unit 7 Flashcards
What condition is characterized by insufficient aldosterone production?
Addison’s Disease (Primary Adrenal Insufficiency).
What are the causes of Addison’s Disease?
Insufficient production of aldosterone and cortisol due to adrenal gland dysfunction.
What are common symptoms of Addison’s Disease?
Fatigue, low blood pressure, hyperkalemia (high potassium levels), and hyponatremia (low sodium levels).
What is Cushing’s Syndrome?
A condition characterized by excess cortisol production, often due to a tumor or overuse of corticosteroid medications.
What are the common causes of Cushing’s Syndrome?
- Pituitary adenoma (Cushing’s disease) leading to excess ACTH.
- Adrenal tumors causing overproduction of cortisol.
- Exogenous corticosteroid use (e.g., prednisone or hydrocortisone).
What are common symptoms of Cushing’s Syndrome?
- Weight gain (especially around the abdomen and face).
- Thin skin.
- Easy bruising.
- Hypertension.
- Hyperglycemia.
- Osteoporosis.
- Emotional disturbances like anxiety or depression.
What defines hyperkalemia?
Serum potassium concentration greater than 5.5 mEq/L.
What are some causes of hyperkalemia?
- Renal failure (impaired kidney function).
- Diminished aldosterone secretion.
- Severe burns.
- Rapid IV administration of potassium.
How do diuretics work?
Diuretics increase urine production by inhibiting sodium reabsorption in the renal tubules, which reduces blood volume and blood pressure.
What are some common uses of diuretics?
- Hypertension (high blood pressure).
- Heart failure (to reduce fluid overload).
- Edema (fluid retention).
What is the difference between a Lower UTI and an Upper UTI?
Lower UTI: Restricted to the bladder and urethra, involves superficial mucosa, and generally has no long-term effects.
Upper UTI: Affects the kidneys and ureters, involves deep renal tissue, and can permanently damage the kidneys.
How is a UTI diagnosed?
A UTI is diagnosed when there are 100,000 organisms of the same bacterial species per milliliter of urine.
What are some factors that predispose individuals to UTIs?
- Female sex
- Pregnancy
- Prostate disease
- Stones
- Obstruction
- Reflux
- Congenital anomalies
- Diabetes
- Renal transplant
- Catheters
- Urinary stones
- Chronically infected prostate gland
- Immunosuppression
What is an uncomplicated UTI?
An uncomplicated UTI is defined as an infection in a healthy, non-pregnant, pre-menopausal female with an anatomically and functionally normal urinary tract.
What are common symptoms of an uncomplicated UTI?
- Burning/stinging during urination
- Lower abdominal pain
- Increased frequency
- Urinary urgency
- Inflamed bladder
- Cloudy, foul-smelling urine
- Blood in the urine
What pathogens are commonly involved in UTIs?
- Gram-negative organisms:
- Escherichia coli
- Klebsiella spp.
- Proteus mirabilis and Proteus vulgaris
- Gram-positive bacteria:
- Enterococcus faecalis
- Staphylococcus spp.
What is the recommended treatment for non-pregnant women with a UTI?
Antibiotics should be prescribed if symptoms worsen or do not improve within 48 hours, or immediate antibiotics can be prescribed for 3 days.
What is the treatment for UTIs in pregnant women?
Pregnant women should receive immediate antibiotics for UTIs.
What is the treatment for UTIs in men?
Immediate antibiotics for 7-10 days.
What are some common antibiotics for treating UTIs?
- Trimethoprim (200mg BD)
- Nitrofurantoin (100mg MR BD or SUG&DS)
- Cefalexin (500mg BD), but not recommended due to the risk of Clostridium difficile infection.
What are some self-care measures for UTIs?
- Drink plenty of water.
- Go to the toilet regularly and don’t hold urine.
- Wipe from front to back.
- Empty bladder after sex.
- Avoid perfumed bubble baths and soaps.
- Wear cotton underwear and avoid tight clothing.
What are some preventive measures for UTIs in children?
- Ensure the child is well-hydrated.
