Implants, Devices, Patches

Implants, Devices, Patches

Hormonal implant device (Failure rate: 0.07 per 100 women)

Hormonal implant device is a hormonal implant that is placed under the skin of a woman’s upper arm. This is an effective way of preventing pregnancy for up to 3 years. The implant is approximately the size of a toothpick. It contains synthetic progestin hormone (68mg etonorgestrel).

How does hormonal implant device work?

The progestin hormone released by the ImplanonÆ will suppress the pituitary gland which then stops the ovaries from releasing eggs. It also makes the cervical mucus thicker, preventing the sperm from reaching the egg.

When should I insert hormonal implant device?

It can be inserted any time as long as one is not pregnant. It is ideally inserted within the first 5 days of your menstrual cycle. If you are on other forms of contraception and switching over, do speak to your doctor on the suitable time for insertion of ImplanonÆ.

Can you see or feel the Hormonal implant device?

Usually you will not see it under your skin. In thinner women, the outline of the implant may be visible. You may be able to feel it under your arm, but it should not be painful.

Benefits of hormonal implant device:

  • Lighter or stops menstrual period
  • Reduce menstrual cramps

Common side effects of hormonal implant device:

  • Irregular or absence of menses
  • Headache
  • Acne
  • Breasts tenderness
  • Mood swings
  • Weight gain

Direct side effects due to insertion of Hormonal implant device:

  • Infections
  • Bleeding
  • Local skin irritation
  • Allergic reaction
  • Displacement or explusion of the implant

Contraindication of using Hormonal implant device:

  • Pregnant
  • Undiagnosed vaginal bleeding
  • Liver disease
  • Breast cancer

What happens after 3 years of hormonal implant device?

You should make an appointment with your doctor, to discuss on taking out the implant. A new implant can be inserted on the same setting after the old implant being removed. If you are switching to other methods of contraception, do discuss with your doctor.

Good news is, 90% of women restore their ovulation and fertility within 3-4 weeks after removal of hormonal implant device.

Intrauterine Contraception Device (IUCD) (Failure rate: 0.1-0.5 per 100 women)

IUCD is a method of contraception whereby a copper-containing IUCD or Lenovogestrel containing IUCD (Mirena) is inserted through the vagina and cervix into the uterus to prevent pregnancy.

In copper containing IUCD, it is hormone-free. It has copper wire coiled around the stem and arms of IUD. In Mirena IUCD, there is continuous release of levonogestrel (a type of progestin) into the uterus.

IUCDs have strings attached at the end for patient to check, making sure the device is in place. The strings also facilitate doctors during removal of the IUCD later on.

How does IUCD work?

The device prevents the burying and implantation of fertilized eggs onto the uterus and also thickens the mucous of cervix, preventing the sperm to reach the egg

Where, when, how can I get an IUCD? Do I get instant protection against pregnancy?

You are advised to discuss with your doctor on the different methods of contraception. IUCD can be inserted by your trained doctor. Your schedule of insertion is the time of your period. Once the IUCD is inserted, it will stay in your uterus, and protects you against pregnancy until you remove it. IUCD typically protects against pregnancy 3-5 years, depending on the types of IUCD.

If the IUCD is inserted during your period, the protection against pregnancy starts right after insertion. If it is inserted in another time of your menstrual cycle, the Copper-containing IUCD will work immediately for contraception. However, for Mirena, that will take 7 days before able to fully work as an effective contraception.

What should I do after IUCD being inserted?

At regular monthly time interval, such as the end of monthly menstrual period, you are advised to check the strings inside your vagina. This can be done by inserting a clean finger into your vagina all the way to your cervix. Your doctor will explain further during consultation and show you how it should look like with a mirror. IUCD strings feels like a light plastic thread or fishing line. They should be 4-5cm down below your cervix into your vagina.

If you cannot felt the strings, or you have felt the IUCD itself, chances are the IUCD is not in the right place. You will need extra contraception method if you have sex and you will need to consult your doctor.

When should I remove IUCD?

This depends on the type of IUCD, and how long your IUCD is able to protect you against pregnancy. However, you can opt to remove the IUCD by your doctor at any time. A new IUCD can be inserted at the same setting of removal. Once the IUCD is removed, you can be pregnant, hence you will need to consider other forms of contraception.

Side effects of IUCD:

  • Injury to the uterus
  • Fainting spells
  • Pelvic pain
  • Pelvic infection
  • Heavy menses

Contraindication for using IUCD:

  • Pregnant
  • Abnormal structure of the womb
  • At risks of sexually transmitted infection
  • Infection of the pelvis
  • Copper allergy
  • Liver disease
  • Cervical, uterine, ovarian cancer
  • Breast caner

When should I be concerned of my IUCD and see my doctor?

