Long Acting Reversible Contraceptive Methods

Long-acting reversible contraceptives (LARC) are a class of birth control treatments that provide effective contraception for an extended period of time without the requirement for user interaction. They include subcutaneous contraceptive implants, injections, and intrauterine devices (IUDs).

Intrauterine Contractive Devices (IUCD)

The intrauterine device is one of the most well-liked and reliable methods of birth control offered to women globally (IUD). Currently, it is estimated that over 100 million women use IUDs. Recently, TCu 380A IUD acquired a 12-year approval. Types of IUCDS:

There are three types of IUCDS.

• Inert
  • Made of stainless steel or plastic (lippes loop or Saf-T-Coil).
• Copper bearing (Tcu-380)
• Medicated
  • Utilizing a steroid hormone

The TCu-380A is the newest IUD generation available in Nepal; it has a tatal exposed copper area of 380 square mm as well as copper on the stem and arms. Copper collars mounted on the arms will transport copper high in the fundus of the uterus. This IUD comes in pre-sterilized packaging. The lifespan of the TCu 380A is 12 years. The copper TCu 380A has a white string.

Mechanism of Action

IUDs were once thought to only have uterine effects, acting to either stop implantation or destroy developing embryos in the uterus before implantation. IUDs made of copper primarily operate as contraceptives by preventing fertilization, limiting the number of sperm that enter the fallopian tube, and inactivating those that do, according to scientific evidence from various studies.

Ten years after the client receives the injection, the contraceptive function is still effective. Take notice that an IUD that has been inserted in a customer has a 10-year shelf life. After 12 years, a client can get a replacement IUD if they still want to use one.

Benefits:

• Incredibly effective In the first year, there were 0.3 to 1 births per 100 women.
• Enduring security that takes action right away (up to 12 years or more)
• Immediately return to fertility after removal
• Little negative repercussions from the strategy (local only)
• Doesn't interfere with sexual activity Conveniently, strings only need to be checked once a month.
• Customers don't need any more materials; economical
• Mothers who are nursing can use it.
• No matter what age a lady is, she can use it as long as she
• May increase the incidence of PID in women at high STD risk, which may result in subsequent infertility.
• Insertion and removal only need a tiny amount of surgery.
• After each menstrual cycle, strings need to be checked.
• During the first few months, many users experience increased cramping and menstrual bleeding, which the client is unable to stop on her own.
• There is no protection against STDS or AIDS/HIV.
• It might exit the uterus into the vagina after passing through the cervical canal (os).

Menstrual Changes in IUD Users

An important counseling point for prospective and current IUD users is the fact that it's typical for them to experience heavier and longer menstrual bleeding, intermenstrual bleeding, spotting, and more cramping during the first few months after insertion. Assure your customers that these adjustments are typical and that they should resume having their regular menstrual cycle in a few months.

STD Prevention and IUDS

Clients who are considering having an IUD should be informed that they do not provide protection against AIDS or STDs. For people who may be at risk of STDs, condom use should still be strongly encouraged even if a person has an IUD.

Timing for Insertion

IUDs are frequently put during the beginning or end of menstruation. The following are some advantages of having insertions performed:

• There is very little probability that the woman is pregnant.
• Cramps and bleeding might not be as visible or worrisome.

IUD insertions may also be performed at the times after anxiety:

• If it is known that the woman is not pregnant, it can happen at any point during the menstrual cycle.
• Postpartum:
  • 48 hours after delivery or when the uterus has finished involution
• Post-abortion:
  • If there is no indication of infection, immediately for first trimester abortions. Abortions performed in the second trimester following uterine involution
• The health care provider should give the woman a month's worth of condoms or another form of family planning to ensure that she does not become pregnant until the woman's next menstrual cycle, when the IUD can be implanted.

Effectiveness

IUDs have a 97% to 99% technique effectiveness. One of the key advantages of the IUD is that its range of actual efficacy for users (about 90–96%) is quite equal to its theoretical effectiveness because its action is independent of the customers' decisions.

Side Effects

• Side effects control.
• Remove IUCD if fewer than 13 weeks pregnant (if strings visible).
• Reassure if not pregnant.
• Identify any pregnancy.
• Amenorrhoea.

