Long Acting Reversible Contraception 11/2017 Flashcards
ive IUDs are currently marketed in the United States: the copper-containing IUD and four levonorgestrel-releasing intrauterine devices (LNG-IUDs)
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copper IUD exerts its contraceptive effects primarily by preventing fertilization through inhibition of sperm migration and viability
most common side effect:
The most common adverse effects reported are heavy menstrual bleeding and pain
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Two types of LNG-IUDs contain a total of 52 mg of levonorgestrel: the LNG-20 IUD (Mirena) releases 20 micrograms/day, and the LNG-18.6 IUD (Liletta) releases 18.6 micrograms/day (17, 18). The LNG-19.5 IUD (Kyleena) contains a total of 19.5 mg of levonorgestrel, releasing 17.5 micrograms/day of levonorgestrel, and the LNG-13.5 IUD (Skyla) contains a total of 13.5 mg of levonorgestrel, releasing 14 micrograms/day of levonorgestrel
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All LNG-IUDs have a similar primary mechanism of action: they prevent fertilization by causing a profound change in the amount and viscosity of cervical mucus, making it impenetrable to sperm (
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The available evidence supports that LNG-IUDs do not disrupt pregnancy (15) and are not abortifacients. The LNG-20 IUD is FDA approved for up to 5 years of use (17). The LNG-18.6 IUD is FDA approved for up to 4 years of use (18).
The LNG-19.5 IUD is FDA approved for up to 5 years of use with a cumulative pregnancy rate of 0.31 per 100 women-years (19, 24). The LNG-13.5 IUD is FDA approved for up to 3 years of use (20). The cumulative pregnancy rate is 0.33 per 100 women-years of use (24). Compared with the LNG-20 IUD, the LNG-13.5 IUD has a narrower inserter, smaller “T” frame, and releases less hormone daily (25).
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Although only a small amount of steroid is released from the LNG-IUD, some women may experience hormone-related effects, such as headaches, nausea, breast tenderness, mood changes, and ovarian cyst formation. Users of the LNG-IUD report weight gain that is comparable to those using the copper IUD (26, 27). Acne is rarely reported with use of the LNG-IUD (28). The LNG-IUD does not appear to have an adverse effect on bone mineral density or to increase the risk of fracture (29, 30). Most women who use an LNG-IUD continue to ovulate but experience diminished menstrual bleeding because of the local effect of levonorgestrel on the endometrium.
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The primary mechanism of action of the implant is suppression of ovulation (35). Additional contraceptive efficacy may be conferred by the implant’s thickening of cervical mucus (36, 37) and alteration of the endometrial lining (37, 38). The contraceptive implant is the most effective method of reversible contraception, with a typical-use pregnancy rate of 0.05% (12). Pregnancy rates are similarly low in obese, overweight, and normal-weight users of the contraceptive implant (39). After implant insertion, changes in menstrual bleeding patterns are common and include amenorrhea or infrequent, frequent, or prolonged bleeding. Other reported adverse effects include gastrointestinal difficulties, headaches, breast pain, and vaginitis (40–42). Approximately 12% of implant users in contraceptive studies report weight gain
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implant:
Approximately 10–14% of users experience worsening of acne
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Insertion of a copper IUD is the most effective method of emergency contraception when inserted no later than 5 days after unprotected intercourse
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The efficacy of the copper IUD is not affected by body weight (101, 106). Consideration should be given to use of a copper IUD as an alternative to oral emergency contraception for all women, but particularly for obese women
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should receive CDC-recommended STI screening at the time of a single visit for IUD insertion. Intrauterine device insertion should not be delayed while awaiting test results. Treatment for a positive test result may occur without removal of the IUD
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A positive test result for chlamydial infection or gonorrhea that was detected after IUD insertion should be treated, and the IUD may be left in place
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naproxen significantly reduced bleeding and spotting days in the first 12 weeks of LNG-20 IUD use
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A noncontraceptive benefit of the implant is a significant decrease in dysmenorrhea (44, 137, 138). However, uterine bleeding patterns with contraceptive im-plant use are unpredictable and are cited as among the most common reasons for discontinuation.
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Endometrial biopsy, colposcopy, cervical ablation or excision, and endocervical sampling may all be performed with an IUD in place. As with other women who experience abnormal uterine bleeding in the perimenopausal period, unexpected bleeding should prompt evaluation in women with IUDs (143). Endometrial sampling can be performed with a small endometrial suction curette; sampling should be repeated if there is insufficient tissue for diagnosis. During cervical ablation or excision procedures, IUD strings may be tucked into the cervical canal if possible, or cut.
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