  • Cannot feel the strings attached to IUCD
  • Cannot feel the IUCD in your cervix
  • Severe abdominal pain and cramps
  • Painful menses
  • Bleeding during sex
  • Fever
  • Abnormal vaginal discharge and odor
  • Found to be pregnant

Intrauterine Contraception Device (IUCD) (Failure rate: 0.1-0.5 per 100 women)

IUCD is a method of contraception whereby a copper-containing IUCD or Lenovogestrel containing IUCD (Mirena) is inserted through the vagina and cervix into the uterus to prevent pregnancy.

In copper containing IUCD, it is hormone-free. It has copper wire coiled around the stem and arms of IUD. In Mirena IUCD, there is continuous release of levonogestrel (a type of progestin) into the uterus.

IUCDs have strings attached at the end for patient to check, making sure the device is in place. The strings also facilitate doctors during removal of the IUCD later on.

How does IUCD work?

The device prevents the burying and implantation of fertilized eggs onto the uterus and also thickens the mucous of cervix, preventing the sperm to reach the egg

Where, when, how can I get an IUCD? Do I get instant protection against pregnancy?
You are advised to discuss with your doctor on the different methods of contraception. IUCD can be inserted by your trained doctor. Your schedule of insertion is the time of your period. Once the IUCD is inserted, it will stay in your uterus, and protects you against pregnancy until you remove it. IUCD typically protects against pregnancy 3-5 years, depending on the types of IUCD.

If the IUCD is inserted during your period, the protection against pregnancy starts right after insertion. If it is inserted in another time of your menstrual cycle, the Copper-containing IUCD will work immediately for contraception. However, for Mirena, that will take 7 days before able to fully work as an effective contraception.

What should I do after IUCD being inserted?

At regular monthly time interval, such as the end of monthly menstrual period, you are advised to check the strings inside your vagina. This can be done by inserting a clean finger into your vagina all the way to your cervix. Your doctor will explain further during consultation and show you how it should look like with a mirror. IUCD strings feels like a light plastic thread or fishing line. They should be 4-5cm down below your cervix into your vagina.

If you cannot felt the strings, or you have felt the IUCD itself, chances are the IUCD is not in the right place. You will need extra contraception method if you have sex and you will need to consult your doctor.

When should I remove IUCD?

This depends on the type of IUCD, and how long your IUCD is able to protect you against pregnancy. However, you can opt to remove the IUCD by your doctor at any time. A new IUCD can be inserted at the same setting of removal. Once the IUCD is removed, you can be pregnant, hence you will need to consider other forms of contraception.

Side effects of IUCD:

  • Injury to the uterus
  • Fainting spells
  • Pelvic pain
  • Pelvic infection
  • Heavy menses

Contraindication for using IUCD:

  • Pregnant
  • Abnormal structure of the womb
  • At risks of sexually transmitted infection
  • Infection of the pelvis
  • Copper allergy
  • Liver disease
  • Cervical, uterine, ovarian cancer
  • Breast caner

When should I be concerned of my IUCD and see my doctor?

  • Cannot feel the strings attached to IUCD
  • Cannot feel the IUCD in your cervix
  • Severe abdominal pain and cramps
  • Painful menses
  • Bleeding during sex
  • Fever
  • Abnormal vaginal discharge and odor
  • Found to be pregnant

Hormonal Intrauterine Device (IUCD) (failure rate: 0.16 per 100 women

Hormonal IUCDs contains 52mg levonogestrel and releases 20μg of levonogestrel every day.

How do IUCDs work?

The way of preventing pregnancy has been discussed as per in IUCD chapter. Furthermore, with the presence of levonogestrel (progestin) hormone, there is local effect to the uterus leading, lightening up the period.

Common side effects of hormonal IUCDs:

  • Intermittent menstrual spotting up to first 6 months
  • Absence of menses after 1 year
  • Risk of ectopic pregnancy 0.02 per 100 women
  • Headache
  • Mood swing

Contraindication of using hormonal IUCD:

  • Pregnancy
  • Pelvic infection
  • Risks of sexually transmitted disease
  • Unexplained vaginal bleeding
  • Liver disease
  • Breast cancer
  • Blood clotting histories or risks of blood clotting
  • Severe migraine

Hormonal Transdermal Patch (Failure rate <1 %)

Hormonal transdermal patch looks like a square band-aid (size less than 2’’ x2’’). It is a patch that sticks on the skin. It works similarly to birth control pills, with 60% higher dose in comparison on oral contraceptives, absorbed through the skin. A single Evra Patch consists of 0.75mg ethinylestradiol and 6mg norelgestromin.

How can I apply hormonal transdermal Patch?

You are advised to apply 1 patch each week for 3 weeks, and have patch-free for 1 week.

