Contraception for the Medically Challenging Patient by Rebecca H. Allen, Carrie A. Cwiak

By Rebecca H. Allen, Carrie A. Cwiak

Women with continual scientific difficulties are at better probability for problems while pregnant and as a result, they're specifically short of applicable preconception and birth control care. in addition, many girls with power clinical difficulties don't receive enough preconception and birth control care. regardless of released instructions via the facilities for disorder keep an eye on and Prevention, there's a enormous hole in clinical perform in regards to the use of birth control in girls with co-existing clinical problems.

Contraception for the Medically not easy Patient fills the space that at present exists within the wisdom of right contraceptive prescribing perform and exhibits that beside the point contraindications can simply turn into a barrier to powerful birth control use between ladies. Chapters spotlight out of date perspectives approximately applicable applicants for birth control and deal with the advanced contraceptive wishes of present day medically demanding sufferers with HIV/AIDS, uterine fibroids or cardiac, neurologic or thyroid illness. The ebook offers recognition to tips about using birth control in girls with scientific difficulties equivalent to diabetes, weight problems, epilepsy, and lupus, between others and offers entire information about the results that sure medicinal drugs can have on contraceptive hormone degrees. whereas nationwide instructions do exist for contraceptive eligibility, this e-book discusses in additional element the proof at the back of the rule of thumb options and the nuances that clinicians confront in day-by-day practice.

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Example text

Additionally, the working group on pregnancy and contraception for women with cardiac disease, as described previously, provides a risk classification system specifically for contraception for women with cardiac disease [24]. This group adapted and expanded on the World Health Organization’s contraceptive risk classification system and used the same four-tiered risk stratification (1 = no restriction, 2 = advantages generally outweigh theoretical or proven risk, 3 = theoretical or proven risk generally outweighs advantages, and 4 = unacceptable method).

Thus, although we recognize the potential for bleeding at insertion site, we assert that subdermal contraceptive implants are a preferable contraceptive method to DMPA in anticoagulated women. Finally, anticoagulated women are at risk for heavy menstrual bleeding, and may benefit from the use of contraceptive methods that reduce menstrual flow or induce amenorrhea. A theoretical concern with intrauterine devices (IUD) for 21 women with cardiac disease is the possible increased risk of endocarditis in high-risk women (see section “Valvular Heart Disease”).

4) c Uncomplicated vs. complicated d Uncomplicated vs. with hypertension or aneurysm Although the contraceptive implant is safe and effective in women with A-fib and A-flutter, case reports suggest that in anticoagulated women the INR should be closely monitored for potential interaction between warfarin and etonogestrel [24, 34]. There are no specific recommendations for the use of the copper IUD in women with arrhythmias. However, the levonorgestrel intrauterine device (LNG-IUD) has been used safely in women on warfarin and may be more appropriate than the copper IUD in anticoagulated women due to its beneficial effects on uterine bleeding profiles [77– 80].

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