JHPIEGO TrainerNews™ |
Contraceptive Update
(December 2001)
Contraceptive Pearl: Contraceptive Patch
Question: This contraceptive patch sounds interesting, but I have a couple of questions. Where on the body do you wear it? And how much will it cost?
Answer: It is recommended to wear it in any of 4 places--the buttocks, the abdomen, the upper torso (front or back, excluding the breasts) or upper outer arm. Part of the idea is to find a flat spot on the skin. The patch is actually not very large. It is somewhat diamond or "rhomboid" in shape and each of its 4 sides is 1 and three-quarters inches long.
When actually marketed in the US next year, it is expected to cost a bit more than OCs--perhaps $40 a cycle.
Contraceptive Pearl: IUD followup
Question: In my country, IUDs seem to be increasing a bit in popularity, particularly in a number of our clinics where an especially strong emphasis is on quality provision of IUDs. Some of our clinics recommend followup every 3 months after the insertion but other providers say so many followup visits aren't needed. So we are wondering, when is it most appropriate to advise clients to return to the clinic for followup?
Answer: At approximately 1 month and also any time the client has problems or questions, or has need of other offered services. While pelvic inflammatory disease (PID) is actually uncommon as a result of IUDs and only increased in women at risk of STIs, the incidence of PID is highest within the first month or so after insertion and falls off very rapidly after that. Other problems such as pain, bleeding and expulsion also tend to cluster within the first month. So it is important to put the emphasis on the 1-month visit and then encouraging and making it easy for clients to return when and if they have specific felt needs. Additional routine scheduled followup visits are of low utility and resources can be better used for other services.
Contraceptive Pearl: Bleeding and pain with IUDs
Question: I see your point about the low risk of PID attributable to the IUD, but what about increased bleeding and cramping that can come as a result of IUD insertion? Aren't they common? Can anything be done for them?
Answer: Yes increased bleeding and cramping are both relatively common with IUDs--especially soon after insertion. Good counseling before and after insertion is of course the first priority. In addition, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can reduce the cramping pain and bleeding sometimes associated with IUD insertion.
NSAIDs' effectiveness appears to be partly related to their anti-prostaglandin activity (since uterine pain and bleeding are partly mediated by prostaglandins) as well as more direct pain relief. Some providers prefer to use other pain relievers, and provider opinions differ on exactly under what circumstances and how such drugs should be used. Though some NSAIDs such as ibuprofen are available over-the-counter in the US, they have their own side effects. Still, NSAIDs such as ibuprofen tend to be cheap and easily obtained in the developing world.
Of course, according to the client's wishes, pain and bleeding may necessitate removal of the IUD. However, if problems such as pain and bleeding that tend to occur early can be addressed sufficiently well, women who use IUDs are among the most satisfied contraceptive users.
These "Pearls" were prepared by Dr. James D. Shelton, Senior Medical Scientist, Office of Population, United States Agency for International Development (USAID).