Intra uterine device (Mirena) vs Depo-Provera Contraception MN 576 Essay.

Many elements need to be considered individually by a woman, man, or couple when choosing the most appropriate contraceptive method. Some of these elements include safety, effectiveness, availability (including accessibility and affordability), and acceptability. Although most contraceptive methods are safe for use by most women, U.S. MEC provides recommendations on the safety of specific contraceptive methods for women with certain characteristics and medical conditions.

Compare and contrast two forms of contraception including indications, contraindications, side effects, US Medical Eligibility Criteria (USMRC), US Selected Practice Recommendations for Contraceptive Use (USSPR), affordability, and mechanisms of action. Intra uterine device (Mirena) vs Depo-Provera Contraception MN 576 Essay.

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Intra uterine device (Mirena)

Intra uterine devices (IUD) are considered long-acting, reversible contraception (LARC). These types of contraceptives are highly effective since they do not depend on patient’s compliance on a daily basis. Most LARC methods of contraception are appropriate for the majority of women, including adolescents and nulliparous women.

Mechanisms of action: There are two different type of IUD’s, those with hormones and those without hormones. The Mirena is an IUD that contains synthetic hormones that is 99.9% effective and can stay in for up to 5 years (Mirena, 2018). The ParaGard is also an IUD and is 98% effective with no hormone release and can stay in for up to 10 years. For the sake of this review the author will talk about the Mirena. The Mirena is placed in the uterus by a provider. Mirena has several ways of working, it thickening of the cervical mucus and thins out the lining of the uterus due to the hormone release. The actual device itself sperm movement which reducing sperm survival (Patient Information Mirena, 2017).

Indication: Mirena release hormones that prevents pregnancy for up to 5 years. It is also indicated for treatment of heavy menstrual cycles in women who are also choosing to use a contraceptive (Curtis et al., 2016).

Contraindications: The U.S Medical Eligibility Criteria for Contraception Use advises that an IUD is contraindicated in women with distorted uterine cavity, current breast cancer the LNG- IUD the copper T is safe, endometrial cancer, gestational trophoblastic disease, current pelvic inflammatory disease, immediate post-septic abortion, postpartum sepsis, STD’s, pelvic tuberculosis, and unexplained vaginal bleeding (Summary Chart of U.S. Medical Eligibility Criteria for Contraceptive Use, 2017). Intra uterine device (Mirena) vs Depo-Provera Contraception MN 576 Essay.

Side effects: Side effects include but are not limited to bleeding, and pain after insertion. Possible expulsion after insertion. Changes in menstrual cycle that include spotting between cycles especially during the first 3- 6 months and menstruation may be heavier the first 3 months as well. About 12% of women develop ovaria cysts (Curtis et al., 2016).

USSPR: When a woman has not had her cervix dilatate it can become difficult to insert the Mirena, therefore some providers use Misoprostol to dilatate the cervix for insertion. However, this is noS longer the recommended. It is only indicated who have failed previous insertion (Curtis et al., 2016). Intra uterine device (Mirena) vs Depo-Provera Contraception MN 576 Essay.

Affordability: The manufacturing company is Liletta’s who has strived to make it affordable or all income levels. Unlike a daily contraception method, the Mirena is a onetime cost that includes the providers services. The price to the patient may range depending on their insurance yet an estimated price is about $1000 (Mirena, 2018).

Depo-Provera

Mechanisms of action: Depo-Provera is an injection that is administered every 3 months. It contains medroxyprogesterone acetate that inhibits the secretion of gonadotropins that prevents follicular maturation and ovulation. It thins the endometrial lining; these are the contraceptive effects. It is 94% effective (Highlights of Prescribing Information, 2018). Intra uterine device (Mirena) vs Depo-Provera Contraception MN 576 Essay.

Indications: Depo-Provera clinical indication is to prevent pregnancy. However, it is also used for women who suffer from dysmenorrhea. Since Depo-prover thin the lining of the uterus I can eventually result in amenorrhea (Highlights of Prescribing Information, 2018).

Contraindications: The U.S Medical Eligibility Criteria for Contraceptives Use states that contraindications of the use of Depo-Provera is a current diagnosis of breast cancer. Depo-Provera theoretically or proven risks usually outweigh the advantages in patients who have had past and no evidence of current breast disease for 5 years, severe cirrhosis, nephropathy, retinopathy, neuropathy, other vascular disease or diabetes longer the years, history of stroke, systemic lupus erythematous, unexplained vaginal bleeding (Summary Chart of U.S. Medical Eligibility Criteria for Contraceptive Use, 2017).

Side effects: More the 5% of women reported having side effects that include headache, abdominal pain, increased weight gain of more than 10 lb. at 24 months, nervousness, dizziness, decreased libido, irregularities with menstruation. About 1-5% of women reported fatigue, backache, dysmenorrhea, hot flashes, nausea, bloating, edema, leg cramps, depression, insomnia, acne, alopecia, rash, leukorrhea, breast pain and vaginitis (Highlights of Prescribing Information, 2018). Intra uterine device (Mirena) vs Depo-Provera Contraception MN 576 Essay.