- Encourage regular toilet visits and not holding urine.
- Address constipation and ensure the child drinks enough fluids to keep urine pale.
What are the common causes of UTIs in children?
Bacteria from the digestive system entering the urethra.
What are the common symptoms of UTIs in young children?
- High temperature
- Vomiting
- Tiredness
- Irritability
- Poor feeding
- Jaundice
What is the recommended treatment for UTIs in children?
UTIs in children often clear up within 24-48 hours with antibiotics, which do not usually cause long-term problems. Babies under 3 months old or children with severe symptoms may be admitted to the hospital for IV antibiotics.
What is the risk of recurrent UTIs in children?
Recurrent UTIs may be caused by anatomical abnormalities that allow urine to flow the wrong way. In some cases, long-term low-dose antibiotics may be prescribed to prevent further infections.
What are some underlying causes of glomerular disease?
Immunological abnormalities, ischemia, free radicals, drugs, toxins, vascular disorders, diabetes, and lupus erythematosus.
What are the common effects of glomerular damage?
- Reduced glomerular filtration rate (GFR)
- Hypertension
- Edema
- Proteinuria
- Hematuria
How can hematuria help determine the location of bleeding?
- Throughout the urine stream suggests damage to the glomerulus
- At the beginning of the stream suggests bleeding from the urethra
- At the end of the stream suggests bleeding from the bladder or prostate
What are the classifications of glomerular disease?
- Primary
- Secondary
What are the five major clinical syndromes associated with glomerular disease?
- Asymptomatic proteinuria/hematuria
- Acute glomerulonephritis
- Chronic glomerulonephritis
- Rapidly progressive glomerulonephritis
- Nephrotic syndrome
How is glomerular disease diagnosed?
Diagnosis is based on clinical assessment and investigations including urine analysis, GFR determination, blood analysis, blood cultures, and kidney biopsy.
What is nephrolithiasis (kidney stones)?
Nephrolithiasis refers to the formation of kidney stones, which are relatively common and can cause severe pain, known as renal colic.
What are the common risk factors for kidney stones?
- Age (30-60 years old)
- More common in men than women
- Family history of stones
- Diet high in protein and low in fiber
- Diseases like Crohn’s disease
- Medications such as aspirin, antacids, calcium, and vitamin D supplements
What size kidney stones can usually pass in urine?
Stones up to 4mm can often pass in urine easily.
What happens when a kidney stone obstructs the ureter or urethra?
It causes severe pain (renal colic) and may lead to urinary tract infection (UTI).
How are larger kidney stones treated?
Larger stones may be removed by ultrasound, extracorporeal shockwave lithotripsy, or surgically.
What are common symptoms of kidney stones?
- Intense pain in the back, side, or groin
- Restlessness and difficulty lying still
- Nausea and vomiting
- Hematuria
- Cloudy or foul-smelling urine
- Burning sensation during urination
- High temperature (>38°C)
- Increased frequency and pain during urination
What are the common substances that contribute to kidney stone formation?
High levels of calcium, ammonia, uric acid, and cystine can contribute to kidney stone formation.
What can result from untreated glomerular disease?
Untreated glomerular disease can lead to chronic kidney disease (CKD) and end-stage renal failure.
What is the role of kidney biopsy in glomerular disease?
Kidney biopsy is crucial for differentiating the type and severity of glomerular disease and guiding treatment decisions.
What is the difference between acute and chronic glomerulonephritis?
- Acute glomerulonephritis occurs suddenly and can be reversible with treatment
- Chronic glomerulonephritis progresses slowly, often over years
What are the features of nephrotic syndrome?
Nephrotic syndrome includes severe proteinuria, hypoalbuminemia, edema, hyperlipidemia, and an increased risk of infections.
What are the types of kidney stones?
- Calcium stones
- Uric acid stones
- Struvite stones
- Cystine stones
What are some preventive measures for kidney stones?
- Increase fluid intake
- Dietary modifications
- Medications may be prescribed
What are common treatments for renal colic (severe kidney stone pain)?
