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LONG-ACTING REVERSIBLE CONTRACEPTIVE (LARC) METHODS
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These methods are a non-permanent contraception administered less frequently than once a month, and include implants and IUCDs. LARC methods are the most effective reversible contraceptives, with failure rates for typical use virtually the same as for perfect use. They play an important public health role in reducing unintended pregnancies.
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ETONOGESTREL IMPLANT (IMPLANON)
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This is a subdermal contraceptive implant of a 3-yr system consisting of a single rod of the progestogen, etonogestrel (68 mg).
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INTRA-UTERINE CONTRACEPTIVE DEVICES (IUCDs)
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The two common types are:
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copper devices, e.g. Multiload-CU3751 (span 5–10 yrs)
progestogen (levonorgestrel)-releasing system, e.g. Mirena or Kyleena (span 5 yrs)
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DEPOT MEDROXYPROGESTERONE ACETATE—IM INJECTABLE
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Dose: 150 mg by deep IM injection in first 5 days of cycle, repeated every 12 weeks.
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PROGESTOGEN-ONLY CONTRACEPTIVE PILL (POP)
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The POP (mini-pill) is most commonly prescribed for breastfeeding women for whom an oestrogen contraceptive is not recommended until at least 6 weeks postpartum. It is safe from delivery.
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The two common formulations are: levonorgestrel 30 mcg/d and norethisterone 35 mcg/d.
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POP must be taken in the same 3-h time period. If delayed >3 h or pill missed, continue taking as usual and take precautions. It is effective after 3 tablets have been taken.
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COMBINED HORMONAL CONTRACEPTION
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Combined hormonal contraceptives (CHC) usually contain a low-dose oestrogen and a moderate dose of progestogen. They are available as a combined oral contraceptive pill (COC) and vaginal ring.
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A suitable first choice is a monophasic pill containing 30 or 35 mcg ethinyloestradiol (EE) with levonorgestrel or norethisterone (e.g. Nordette, Microgynon 30, Monofeme, Levlen ED, Brevinor). Cover starts immediately if active pills started on day 1 of cycle.
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Formulations containing 50 mcg EE are no longer recommended because there is no known additional benefit from their use and they are associated with an increased risk of venous thromboembolism (VTE).
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Acne The oestrogen in any CHC may improve acne. COCs containing ...