0521779407-C03 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:54
Contraception for the Internist 401➣Irregular bleeding, amenorrhea, weight gain, headaches, breast
tenderness, loss of libido, depression, nervousness, fatigue,
delayed return of fertility
➣Contraindications
➣Similar to OCs
➣Complications
➣Thromboembolism, angioedema, anaphylaxis, seizures
➣Prognosis
➣0.3% failure rate in first y; delay fertility up to 9 mo
■Subdermal implant:
➣Levonorgestrel placed subdermal for 5 y
➣Side Effects
➣Menstrual irregularities, headaches, acne, weight gain, nausea,
depression
➣Contraindications
➣Active thrombophlebitis, undiagnosed vaginal bleeding, acute
liver disease, breast cancer, known pregnancy, depression
➣Prognosis
➣0.2% failure rate in first y
■Patch
➣Estrogen/progestin patch weekly for 3 weeks and off for 1 week
➣Side Effects
➣Similar to OCs
➣Contraindications
➣Similar to OCs
■Vaginal Ring
➣Estrogen/progestin ring worn 3 weeks out of 4
➣Side Effects
➣Similar to OCs
➣Contraindications
➣Similar to OCs
■Intrauterine device (IUD):
➣Copper IUD replaced q 10 y
➣Progestin IUD replaced q 5 y
➣Side Effects
Dysmenorrhea, heavier menses esp with copper IUD
➣Contraindications
Absolute: cervical or uterine cancer, undiagnosed vaginal
bleeding, pregnancy, active PID
Relative: high risk of STD
➣Special Situations