You can apply the patch over the lower abdomen, the buttock, back, upper arm. Once you have stuck the patch on, you should leave it there for 7 days. You are advised to change the location of patch every week.

It is important to ensure the skin area is not irritated or there was a rash or a cut. Avoid sticking the patch over a skin surface that has lotion or cream on.

Timing of application of hormonal transdermal Patch

  • You are advised to apply the patch on the first day of your menstrual cycle or any other day of your menstrual cycle. You will need extra contraception method for 7 days.
  • If the patch is detached < 24hours, reapply the patch.
  • If the patch is detached > 24hours, apply a new patch, and you will need extra contraception methods for 7 days.

You are advised to change the patch on the same day of the week. For example, if you start on Monday, then you change your patch every Monday, and so on.

What if my skin under the hormonal transdermal Patch becomes red and irritated?

You can remove the patch and replace a new patch over another area of unaffected skin. Leave the new patch in place until your normal time for change of patch. Never wear 2 patches together.

Can I continue shower, bath, swimming, exercise with hormonal transdermal Patch?

Yes, you can. The patch should not impair you from our normal functional routine.

Is hormonal transdermal Patch as effective as oral contraceptive pills in preventing pregnancy?

Yes, if it is used correctly.

Common side effects of hormonal transdermal Patch:

  • Irregular bleeding
  • Headache
  • Nausea
  • Allergy and irritation to patch
  • Breast tenderness
  • Mood swing
  • Risks of blood clot events

Contraindication of using hormonal transdermal Patch:

  • Pregnancy
  • History of blood clots events
  • Undiagnosed vaginal bleeding
  • Uterine, ovarian, cervical cancer
  • Breast cancer
  • Liver disease

Vaginal Hormonal Ring (Failure rate: <1%)

Vaginal hormonal rings are a female method of contraception. Vaginal hormonal rings contains combination estrogen (15μg ethinyl estradiol) and progestin(etonogestrel 0.12mg) hormones.

How does A vaginal hormonal ring work?

When a vaginal hormonal ring is inserted into a woman’s vagina, the hormones are absorbed through the vaginal wall and this will enter the blood stream. The hormone works by avoiding the release of eggs from the ovaries and thickening the mucous of the cervix, preventing the sperm meeting the egg.

How to insert a vaginal hormonal ring?

A vaginal hormonal ring is inserted into the vagina the same way as inserting a tampon. Once in place, the ring is left in the vagina for 3 weeks, then removed for 1 week. A new ring is then inserted 7 days after removal of the old ring.

Timing of insertion for a vaginal hormonal ring

You are advised to insert Nuva RingÆ on the first day of menses, you will need 7 days of extra contraceptive measures.

Will I feel the vaginal hormonal ring once inserted?

Most women do not feel it once it is in place. If you do feel it, you can gently push in further the ring. If you feel uncomfortable, you can remove it and speak to your doctor.

Will vaginal hormonal rings fall out?

It is possible for the Nuva RingÆ to fall out if the insertion is not high enough in your vagina, or you strained yourself during bowel movement, or slipped out altogether when you are removing a tampon.

What should I do if the vaginal hormonal ring falls out?

  • If this occurs within 3 hours, you can gently rinse it under cold water and re-insert the ring back into your vagina.
  • If this occurs more than 3 hours, or you forget to put the ring back your vagina, re-insert the ring back as soon as possible, but you will need extra method of contraception for 7 days

If I am wearing vaginal hormonal rings, can I use tampons?

Yes, but removal of tampon increase risk of the ring falling out. In theory you should not have your period during the 3 weeks when you are wearing the ring, and you should have your period only during the ring-free-week. So, you should not be concern about wearing tampon at that time.

What if I forgot to remove the vaginal hormonal ring?

  • If you are using Nuva RingÆ in a cyclic way (3 weeks on, 1 week off), and you have left the ring up to 4 weeks, remove the ring, wait for 1 week before you insert a new ring.
  • If you are using the ring in a continuous way, and you leave the ring in for up to 4 weeks, remove the ring, throw it away, and insert a new ring.

Medical Benefits of the vaginal hormonal ring:

  • Lightens period
  • Reduce menstrual cramps
  • Alleviate symptoms in women with endometriosis

Common side effects of the vaginal hormonal ring:

  • Headache
  • Nausea
  • Weight gain
  • Mood swing
  • Melisma
  • Irregular bleeding
  • Blood clotting events

Contraindication with the vaginal hormonal ring:

  • Pregnancy
  • Undiagnosed vaginal bleeding
  • Liver disease
  • History or active blood clot events

Are vaginal hormonal rings as effective as oral contraceptive pills in preventing pregnancy?

Yes, if used correctly.

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