Oral Contraceptives - Pill Perils & Predicaments
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Injectables & Implants - LARC Landmines & Lessons
- DMPA (Depot Medroxyprogesterone Acetate)
- SE: Menstrual irregularities (amenorrhea/spotting), weight gain, mood changes.
- ⚠️ Reversible BMD ↓ (prolonged use > 2 yrs).
- Delayed fertility return (avg 9-10 mo).
⭐ DMPA is associated with a significant delay in return to fertility (average 9-10 months).
- Etonogestrel Implant (e.g., Nexplanon)
- SE: Irregular bleeding (most common), headache, acne, weight gain, local site reactions.
- SE: Irregular bleeding (most common), headache, acne, weight gain, local site reactions.
IUDs - Coil Complications & Cautions
| Feature | Copper IUD (Cu-IUD) | Levonorgestrel IUD (LNG-IUS) |
|---|---|---|
| Menstrual Bleeding | ↑ Heavier, prolonged menses, dysmenorrhea, intermenstrual bleeding/spotting | ↓ Amenorrhea, oligomenorrhea, spotting (initially then ↓) |
| Hormonal Effects | None systemic | Headache, acne, mood changes (less systemic than pills) |
| Other Issues | PID risk (highest first 20 days), expulsion, perforation | Functional ovarian cysts (usually resolve spontaneously) |
- Period late/abnormal bleeding
- Abdominal pain, pain with intercourse
- Infection exposure, abnormal discharge
- Not feeling well, fever, chills
- String missing, shorter, or longer
⭐ LNG-IUS can be used to treat heavy menstrual bleeding and provides endometrial protection.
Other Methods - Barrier Bumps & Sterilization Snags
- Barrier Methods (Condoms, Diaphragms)
- Issues: Local irritation, allergy (latex), UTIs (diaphragm), Toxic Shock Syndrome (TSS) risk (prolonged diaphragm/cap use).
- Sterilization (Tubal Ligation, Vasectomy)
- Issues: Surgical risks (infection, bleeding, anesthesia).
- Failure leads to pregnancy; female sterilization failure carries high ectopic risk.
⭐ Failure of female sterilization carries a high risk (e.g., 30-50%) of subsequent ectopic pregnancy.
- Post-Tubal Ligation Syndrome (PTLS): Menstrual changes, pelvic pain.
- Post-Vasectomy Pain Syndrome (PVPS): Chronic testicular pain.
- Emergency Contraception (EC)
- Issues: Nausea, vomiting, headache, fatigue, menstrual irregularities (spotting, changed timing).
High‑Yield Points - ⚡ Biggest Takeaways
- OCPs/CHCs: Key risks: venous thromboembolism (VTE), hypertension. Avoid in smokers >35 (↑ arterial thrombosis).
- Progestin-only Pills (POPs): Irregular bleeding common; risk of functional ovarian cysts.
- DMPA (Injectable): Causes weight gain, delayed fertility return, ↓ bone mineral density (long-term).
- Implants: Main side effect: irregular menstrual bleeding.
- Copper IUDs: Cause heavier menses, dysmenorrhea; ↑ PID risk (insertion).
- Levonorgestrel IUDs: Initially irregular bleeding, then amenorrhea; may cause ovarian cysts.
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