- NSAIDs (e.g., ibuprofen)
- Opioid analgesics may be prescribed
What are some long-term risks of untreated kidney disease?
Both glomerular disease and chronic kidney stones can lead to renal failure and may require dialysis or a kidney transplant.
How do diabetes and hypertension contribute to kidney diseases?
Diabetes and hypertension are major risk factors for both glomerular disease and kidney stones.
What is renal replacement therapy?
Dialysis (hemodialysis or peritoneal dialysis) is required when kidney function declines.
What is Acute Kidney Injury (AKI)?
AKI is a rapid decline in kidney function leading to loss of homeostasis, fluid, electrolyte, and acid-base imbalances, and toxin build-up. It can be reversible if treated promptly.
AKI occurs within hours or a few days.
Who is most affected by Acute Kidney Injury (AKI)?
AKI mostly affects older adults, seen in up to 20% of people admitted to hospitals, and 65% of cases start in the community.
What is the mortality rate associated with untreated Acute Kidney Injury (AKI)?
The mortality rate for untreated AKI is between 30-70%, depending on age and comorbidities.
What are common risk factors for Acute Kidney Injury (AKI)?
- Age: Over 65 years of age.
- Co-morbidities: Diabetes, heart failure, chronic liver disease, chronic kidney disease, vascular disease.
- Medications: NSAIDs, Aminoglycosides, ACE inhibitors, ARBs, diuretics, IV contrast.
- Existing disease: Further insult/damage to kidneys.
- Sepsis, Hypovolaemia, Hypotension, Post-op: Reduced blood flow to kidneys.
- Poor nutritional status: Reduced kidney reserve.
How can Acute Kidney Injury (AKI) be managed?
Management of AKI depends on the type (pre-renal, intra-renal, post-renal) and is potentially reversible if the factors causing it are corrected.
What is Chronic Kidney Disease (CKD)?
CKD is defined as abnormalities in kidney function or structure present for more than 3 months, leading to a decline in glomerular filtration rate (GFR) (< 60 ml/min/1.73 m²) on at least two occasions separated by 90 days.
What is the prevalence of Chronic Kidney Disease (CKD) in the UK?
CKD affects 1 in 10 people in the UK.
What are the main risk factors for Chronic Kidney Disease (CKD)?
- Diabetes
- Hypertension (may cause or result from CKD through sodium retention & RAAS changes).
- Higher prevalence in South Asian & Afro-Caribbean populations due to increased risk of diabetes & hypertension.
What are additional risk factors for Chronic Kidney Disease (CKD)?
- Age (renal decline starts at 40).
- CVD, AKI, smoking, obesity, hyperlipidemia.
- Chronic NSAID use, family history of CKD.
- Multisystem diseases (e.g., lupus, vasculitis).
- Structural renal disease, renal calculi.
- Hereditary conditions (e.g., polycystic kidney disease).
What is the relationship between Chronic Kidney Disease (CKD) and other diseases?
CKD has shared risk factors with hypertension, CVD, and diabetes.
How can Chronic Kidney Disease (CKD) be prevented or managed?
Prevention includes lifestyle changes and managing hypertension and diabetes to slow CKD progression.
What role do pharmacists play in the management of Chronic Kidney Disease (CKD)?
Pharmacists promote healthy lifestyles and help in preventing and managing CKD.
pcos
excess testosterone and LH , low fsh disrupting ovulation
irregular periods, infertility, weight gain, acne
menopause/eostrogen def
oestrogen and progestron dec
hot flash, osteoporosis, mood swings, increased CVD risk
endometriosis
oestrogen dependent
infertility
hormonal influence due to imbalance fsh lh testo on sperm prod
difficult coception
What is Low Testosterone (Hypogonadism) and its consequences?
Hormonal Influence: Decreased testosterone.
Consequences: Infertility, fatigue, erectile dysfunction, reduced bone density.
Hypogonadism can significantly impact overall health and well-being.
What is Erectile Dysfunction (ED) and its consequences?
Hormonal Influence: Low testosterone.
Consequences: Impaired sexual function, psychological distress.