Do not remove the IUCD if you are more than 13 weeks pregnant.

• Heavy bleeding
  • Examine your pelvis for any infections. Consult the Bleeding/Spotting Protocol 1-9 and/or the Bleeding P/V Protocol 7-1 (p. 26). (p.146). If you are not pregnant and there is no infection, give Brufen 400 mg eight hours each day for eight days.
• Abdominal pain
  • Examine and treat any ectopic pregnancies or pelvic infections. For lower abdominal pain, go to Protocol 7-1 or Protocol 4-7 (p.116) (p.146). A P/V bleed
• Severe uterine cramps
  • IUCDs that were implanted less than three months ago should be treated with brufen. Use Brufen to treat if it occurred more than three months ago. If there is no improvement, consider removal.
• A partner offers criticism Check to make sure IUCD wasn't rejected. If necessary, cut the strings.
• The need for follow-up is stressed and it is advised to return for a continuous method of contraception if the period is delayed for longer than 7 days.

Warning Signs of IUCD

• P: Period missing
• A: Abdominal discomfort
• I: Infection
• N: Not feeling well
• S: String missing

Norplant Implant

Subdermal implants are a new kind of long-acting contraceptives. The Norplant trademark for subdermal contraceptive implants has been registered by the population council. When a woman decides to have Norplant implants placed during a brief surgical procedure under local anesthesia, she has the option of birth control with just one decision.

Mechanism of Action

• Stop ovulation.
• To lessen tubal turgor.
• The endometrium be altered.

Effectiveness

Norplant implants are among the best reversible contraceptive options. Despite the fact that no method of birth control is 100% successful, the average annual pregnancy rate for norplant is less than 1%.

Timing of Insertion

At any stage of the menstrual cycle, Norplant implants can be inserted. Assuming it is possible to prove the client's infertility. The following situations are ideal for implanting Norplant:

• During menstruation
  • After seven days since the start.
• Post-abortion
  • Within the first week or right away.
• Post partum
  • when a postpartum mother receives her child's F3 vaccine. Insertion may be postponed for up to six months after delivery if the woman is exclusively breastfeeding and has not yet begun menstruating.

Benefits

• Highly effective, continuing therapy for up to 7 years.
• Immediate return to old level of fertility.
• It is safe, easy to use, and doesn't interfere with sex or sexual desire.
• It does not prevent breastfeeding
• Deleted at any time and for any reason.
• Client doesn't need any supplies.
• Because the surgery is estrogen-free, there are little health risks linked with it.
• Reversible
• A pelvic exam is not required.
• Comfortable and discreet

Limitation

• Periodic modifications are rather common.
• It's possible to see the implants.
• Absence of AIDS, HIV, or STI defense
• It's possible to acquire or lose weight.
• Implantation and removal require surgery.

Indication for Use

Women Who:

• Want a protracted gestation period.
• Are unwilling to have any more children but are not yet ready for sterilization.
• Following childbirth (after 6 weeks if breast feeding).
• After-abortion clientele.
• Have successfully used progesterone-only methods.
• If your period is irregular, don't worry.
• Desire or require abstinence from estrogen.
• Not interested in daily birth control.

Side Effects

• Breast sensitivity.
• Chest pain
• Depression.
• Headache.
• A feeling of nausea, dizziness, or nervousness.
• Weight fluctuation
• Periodic changes.
• Over the implant site, hyperpigmentation.
• Galactorrhea.
• Change in appetite.

Precautions for Use

Caution should be used before a lady has norplant implants.

• Hepatic tumors that are cancerous or not.
• Mammary cancer (past or current)
• Liver disease in progress
• Vaginal bleeding that is undiagnosed.
• Possible pregnancy
• Breast swell

Commonly observed negative effects (> 1/100, 1/10)

• Mood shifts
• Depression
• Alterations in libido
• Dyspareunia
• Hypertension, palpitations, and chest pain
• Dilated veins
• Dyspnoea
• Uncomfortable stomach
• Contact dermatitis and acne
• Alopecia
• Colour of the skin
• Breast drooling
• Near the insertion site, there is itching
• Loss of weight
• Back ache
• Implant expulsion is hardly common.