This category includes contraception devices which have long duration of action and fertility can be regained at any point of time by its expulsion from the body.
These includes:
• Injectable DMPA
• Progesterone Implants
• Intrauterine devices – CuT
• MIRENA
Injectable DMPA:
• It is available under the name DEPO – PROVERA.
• DMPA stands for Depo Medroxy Progesterone Acetate.
• It is made available free of cost by the government of India.
• It can be used freely by breastfeeding mother also after 6 weeks post partum as it only contains progesterone.
• A dose containing 150 mg is injected every 3 monthly intramuscularly.
• It is contraception of choice in:
– Females with epilepsy as it decreases seizures.
– Females with scikle cell anemia as DMPA decreases sickling crisis.
• Some adverse effects associated with it are:
– Bone loss
– Irregular vaginal bleeding
– Delay in return of fertility after stopping the method (about 12 months)
Progesterone Implants:
• It contains 6 Silastic rods containing Levonorgestral.
• It is a Norplant system.
• It acts by inhibiting ovulation, cervical mucus thickening, altered tubal motility and makes endometrium thin (all these actions are due to progesterone in it).
• Failure rate is 0.05%
• Return to fertility after implant withdrawal is quick unlike that of injectable DMPA.
IMPLANON
• Latest type of progesterone implants.
• It consists of only one rod containing 68 mg of etonorgestral.
• It is inserted subdermally in medial aspect of non dominant arm.
• It is effective for 3 years.
• It is most effective method with failure rate of 0.01%.
NEXPLANON
• Same as IMPLANON
• It is radio opaque
CAPRANON
• It is biodegradable type of implant, i.e., its removal is not required (gets destroyed in the body itself by the action of enzymes after a certain period of time).
• It is effective for 12 months.
Intrauterine Devices:
Intrauterine devices (IUD) or intrauterine contraceptive devices (IUCD) are the devices which are inserted in the uterine cavity in order to control pregnancy.
Intrauterine devices are as follows:
1. Lippes Loop – these are large loops which are now no longer in use.
2. Copper containing – CuT, Multiload
3. Hormone releasing – Progestasert, MIRENA
CuT 380 A:
• It is available by the government of India free of cost.
• It has a life span of 10 years.
• It may sometimes be used as a method of emergency contraception.
• Copper decreases sperm motility and viability hence helps in inhibition of fertilization. It also inhibits implantation by initiating local inflammatory response in the endometrium.
• Contraindications of CuT are-
– Post septic abortion
– Anatomical uterine abnormalities (eg -septate uterus)
– Active genital tract infection
– Current PID
– Puerperal sepsis
– Genital tract malignancy
– Unexplained vaginal bleeding
– Prolonged labor
• Timing of insertion of CuT-
– Post partum (within 48 hrs of delivery)
– Immediately after delivery of placenta
– After cesarean section
– Post abortal
– Interval insertion (within first 5 days of menstrual cycle otherwise other contraception method needed for that month)
• Adverse effects of CuT-
– Increased mentrual bleeding
– Increased pelvic pain
– May cause actinomycosis infection
– May cause perforation of membranes
– Expulsion of CuT which may not be noticed.
MIRENA:
• This method is effective for 5 years.
• It contains 52 mg levonorgestral
• It can be used in hormone replacement therapy (for progesterone)
• It’s main mechanism of action is by inhibiting implantation.
• It lowers the risk of PID.
• It also lowers the blood loss which is helpful in abnormal uterine bleeding (endometriosis, fibroids)
• It has a local effect, therefore it causes no systemic adverse effects.
• It is not a method of emergency contraception.
Contributor- Medico Eshika Keshari