ED can be a symptom of underlying health issues.
What is Benign Prostatic Hyperplasia (BPH) and Prostate Cancer, and their hormonal influence and consequences?
Hormonal Influence: Excess DHT causes prostate enlargement.
Consequences: Urinary obstruction, frequent urination, kidney damage, and painful periods (in women).
DHT is a potent androgen that affects prostate health.
What is Infertility and its hormonal influence and consequences?
Hormonal Influence: Disruptions in FSH, LH, oestrogen, and progesterone.
Consequences: Difficulty conceiving, need for assisted reproductive techniques.
Infertility can be due to various hormonal imbalances.
What are Androgens (Testosterone, Mesterolone) used for?
Indications:
* Testosterone replacement therapy for hypogonadism (low testosterone).
* Mesterolone is used in male infertility due to low androgen levels.
Androgens play a crucial role in male reproductive health.
What are the cautions when using Androgens (Testosterone, Mesterolone)?
Monitor for cardiovascular risks (hypertension, heart disease).
* Risk of prostate enlargement or cancer progression.
* May affect liver function and blood clotting.
Regular monitoring is essential during androgen therapy.
What are the contraindications for using Androgens (Testosterone, Mesterolone)?
Contraindications:
* Prostate or breast cancer in men.
* Severe liver or kidney disease.
* High red blood cell count (polycythaemia).
Contraindications must be evaluated before treatment initiation.
What are the side effects of Androgens (Testosterone, Mesterolone)?
Side Effects:
* Acne, fluid retention, mood changes.
* Increased red blood cell count (risk of clots).
* Gynecomastia (breast enlargement) due to oestrogen conversion.
* Reduced libido, erectile dysfunction, ejaculation disorders.
* Breast tenderness or enlargement.
* Depression and mood changes.
Side effects can vary and may require management.
What forms are Androgens (Testosterone, Mesterolone) available in?
Forms:
* Oral (Mesterolone).
* Buccal (Testosterone tablets).
* Intramuscular (IM) injections (Testosterone enanthate, undecanoate).
* Transdermal (patches, gels).
Different forms may have varying bioavailability and effects.
What pre-conception advice should be given to women?
Advice:
* Folic acid supplementation.
* Stop smoking and avoid alcohol and illicit drug use.
* Maintain a healthy diet and body weight.
* Avoid environmental risks, exercise, and maintain a healthy lifestyle.
* Regular cervical screening and up-to-date immunisations.
* Considerations for women with long-term conditions or co-morbidities.
Pre-conception health is vital for maternal and fetal well-being.
What pre-conception advice should be given to men?
Advice:
* Stop smoking, reduce alcohol and caffeine intake.
* Achieve ideal body weight and exercise regularly.
* Eat a healthy, balanced diet.
* Ensure testicles are cooler than the body to promote sperm production. Avoid tight underwear, hot showers, or hot baths.
Men’s health can significantly impact fertility.
What are the common physiological changes in the GI system during pregnancy?
Nausea or morning sickness
Heartburn
Constipation
These changes can significantly impact a pregnant woman’s comfort and health.
What changes occur in the urinary system during pregnancy?
Increased urine production
Bladder compression leading to incontinence
Frequent urination in early pregnancy (due to increased hCG)
UTIs are more common, which can cause pre-term labor if untreated
Increased urine production is due to higher kidney function.
What causes dyspnoea (difficulty breathing) in pregnancy?
Increased vital capacity and respiratory rate
Changes in the body’s oxygen demand due to pregnancy
Pressure from the growing uterus on the diaphragm
This can lead to feelings of breathlessness, especially in later stages.
Why do varicose veins occur during pregnancy?
Due to venous hypertension and ineffective valves
Caused by increased blood volume and the growing uterus compressing pelvic blood vessels
Symptoms include aching legs, swollen feet, muscle cramps, and a burning or throbbing sensation
Varicose veins are common and usually improve postpartum.
How can you treat constipation during pregnancy?
