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Pre-service Education on FP and AYSRH

Pre-service Education on FP and AYSRH. Session II, Topic 2 Progestin-only Contraceptive Pills (POPs). PoPs, Session II Topic 2 Slide 1. POPs Are Safe for Nearly All Women. Almost all women can use POPs safely, including women who : Are breastfeeding (can start immediately after birth)

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Pre-service Education on FP and AYSRH

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  1. Pre-service Education on FP and AYSRH Session II, Topic 2 Progestin-onlyContraceptive Pills(POPs) PoPs, Session II Topic 2 Slide 1

  2. POPs Are Safe for Nearly All Women • Almost all women can use POPs safely, including women who: • Are breastfeeding (can start immediately after birth) • Have or have not had children • Are not married • Are of any age • Have just had an abortion, miscarriage, or ectopic pregnancy • Smoke (no matter their age or the number of cigarettes) • Have anemia now or had it in the past • Have varicose veins • Have an STI or HIV/AIDS • Most health conditions do not affect safe and effective use of POPs PoPs, Session II Topic 2 Slide 2

  3. What Are POPs? Content and Types PoPs, Session II Topic 2 Slide 3

  4. Effectiveness of POPs More effective Less effective In this progression of effectiveness, where would you place combined oral contraceptives (POPs)? POPs (breastfeeding) POPs (not breastfeeding) PoPs, Session II Topic 2 Slide 4

  5. POPs: Mechanism of Action Suppresses hormones responsible for ovulation (secondary) Thickens cervical mucus to block sperm (primary) POPs have no effect on an existing pregnancy. PoPs, Session II Topic 2 Slide 5

  6. POPs: Characteristics • Safe and more than 99% effective if used correctly • Can be stopped at any time • No delay in return to fertility • Are controlled by the woman • Do not interfere with sex • Very few health risks • Safe for breastfeeding • Less effective when not used correctly when breastfeeding (99%), especially if not breastfeeding (90-97%) • Require taking a pill every day at the same time • Do not provide protection from STIs/HIV • Have side effects PoPs, Session II Topic 2 Slide 6 Source: Hatcher, 2011; WHO, 2010; CCP and WHO, 2011; Trussell , 2011.

  7. POPs: Advantages • All pills the same (no pill color changes or days without pill taking) • Slightly faster return to fertility • Okay for women who cannot use estrogen (such as a woman over 35 who smokes cigarettes • Less restrictive screening can increase distribution • Lower risk of complications such as stroke and blood clots • No impact on quality or quantity of milk for breastfeeding moms • One of the only methods that can be started right after delivery, even if a woman is breastfeeding PoPs, Session II Topic 2 Slide 7 Source: Hatcher, 2011; WHO, 2010; CCP and WHO, 2011; Trussell , 2011.

  8. POPs: Disadvantages • Need to be taken not only every day but every day at the same time • More menstrual changes, especially bleeding and spotting • Possibly more ovarian cysts • No reduction in risks of ovarian and endometrial cancer (but also no increase) PoPs, Session II Topic 2 Slide 8 Source: Hatcher, 2011; WHO, 2010; CCP and WHO, 2011; Trussell , 2011.

  9. Possible Side-Effects of POPs If a woman chooses this method, she may have some side-effects. They are not usually signs of illness. • But many women do not have any side-effects. • Side-effects often go away after a few months and are not harmful. • Common (when not breastfeeding): irregular bleeding, spotting, no monthly bleeding • Less common:nausea, headache, tender breasts, dizziness PoPs, Session II Topic 2 Slide 9

  10. Who Can and Cannot Use POPs Most women can safely use POPs. But usually cannot use POPs if: • Some other serious health conditions • May be pregnant PoPs, Session II Topic 2 Slide 10

  11. Who Should Not Use POPs My period is late… Are pregnant Have rheumatic disease, such as lupus Have or had breast cancer Had blood clots in legs or lungs Think they may be pregnant Take pills for TB or seizures Have serious liver disease Source: WHO, 2015 PoPs, Session II Topic 2 Slide 11

  12. Category 1 and 2 Examples:Who Can Use POPs Source: WHO, 2016. PoPs, Session II Topic 2 Slide 12

  13. Category 3 ExamplesWho Should Generally Not Use POPs PoPs, Session II Topic 2 Slide 13 Source: WHO, 2015; White, 2012

  14. Category 4 Examples:Who Should Not Use POPs PoPs, Session II Topic 2 Slide 14 Source: WHO, 2015, White, 2012

  15. POP Use by Women with HIV • Women with HIV or AIDS can use without restrictions • Women on all ARVs can use POPs safely • Condom use should be encouraged in addition to POPs PoPs, Session II Topic 2 Slide 15 Source: WHO, 2010

