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FamilyPlanning DIWENM D Ph D Professor ChairmanDepartmentOfObstetrics GynecologyRenjiHospitalAffiliatedtoSJTUSchoolofMedicine BirthControl Pregnancy andChildbirth ManagingYourFertility HormonalmethodsOralcontraceptivesPillsDepo ProveraOrtho EvraNuvaringLunelleandNorplant currentlyoffthemarket MethodsofFertilityManagement SurgicalmethodsofsterilizationFemaleTuballigationMaleVasectomy MethodsofFertilityManagement OthermethodsofcontraceptionIUDsProgestasertParaGuardWithdrawalEmergencycontraceptivepillsEmergencyminipillsAbstinenceand Outercourse MethodsofFertilityManagement EffectivenessComplianceanddesiretoavoidpregnancyFrequencyofintercoursePatient sageCostofmethodSideeffectsPatient sperceptionsandmisperceptionsPatient sconcomitantdrugusePatient shealthstatusandhabits ContraceptiveVariables Preventsovulation FSHsecretionisdepressedLHpeakisabolished Urinaryandrogenexcretionismuchincreased Changesincervicalmucusmakespermpenetrationlesslikely OralContraception FormulationsMonophasicsBiphasicsTriphasicsMechanismofactionSuppressovulationAltercervicalmucusandendometrium OCFormulations MechanismofAction NosignificantincreasedriskamongcurrentorformerusersSmallincreasedriskofbreastcancerdiagnosisLinktoearlierdiagnosisofbreastcancer OCHealthRisks breastCancer NumerousstudieshavelinkedOCuseandcervicalneoplasiaFindingsaredifficulttointerpret OCHealthRisks cervicalCancer NonfatalvenousthromboembolismSimilarlowriskofVTEassociatedwithalllow doseOCsMyocardialinfarctionNoincreaseinriskFurtherstudiesmayproveOCsprotectiveStrokeNoincreaseinrisk OCHealthRisks ReducedriskofovarianandendometrialcancerMenstrualbenefitsImprovementinbenignbreastconditionsandovariancystsImprovementinacneReducedincidenceandseverityofPIDProtectionagainstectopicpregnancyMaintenanceofbonedensity OCNoncontraceptiveBenefits ThrombophlebitisorthromboembolicdisordersPasthistoryofDVTorthromboembolicdisordersCerebralvasculardiseaseorcoronaryarterydiseaseKnownorsuspectedcarcinomaofthebreastCarcinomaoftheendometriumUndiagnosedabnormalgenitalbleedingJaundiceHepaticadenomasorcarcinomasKnownorsuspectedpregnancySmokeroverage35 OCContraindications NauseaBreasttendernessMenstrualchangesWeightgainHeadache OCSideEffects Formulation Containsnorethindroneornogestrel28daysofactivehormonesCandidates WomenwhocannotorwillnottakeestrogenPostpartumandlactatingwomen Progestin OnlyPills Currentlyavailable InjectableDMPA Depo Provera CopperIUD Paragard ProgestinIUD Mirena Long ActingContraceptives DMPAInjections MenstrualchangesDelayedreturnoffertilityAlopeciaReducedlibidoWeightgain Depression DMPASideEffects Lossofbonemineraldensity LoweredHDLlevelProtectionagainstendometrialcancer noimpactonriskofothertypesofcancerReducesPMSsymptoms iron deficiencyanemia risksofPID ectopicpregnancy DMPAHealthRisks Benefits LevonorgestrelImplants Sideeffects risksIrregularbleedingAmenorrheaHeadacheHairlossWeightgainFunctionalovariancysts BenefitsImprovementofdysmenorrheaImprovementofPMS ImplantSideEffects HealthRisks Benefits InertCopperbearingProgestogenreleasing IntraUterineDevices IUDs Risks Perforationoftheuterus rare Infection antibioticprophylaxisnotneeded Expulsionrates CopperT Paragard 6 Progesterone releasingIUDs 3 8 IUDInsertionRisks CopperT increasedmenstrualbleedinganddysmenorrheaMirena irregularbleedingandspottingbeforeeventualamenorrhea IUDInsertionSideEffects MultiplesexualpartnersPregnancyAbnormalitiesoftheuterusPIDPostpartumendometritisorsepticabortionUterineorcervicalmalignancyUndiagnosedgenitalbleedingVaginitisorcervicitisIncreasedsusceptibilitytoinfectionPreviouslyinsertedIUDstillinplace IUD MajorContraindications Increasedmenstrualloss InfectionPregnancyExpulsionTranslocation ComplicationsofIUDS CondomsMalelatex polyurethane animalskinFemalepolyurethaneDiaphragmsCervicalcapSpermicides BarrierContraceptives MaleCondoms HowtoUseaCondom Figure6 1 TheFemaleCondomBrandName Reality TheDiaphragm TheCervicalCap Spermicides CreamsFilmsFoamsJelliesPessariesSponges AllofthesearemainlyNonoxynolbased Spermicides AlsocalledperiodicabstinenceorfertilityawarenessCalendar rhythm methodCervicalmucus ovulationorbillings methodBasalbodytemperaturemethodSymptothermalmethod NaturalFamilyPlanning 24hoursareallowedforovumsurvival3daysareallowedfrothespermsCoitusmustbeavoidedfromthe9thtothe15thday RhythmMethod safePeriod Figure6 4 TheFertilityCycle Billings Method Identifytheperi ovulatoryphasebynotingthevaginalsensationsassociatedwithchangesincervicalmucus HighdosesofcombinedOCsHighdosesofprogestin onlypillsEmergencycontraceptivepillspreventpregnancybyinhibitingordelayingovulation Theymayalsoaltertheendometrium makingitinhospitabletotheimplantationofova Theymayalterspermorovumtransport IUDThemechanismofactionoftheIUDasemergencycontraceptionremainsundefined EmergencyContraception NEWMETHODS OrthoEvra ThePatch SurgicalMethods 1 LaparoscopicsterilisationRings Clips Bipolardiathermy Laser2 Tuballigation ArtificialAbortion Definition Anabortionthatisbroughtaboutintentionally familyplanningetal AlsocalledaninducedortherapeuticabortionTheterminationofapregnancybeforthe24thweek AbortionofMethods Vacuumaspiration 1sttrimestDilationandEvacuation D E 2ndtrimesterDilationandCurettage D C 2ndtrimester4 Figure6 7 Amniocentesis AbortionofMethods Prostaglandinorinductionabortions 2ndtrimesterHysterotomy removalofthefetussurgicallyIntactdilationandextraction D X latetermabortionMifepristone RU 486 inducesabortionbyblockingprogesteroneusedwithMi
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