Contraception

Short-term hormonal contraceptives 

Before initiating hormonal contraceptives: 

• Check blood pressure 
• Perform vaginal examination (to check normal size of uterus)
• Check for contraindications like deep vein thrombosis 

Follow up: 

• Instruct women always to inform the doctor or nurse that they are on contraceptives while attending clinic or hospital. 
• Women on oral contraceptives need regular physical check-ups including blood pressure measurement every six months  
• Need to withdraw Contraceptives in: 
  • Pregnancy 
  • Severe headaches especially associated with visual disturbances 
  • Numbness or paresis of extremities 
  • Unexplained chest pain or shortness of breath 
  • Severe leg pains etc 
  • Deep vein thrombosis.  

The recommended short-term hormonal contraceptives are: 

A: ethinyloestradiol+norgestrel (FDC) (PO) 0.03mg/0.3mg 24hourly   

OR 

A: ethinyloestradiol+levonogestrel (FDC) (PO) 0.03mg/0.15mg 24hourly            

OR 

A: ethinyloestradiol+desogestrell (FDC) (PO) 0.03mg/0.15mg) 24hourly 

OR 

A: medroxyprogesterone acetate (IM) 150mg every three months 

OR 

A: levonorgestrel (PO).0.03mg 24hourly  

Note: Take the first pill on the 5^th day of menstruation and then continue every day without any interruptions 

      Check blood sugar and hypertension after every 6 months  

      Avoid use in women with severe hypertension and women without proven fertility 

The method is applicable mostly after rape and unprotected sexual intercourse where pregnancy is  not desired. Within 3 days (72 hours) of unprotected sexual intercourse, give: 

A: levonorgestrel (PO) 1.5mg stat 

OR 

A: levonorgestrel (PO) 0.75mg 12hourly. 2 doses 

OR 

B:CuT380A Intrauterine Contraception Device (IUCD) may also be used. 

Note: Emergency contraception should not be used as a routine method of contraception. Clients should  be advised to use regular effective contraceptive methods of their choice. 

A: Male Condoms 

A: Female Condoms 

A correct use of both male and female condoms is required with every act of sexual intercourse for  greatest effectiveness.   

Note: Condoms are the only contraceptives that can protect against both pregnancy and STIs

Implant Contraceptives 

Implants are contraindicated to: 

• Severe hypertension 
• Thromboembolism 
• Active liver disease 
• Sickle cell anaemia 
• Genital bleeding 
• Severe headaches 

The following are the recommended implants: 

A: etonogestrel 68mg in single silastic capsule with applicator is implanted in the left upper arm with local anesthesia. Is effective for 3 years 

OR 

A: levonorgestrel 75mg in two silastic capsules implanted subdermal in the left upper arm with local anesthesia. Is effective for 5 years and is recommended for women who have  completed  their  family  or  not  ready  for  sterilization  or  those  not  able  to  take  estrogen  containing contraceptives. 

Note: Implants may be inserted during the immediate postpartum period, or after 4 weeks postpartum 

Intrauterine Contraceptive Device 

It  is  the  devise  containing  copper  or  Levonorgestrel  that  is  inserted  in  the  uterus  to  prevent  pregnancy 

B: CuT380A Intrauterine Contraception Device (IUCD) may also be used 

It  can  be  inserted  during  the  immediate  postpartum  period,  within  48hours  postpartum  or  after  4  weeks postpartum  

The contraindication to postpartum IUD includes

• Active postpartum haemorrhage 
• Puerperal sepsis/chorioamnionitis, active PID 
• Allergy to copper 
• Period within 48 hours and 4we                                

Note: Use the WHO Medical eligibility criteria (MEC) wheel on providing FP methods

The available permanent contraceptive options include; 

• Bilateral tubal ligation (female sterilization) for women who will not want more children 
• Vasectomy for men who will not wat more children