. CLINICAL ASSESSMENT I WILL ASK ABOUT HER PREVIOUS EXPIERINCE OF CONTRACEPTIVE METHOD WHICH METHOD SHE WAS USE AND FOR HOW LONG . HER MENSTRUAL HISTORY REGULARITY , DATE . IF SHE HAS ABNORMAL BLEEDING . IWILL ASK HER ABOUT HER MEDICAL HISTORY AS HER BMI 42 MAY HAS HYPERTENSION , DIABETIES . ASK ABOUT PREVIOUS HISTORY OF VTE OR STROKE . ANY RECENT ATTACK OF STD FAMILY HISTORY OF CANCER BREAST , OVARIAN CANCER .IWIIL CHECK HER BP . BREAST EXAMINATION . LOCAL EXAMINATION FOR ANY ABNORMAL DISCHARGE TENDERNESS ON VAGINAL EXAMINATION . PELVIC MASSES I WILL CHECK HER RBS TO DETECT DM FBC FOR ANEMIA . LIVER FUNCTION TEST PREGNANCY TEST IF SHE HAS IRREGULAR CYCLE
OPTIONS FOR HORMONAL CONTRACEPTIVE . COMBINED METHOD , COC FAILURE RATE 0.1/100 WOMEN YEAR , IT REDUCE CYCLE, CORRECT ANEMIA ,IMPROVE DYSMENORRHEA DECREAS RISK OF PID OVARIAN AND ENDOMETRIAL MALIGNANCY . RAIPD RERETURN OF FERTEILTY. ITS COMIPLCATION S INCREASE RISK OF VTE . STROK ,BREAST CANCER, CX CANCER , MYOCARDIAL INFARCTION, HYPERTENSION , LIVER DISEASE . HER BMI 42 SO UK MEC 3
OTHER PREPARATION OF COMBINED METHODS ARE INJECTABLE USED ONCE MONTHLY . CONTRACEPTIVE PATCHES, PEARL INDEX 0.88 , PATCH CHANGE EVERY 7D FOR 3W THEN 7 DAYS FREE SIDE EFFECT SKIN REACTION HEADACHE BREAST TENDERNESS ,NAUSEA.
PROGESTOGEN ONLY METHODS . POP EFFECT CAUSE THICKNING OF CERVICAL MUCUS CERRAZETTE INHBIT OVULATION IN 97% PEARL INDEX 0.3/ 100 WOMEN YEAR, ADVANTAGES EFFECTIVE . REVERSIBLE NO DELEAY IN FERTILITY.DISADVANTAGES AMENORRHEA . IRREGULARE BLEEDING WT GAIN VAGINAL DRYNESS MOOD SWINGES . INJECTABLE PEARL INDEX 0.2 100WOMEN YEAR INJECTION IM EVERY 3M FOR DEPO-PROVERA , 2MOMTH FOR NORISTERAT . DISADVANTAGES MENSTURAL IRREGULARTY . DELAY RETURN FOR FERTLITIY UP TO 2 YR , WEIGHT GAIN . OSTEOPROSIS
SUBDERMAL IMPLANTS INHIBIT OVULATION PEARL INDEX LESS THAN 1 /1000 3YR USE LARC CAN BE USE WITH BMI MORE THAN 30 DISADVANTAGES . IRREGULAR BLEEDING NEED EXPIRENCE PERSON FOR INSERTION AND REMOVAL.WRITTEN INFORMATION ABOUT ALL CONTRACEPTION SIDE EFFECT ADVANTAGES . DISADVANTAGES WHEN TO SEEK ADVICE SHOLUD GIVEN TO THE WOMEN .
. USE OF INTRAUTRINE CONTRACEPTION IN THE WOMEN IT PREVENT FERTILZATION AND IMPLANTATION . IUS HAS LOCAL PROGESTOGENIC EFFECT ON ENDOMETRIUM AND CX MUCUS . DISADVANTAGES DIFFICULT IN INSERTION .PAIN VAGINAL BLLEDING RISK OP PID . EXPULSION . . CONTRAINDICATIONS SEPTIC ABORTION .GESTAIONAL TROPHOBLAST WITH ELEVATED HCG UNEXPLAINED VAGINAL BLEEDING . ENDOMETIRIAL CANCER ..TYPES CU T380 A USED FOR 10 YR FAILURE RATE 2 FOR 100WOMEN 5YR EXPALSION 8PER 100WOMEN 5YR . MULTILOAD USE FOR 5YR , GYNAE FIX FOR 5YR REDUCE DYSMENORRHEA . MENSTRUAL LOSS EASY FOR INSERTION IN NULLIPARA . MERINA IUS CONTAIN LEVONORGESTEREL RELEASE 20MCG PER DAY USED FOR 5 Y ADVANTAGES USE IN MANAGMENT OF MENORRHAGIA . DYSMENORRHEA LOWER RATE OF ECTOPIC PREGNANCY PROTECTION AGAINST PID . DISADVANTAGES PROGESTOGENIC SIDE EFFECT. SO INTRAUTRINE DEVICE CAN BE SUTIBLE LARC FOR THIS WOMEN . .
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