  16. When to Start POPs (part 1) • Anytime you are reasonably certain the woman is not pregnant • Pregnancy can be ruled out if the woman meets one of the following criteria: • Started monthly bleeding within the past 7 days • Is breastfeeding fully, has no menses and baby is less than 6 months old • Has abstained from intercourse since last menses or delivery • Had a baby in the past 4 weeks • Had a miscarriage or an abortion in the past 7 days • Is using a reliable contraceptive method consistently and correctly • If none of the above apply, pregnancy can be ruled out by pregnancy test, pelvic exam, or waiting until next menses PoPs, Session II Topic 2 Slide 16 Source: WHO, 2016

  17. When to Start POPs (part 2) • If starting during the first 5 days of the menstrual cycle, no backup method needed • After day 5 of her cycle, rule out pregnancy and use backup method for the next 2 days • Postpartum • Breastfeeding or not breastfeeding: May start immediately after giving birth Source: WHO, 2016 PoPs, Session II Topic 2 Slide 17

  18. When to Start POPs (part 3) • After miscarriage or abortion • If within 7 days after miscarriage or abortion, no backup method needed • If more than 7 days after, rule out pregnancy, use backup method for 2 days • Switching from hormonal method • May start immediately, no backup method needed (with injectables, initiate within reinjection window) • Switching from nonhormonal method • If starting within 5 days of start of menstrual cycle, no backup method needed • If starting after day 5 of cycle, use backup method for 2 days • After using emergency contraceptive pills • Initiate next day, use backup method for 2 days Source: WHO, 2016 PoPs, Session II Topic 2 Slide 18

  19. How to Take POPs The Mini-Pill • Take one pill each day, by mouth, at the same time. • Most important instruction: • Give client her pill pack to hold and look at. • Discuss: • Easy to remember to take pills? • “What would help you to remember? What else do you do regularly every day?” • Easiest time to take the pills? At a meal? At bedtime? • Where to keep pills. • What to do if pill supply runs out. PoPs, Session II Topic 2 Slide 19

  20. How to Take POPs continued The Mini-Pill Caution the client: Waiting too long between packs greatly increases risk of pregnancy. • Take one pill each day at the same time • Once you have finished all the pills in the pack, start a new pack the following day • Late taking a pill? — Take it as soon as you remember — You may need to follow special instructions if more than 3 hours late PoPs, Session II Topic 2 Slide 20

  21. Missed Pills Instructions The Mini-Pill • 3 or more hours late taking a pill and are NOT breastfeeding or breastfeeding but menses has returned: • Take a missed pill as soon as possible. • Continue to take one pill every day. • Use a backup method for next 2 days. • If client has had sex in last 5 days, can consider ECP. PoPs, Session II Topic 2 Slide 21 Source: WHO, 2016; CCP and WHO, 2011.

  22. Missed Pills Instructions continued The Mini-Pill • 3 or more hours late taking a pill and are breastfeeding and menses has not returned: • Take a missed pill as soon as possible. • Continue to take one pill every day. • No extra protection necessary. PoPs, Session II Topic 2 Slide 22

  23. What to Remember See a nurse or doctor if: • Take one pill at the same time each day • If you are late taking pills, you can get pregnant • Side-effects are common but rarely harmful. Come back if they bother you. • Come back for more pills before you run out or if you have problems. • A bright spot in your vision before bad headaches • Unusually heavy or long bleeding • May be pregnant, especially if pain or soreness in belly Anything else I can repeat or explain? Any other questions? • Yellow skin or eyes PoPs, Session II Topic 2 Slide 23

  24. Follow-up for POPs • No fixed schedule; return any time. • Resupply: Give more than 1 cycle of pills, if possible. • Assess for method satisfaction and any health problems or circumstances that may restrict POP use. • Manage and reassure about side effects. • Review correct pill taking and what to do when pills are missed. • If the woman has stopped breastfeeding, discuss switching to another method. PoPs, Session II Topic 2 Slide 24

  25. The Mini-Pill Return Visit • How can I help you? • Are you happy using the mini-pill? • Want more supplies? • Any questions or problems? • Let’s check: • For any new health conditions • When do you take your pills? • What do you do if you forget a pill? • Need condoms too? PoPs, Session II Topic 2 Slide 25

  26. Management of POP Side Effects Counseling and reassurance are key. PoPs, Session II Topic 2 Slide 26

  27. Management of POP Side Effects:Bleeding Changes Source: CCP and WHO, 2011. PoPs, Session II Topic 2 Slide 27

  28. Problems That May Require Stopping POPs or Switching to Another Method Source: CCP and WHO, 2011. PoPs, Session II Topic 2 Slide 28

  29. Problems That May Require Stopping POPs or Switching to Another Method (continued) Source: CCP; WHO, 2011; WHO 2015 PoPs, Session II Topic 2 Slide 29

  30. POPs: Summary • Safe for almost all women, including breastfeeding women • Effective if used consistently and correctly • Fertility returns without a delay • Screening and counseling are essential PoPs, Session II Topic 2 Slide 30

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