USSPR: Depo-Provera can be given at any reasonable time if she meets the criteria of administration. If the injection is given within the 7 first days of menstruation no additional contraceptive is needed. If it is started more then 7 days since menstruation a patient should abstain from sexual intercourse or use another form of contraception (Curtis et al., 2016).

Affordability: Depo Provera starts at about $100 and be as affordable as $40.13 with Good RX. Since the injection is given every 3 months this can be an affordable choice for patients. The administration can be done by the provider medical assistant staff. Just like the Mirena, a patient’s insurance may cover all or some of these costs (Depro Provera, 2018). Intra uterine device (Mirena) vs Depo-Provera Contraception MN 576 Essay.

References

Curtis, K. M., Jatlaoui, T. C., Tepper, N. K., Zapata, L. B., Horton, L. G., Jamieson, D. J., & Whiteman, M. K. (2016). U.S. Selected Practice Recommendations for Contraceptive Use, 2016. MMWR. Recommendations And Reports: Morbidity And Mortality Weekly Report. Recommendations And Reports, 65(4), 1-66. doi:10.15585/mmwr.rr6504a1 ttps://www.cdc.gov/mmwr/volumes/65/rr/rr6504a1.htm?s_cid=rr6504a1_w

Depo Provera. (2018). Good Rx. Retrieved from https://www.goodrx.com/depo-provera?drug-name=depo+provera

Highlights of Prescribing Information. (2018). Food and Drug Administration. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020246s036lbl.pdf Intra uterine device (Mirena) vs Depo-Provera Contraception MN 576 Essay

Summary Chart of U.S. Medical Eligibility Criteria for Contraceptive Use. (2017). Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf

Patient Information Mirena (June, 2017). Food and Drug Administration. Retrieved from https://labeling.bayerhealthcare.com/html/products/pi/Mirena_PPI.pdf

Mirena. (2018). Good Rx. Retrieved at https://www.goodrx.com/mirena?drug-name=mirena

Response

Miriah, thank you for your insightful response to this week’s discussion board. I chose to read and respond to your post because I spent my time researching Mirena and Depo-Provera. I found it intriguing the exact since behind why combined oral contraception (COC) is contraindicated for patients with dyslipidemia. The study was done on women who were taking COC, 665 hypertensive women and 665 normotensive women. In general, women who have hypertensive have a higher risk of mixed hyperlipidemia or dyslipidemia than those that are normotensive. The study results show that dyslipidemia and the long-term use of COC increase the risk of hypertension, which we know leads to stroke. Results also reviled that patients that took COC longer than 15 years and have dyslipidemia had an increased higher risk of hypertension. The study also offered a solution; if the patient stopped taking the COC then this can be considered an effective antihypertensive measure (Wei et al., 2011). Intra uterine device (Mirena) vs Depo-Provera Contraception MN 576 Essay.

Reference

Wei, W., Li, Y., Chen, F., Chen, C., Sun, T., Sun, Z., & … Ba, L. (2011). Dyslipidaemia, combined oral contraceptives use and their interaction on the risk of hypertension in Chinese women. Journal of Human Hypertension, 25(6), 364-371. doi:10.1038/jhh.2010.67 Intra uterine device (Mirena) vs Depo-Provera Contraception MN 576 Essay

Responses

Debbie, thank you for your response of this week’s discussion. I am glad that you chose to write about the Nexplanon. I don’t know about your clinical rotation but during contraception counseling my provider seems to shy away from having women opt to have this implanted due to the issue. One of the biggest concerns that woman worry about and that they have heard through other friends and family is that the Nexplanon travels. I came across this very interesting case study of a 17 year old female that had the Nexplanon implanted by her general practitioner. She was having irregular bleeding, so the plan was for her to have it removed. Once they went in to remove it the implant was no where to be found. Intra uterine device (Mirena) vs Depo-Provera Contraception MN 576 Essay. The provider contacted the manufacturer who suggested that she have a CT done of her thorax. The CT thorax reviled that the implant had traveled to the left lower lobe of the pulmonary artery branch occluding the pulmonary vessel with no necrosis or infection. The options for removal of the device came with high risk and included a lobectomy. The providers and patient opted to leave the implant in place since it was suspected that the implant had been in her left lower lobe for the last 2 years, since the patient felt it was missing. This is an extreme case yet one that we as new nurse practitioner should take into consideration if we ever implant this device (Barlow-Evans, Jaffer, & Balogun, 2017).

Reference

Barlow-Evans, R., Jaffer, K., & Balogun, M. (2017). Migration of a Nexplanon contraceptive implant to the pulmonary artery. BMJ Case Reports, 2017doi:10.1136/bcr-2017-219259 Intra uterine device (Mirena) vs Depo-Provera Contraception MN 576 Essay

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