against the skin.
How is the SDI removed?
Lidocaine is used as a local anaesthetic. The device is located, and a small incision is made in the skin at one end. The device is removed using pressure on the other end or forceps. Contraception is required immediately after it has been removed (but not immediately before).
Benefits of SDI
- Low and stable levels of hormones - Less hormonal side effects
- Progesterone only - Safe for most patients
- Effective and reliable contraception
- It can improvedysmenorrhoea(painful menstruation)
- It can make periods lighter or stop all together
- No need to remember to take pills (just remember to change the device every three years)
- It does not cause weight gain (unlike the depo injection)
- No effect on bone mineral density (unlike the depo injection)
- No increase in thrombosis risk (unlike the COCP)
- No restrictions for use in obese patients (unlike the COCP)
Side effects of SDI?
Prolonged PV bleeding (20%) - Often controlled by COC
