Implants with levonorgestrel.
Contraceptive mechanism of action is based on the allocation of levonorgestrel from capsules, a constant rate of 30 mcg / day, it provides the following effects: the suppression of ovulation, the changes of cervical mucus, the difficulty of sperm penetration, atrophy of the endometrium, preventing implantation premature luteolysis.
Norplant contraceptive efficacy - 0.5-1.5 pregnancies per 100 women / years.
The method of application,
Before replanting the capsule, the patient must p[censored] a detailed gynecological examination. The capsules with contraceptions are implanted in the subcutaneous fatty tissue, the inside part of forearm, through the skin incision of 1 mm, using a special trocar. The procedure is performed under local anesthesia with aseptic technique. The capsules should be placed neither deep (after healing the wounds they are easily palpated through the skin) for easy remove. Contraceptive efficacy lasts for near 5 year.
Time of administration: in the first 7 days of the menstrual cycle, or immediately after abortion. 6-8 weeks after childbirth (provided that the patient before wasn't sexually active or have taken other methods of contraception).
Removal of the implants is performed under local anesthesia in cases if:
a) request of the patient at any time
b) according to doctor's indications
c) at the end of five years of use.
Indications for use of subcutaneous implants: late reproductive age, the patient's wish to increase the interval between childbirths, the presence of estrogen-dependent adverse events in the anamnesis; extragenital diseases that prevent the use of combined estrogen-progestin preparations, uterine fibroids of small sizes (up to 8 weeks), a condition in which progestins have a therapeutic effect (fibrocystic breast disease, algomenoreya, ovulatory pain).
Contraindications: pregnancy, uterine bleeding of unknown origin, malignant tumors of the reproductive system.
Side effects and complications: menstrual disorders (40-45%), mainly in the first 6-12 months of use (metrorrhagia, menorrhagia, oligo-gomenorrhea, amenorrhea), an inflammatory process in the area where capsules were introducted, galactorrhea, nausea, headache (5 - 20%), dizziness, acne (5-20%), hirsutism, weight gain, depression; formation of functional ovarian cysts, ectopic pregnancy (near 0.28 per 100 women / year, which is below the rate of development among women, who don't practice protection against pregnancy) .
Limitations of the method: the relative high cost of the drug, frequent menstrual irregularities.
Advantages of the method: the high contraceptive efficacy, opportunity to use in the extragenital diseases, that exclude the reception of combined estrogen-progestin preparations, minor metabolic changes in carbohydrate and lipid metabolism, can be used if patient has a lack of adverse effects of the cardiovascular system, the convenience associated with the single and continuous use of implants, prolonged action, eliminates the need for daily administration of the drug; reversibility; therapeutic effect in giperpolimenoree, algomenoree, ovulatory pain, fibrocystic [censored] , reducing the risk of endometrial cancer.
Recommendations to patients, using subcutaneous implants:
Keep in mind that the maximum contraceptive effect of the drug beginning after 24 hours from the implantation of the capsule, not to wet the place where were introduced capsules, until complete healing of the skin incision. By the end of year 5, the capsules should be removed.
While appeare some specified below side effects and symptoms, contact your doctor immediately: pain, swelling, redness near injected capsules, absence of menstruation or excessive uterine bleeding (to avoid pregnancy or organic disease), pain localized in the lower abdomen (to exclude ectopic pregnancy or complications of ovarian cysts functions - rupture, torsion of the cyst's "legs" ), expulsion of capsules, migraine, headaches, blurred vision.
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