Increase fluid intake and dietary fiber (first-line)
Regular, light exercise
If needed, use laxatives in the following order:
* Bulk-forming laxatives
* Lactulose or macrogol
* Senna or bisacodyl (short course)
* Glycerol or bisacodyl suppositories
These methods help promote regular bowel movements.
What causes hyperpigmentation and stretch marks during pregnancy?
Hyperpigmentation: Increased levels of melanocyte-stimulating hormone (e.g., linea nigra)
Stretch Marks: Caused by overstretching of elastic tissue in the skin, especially around the abdomen, breasts, and thighs
Hyperpigmentation is common, while stretch marks may fade after delivery.
What is the hormonal influence behind breast swelling and tenderness in pregnancy?
Caused by rising levels of estrogen and progesterone
These hormones stimulate the growth of milk ducts, lobules, and alveolar, preparing for lactation
This is a normal physiological change in preparation for breastfeeding.
What advice can be given to pregnant women with varicose veins?
Reassure that varicose veins are common and not harmful to the baby
Recommend compression stockings to improve symptoms
Lifestyle changes can also help mitigate symptoms.
How can fatigue during pregnancy be managed?
Rest and proper sleep
Healthy diet to combat iron deficiency (e.g., iron supplements, folic acid)
Address psychological factors if present
Fatigue is common, especially in the first trimester.
What changes occur in the cardiovascular system during pregnancy?
Blood volume increases by 25-40%
Increased cardiac output by 20-40%
Blood pressure and pulse may rise
Compression from the uterus can impair venous return, causing varicose veins
These changes support the increased metabolic demands of pregnancy.
What is parturition (birth)?
Occurs around 280 days after the last menstrual period
High estrogen levels increase oxytocin receptors in the uterus
Oxytocin and prostaglandins trigger contractions
A positive feedback loop intensifies contractions until birth
Understanding these mechanisms is crucial for managing labor.
What are the stages of lactation?
Colostrum (Week 1): High in proteins, vitamins, and immunoglobulins
Transitional Milk (Weeks 2-3): More lactose, fat, and calories, fewer proteins
Mature Milk: Fully balanced nutritional composition
Each stage plays a critical role in infant nutrition.
Why is breast milk considered the best nutrition for babies?
Perfect balance of proteins, fats, and vitamins
Boosts immunity with antibodies
Easy digestion, reduces colic and constipation
Lowers the risk of diseases like allergies, obesity, and diabetes
Breastfeeding has long-term health benefits.
What are the common problems during labor?
Coping with pain
Genital trauma (perineal care)
Delay in the first stage of labor
Instrumental birth
Awareness of these issues can help in preparing for delivery.
What advice can be given to men (pre-conception) for optimal fertility?
Stop smoking
Reduce alcohol and caffeine intake
Maintain an ideal body weight
Exercise regularly
Eat a balanced diet
Avoid hot showers or tight underwear to maintain healthy testicular temperature
These lifestyle changes can improve male fertility.
What changes occur during the second trimester (Week 14-28)?
The easiest trimester due to decreasing hCG levels
Organogenesis continues, and the fetus grows
Ailments in this period are linked to rising progesterone and estrogen
Relaxin hormone helps with haemodynamic changes, increasing cardiac output and renal blood flow
This period is often marked by increased comfort for the mother.
What should you do to address nipple soreness or pain while breastfeeding?
Correct the baby’s latch.
Apply lanolin cream or breast milk to soothe the nipple. Let nipples air dry and avoid harsh soaps.
What can you do to increase low milk supply?
Nurse frequently and stay hydrated.
* Eat a balanced diet and practice skin-to-skin contact.
* Consider lactation-boosting foods and consult a lactation specialist.
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What are ways to manage overabundant milk supply?
Feed on one breast per session to regulate supply.
* Express small amounts for comfort.
* Use laid-back nursing positions to slow the flow.
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What are the benefits of breastfeeding for an infant?
Provides all necessary nutrients for the first six months.
* No additional food or fluids needed during the first six months.
* Linked to lower risks of asthma, diabetes, and obesity in the long term.
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What is formula milk made from, and what are the different types?
Formula milk is usually made from processed, skimmed cow’s milk with added vitamins, fatty acids, and prebiotics.
* Whey-based formula is easier to digest, recommended for newborns.
* Casein-based formula is for hungrier babies but has no proven benefits for sleep or fullness.
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What are the advantages and disadvantages of bottle-feeding?
Advantages: A strong bond can form between the baby and the feeder; formula contains essential vitamins like vitamin K.
* Disadvantages: Risk of incorrect formula preparation, bottles and teats require cleaning and sterilizing, switching back to breastfeeding can be challenging, and formula feeding can be expensive.
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How do cervical mucus changes help with contraception?
Cervical mucus changes due to fluctuating hormone levels.
* At peak oestrogen levels, mucus becomes thin, stretchy, and alkaline, which helps sperm entry.
* After ovulation, progesterone thickens the mucus to block sperm.
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What is the significance of body temperature changes in contraception?
Progesterone causes a 0.5°C temperature rise after ovulation, maintained until the end of the cycle.
* Natural family planning involves tracking temperature and cervical mucus for fertility periods.
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What is the effectiveness of Natural Family Planning?
Up to 99% effective when followed correctly.
* Around 75% effective with mistakes.
* No physical side effects, can also be used for planning pregnancy.
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What are the main hormonal contraceptive methods for women?
Combined Oral Contraceptives (COCs): Contain oestrogen and progestogen, prevent ovulation, and thicken cervical mucus.
* Progestogen-Only Pills (POPs): Taken daily, mainly alter cervical mucus, and may suppress ovulation.
* Intra-Uterine Devices (IUDs): Highly effective, but may have local side effects.
* Barrier Methods: Includes diaphragm and cap.
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What are the advantages of condoms as a contraceptive method?
98% effective when used correctly.
* Effective at preventing STIs.
* Safe with water- or silicon-based lubricants.
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What are some male contraceptive methods in development?
Vasalgel: Injectable gel that blocks sperm flow, reversible like a vasectomy.
* YCT-29: Hormone-free pill for men.
* NES/T (Nestorone®/Testosterone): Hormone-based gel that prevents sperm production.
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What is the difference between user failure and method failure in contraception?
User Failure: Occurs when the contraceptive method is not used correctly.
* Method Failure: Pregnancy occurs despite proper use of the contraceptive method.
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What is the mechanism of action of combined hormonal contraceptives?
Oestrogen and progestin prevent ovulation, alter cervical mucus, and modify the endometrium to prevent implantation.
* They suppress the release of gonadotropins (FSH and LH), preventing ovulation.
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What are the types of combined hormonal contraceptives?
Oral Contraceptives (COCs): Taken daily in 21-28 day cycles.
* Transdermal Patch: Applied weekly for 3 weeks.
* Vaginal Ring (NuvaRing): Inserted into the vagina for 3 weeks.
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What should you do if you miss a pill in a COC?
1 pill missed (less than 24 hours): Take it as soon as remembered, continue with the next pill as usual, no backup needed.
* 2+ pills missed (more than 24 hours): Take the last missed pill, skip others, use backup contraception for 7 days.
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What should you do if a contraceptive patch detaches?
If detached for <24 hours: Reapply immediately, no backup needed.
* If detached for >24 hours: Reapply, use backup contraception for 7 days.
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What are the advantages and disadvantages of the long-acting progestogen injection (e.g., Depo-Provera)?
Advantages: Convenient, 99% effective, discreet, can reduce or eliminate periods.
* Disadvantages: Side effects include irregular bleeding, weight gain, and delayed return to fertility.
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What are the benefits and disadvantages of the long-acting progestogen implant (e.g., Nexplanon)?
Advantages: Lasts 3 years, 99% effective, reversible, private use.
* Disadvantages: Requires healthcare provider for implantation/removal, side effects like irregular bleeding, headaches, mood changes.
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What are the main indications for using the Mirena® IUD?
Provides effective contraception for up to 5 years.
* Treats heavy menstrual bleeding.
* Protects the endometrium during oestrogen replacement therapy.
* Off-label use for endometriosis.
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