Teaching material

1. MANAGEMENT OF SIDE
EFFECTS OF DIFFERENT FP
METHODS
By Max BZS Tungaraza,By Max BZS Tungaraza,
RN, BScN, DHPEd, FP TrainerRN, BScN, DHPEd, FP Trainer

2. Contents
 Introduction
 Briefs of Anatomy of Female & Male
Reproductive Organs
 Menstrual Cycle
 Briefs of FP Methods
 Common FP side Effects
 Management of FP side effects
 List of References

3. Introduction
 Management of FP side effects
depends much on prior understanding
of the ins and outs of different FP
methods.
 This is together with understanding the
reproductive systems, hormones and
the menstrual cycle which altogether
affect how FP methods work to
prevent pregnancy.

4. Introduction Cont..
 There is a big challenge on how health
care providers manage side effects
the FP client develops after using
different FP methods.
 Many clients are sometimes
mismanaged, and or discouraged by
some HCPs for using a particular FP
method.

5. Introduction Cont…
 Often-time, FP clinics get many FP
clients getting back to withdraw from
the method after they have been told
negatively about the method, this is
done by relatives, but sometimes HCPs
are part of the problem.
 This is due to inadequate knowledge
on various FP methods. The community
is not well informed.

6. Review of Female
Reproductive Organs

7. Internal Reproductive Organs

8. Review of External & Internal
Male Reproductive Organs

9. Different Hormones Affecting
Reproductive Organs
 Gonadotrophin Releasing Factor
(GnRF)
♦ Follicle Stimulating Hormones (FSH)
♦ Lutermizing Hormone (LH)
┼Oestrogen
┼Progesterone

10. Hormones Involved, Where Secreted
And Their Chief Functions/Changes
 Hormone -GnRF (Gonadotropin)
 Secreted By: Hypothalamus
 Chief Functions: Regulates the secretion of
FSH and LH.
 Hormone FSH (Follicle Stimulating
Hormone)
 Secreted By: Anterior pituitary
 Chief Functions:
♦ Stimulates the growth of ovarian follicles.
♦ Stimulates the ovarian follicle cells to secret
estrogen.

11. Hormones Involved, Where
Secreted Cont……..
 Hormone: LH (Luteinizing Hormone)
 Secreted By: Anterior pituitary lobe.
 Chief Functions:
♦ Causes ovulation.
♦ Converts ruptured ovarian follicle
into the corpus luteum.
♦ Stimulates the corpus luteum to
secret progesterone.

12. Hormones Involved, Where
Secreted Cont……..
 Hormone:- Oestrogen
 Secreted By: Ovary (follicle)
 Chief Functions:
♦ Promotes growth of blood vessels in the
endometrium and increases the amount of
endometrium to be shed.
♦ Promotes maturing of ovarian follicles.
♦ Promotes an increase in the amount of clear,
stretchy and slippery “fertile” cervical mucus
produced to aid sperm mobility and survival.
♦ High levels cause a surge in LH, triggering
ovulation
♦ Very low levels cause the anterior pituitary gland
to produce more FSH and LH.

13. Hormones Involved, Conts…
 Hormone: Progesterone
 Secreted By: Ovary (corpus luteum)
 Chief Functions:
♦ Promotes further development of blood vessels and
glands in the endometrium.
♦ Limits the amount/volume of endometrium.
♦ Decreases the quantity of cervical mucus
produced and causes the mucus to become
so thick that sperm cannot travel through it.
♦ High levels inhibit secretion of GnRF and
therefore FSH and LH.

14. Menstrual Cycle
Phases Days
1. Menstrual phase 1-5
2. Proliferative phase
(Follicular)
6-14
3. Secretory phase
(Luteal)
15-27
4. Regressive (Ischemic)
phase 27-28

15. Menstrual Cycle Cont..

16. Application of Menstrual Cycle
Knowledge in FP Services
 FP method use
 FP management of side effects
and complications
 Fertility/Infertility
 Post Abortion Care
 Early signs of pregnancy and their
similarities to COC side effects

17. QUESTIONS

18. Common FP Methods Used in
Tanzania
 Short Term FP Methods
♦Depo Provera (injectable)
♦Oral Contraceptive Pills (COC,
POP, ECP-Postinor 2)
♦Condoms (male and female
type).
♦Natural including Fertility
Awareness Methods – FAM.

19. Common FP Methods Cont…
♦ Abstinence1
♦ Coitus interruptus -(withdrawal)
♦ Fertility awareness1
methods
 Standard days method (CycleBeads)
 Calendar method (Rhythm Method)
 Basal Body Temperature (BBT)
 Cervical Mucus Method (Ovulation Or Billing
Method)
 Symptothermal Method
♦ Lactational amenorrhea - LAM
1
Society for Adolescent Med., J Adolesc Health 2006;38:83–87

20. Common FP Methods Cont..
 Long Term FP Methods
♦ Implants (Implanon - NXT, Classic &
Jadelle –Two rods)
♦ Copper IUCD (Interval, PPIUCD)
 Permanent FP Methods
♦ BTL, Vasectomy

21. Common Side Effects
 POP
♦ Nausea, dizziness
♦ Mild headache
♦ Migraine headache
♦ Amenorrhea
♦ Irregular PV bleeding
• COC
♦ ACHES (Abdominal pain, Severe Chest pain,
Severe Headache, Eye [blurred vision, brief loss of
vision], Sharp leg pain).
♦ Others as above

22. Common Side Effects Cont..
 Injectable (DMPA)
♦ Delayed fertility return
♦ Menstrual changes
♦ Weight gain
♦ Headaches, dizziness, changes in
mood and sex drive

23. Common Side Effects Cont..
 Implants
♦ Menstrual Changes: (irregular bleeding,
lighter bleeding, fewer days of bleeding,
infrequent bleeding or no monthly
bleeding first several months).
♦ Others: headaches, abdominal pain,
weight change, dizziness, nausea, breast
tenderness, mood change, acne (can
worsen or improve), enlarged ovarian
follicles
 NB: Lighter bleeding, Infrequent bleeding and or
fewer days of bleeding occurs after 1 year of use.

24. Common Side Effects Cont..
 Copper IUCD
♦ Bleeding changes (usually the first 3 to 6
months)
 Prolonged and heavy bleeding
 Irregular bleeding
♦ Uterine cramps and painful menses
♦ Increased vaginal secretions
♦ Risk of infection
NB: PID may Occur if the woman has Chlamydia
or gonorrhea during insertion.

25. QUESTIONS

26. Management of Common
Side Effects of FP Methods
 SOAP approach
♦ S - Subjective data (symptoms)
obtained from the FP client.
♦ O - Objective data (Signs) reached
after physical examination by the
FP provider.
♦ A – Assessment (Diagnosis reached)
♦ P – Planning (action taken).

27. Management Cont…
 Amenorrhea – reassure the client. Thorough and
comprehensive counseling.
 Headache (mild) – Give Paracetamol/ASA
 Migraine W/ Aura – Stop the method.
 Heavy bleeding/Irregular bleeding:
♦ Rule out other gynecological causes
♦ NSADs i.e. Ibuprofen (800mg TID 5days),
Mefenamic Acid 500mg TID for 5 days.
♦ Where the above mgt fails, try the following:
• COC; one Pill taken daily for 21 days.
• Ethinyl oestradiol 50mcg daily for 21 days.

28. Management Cont…
 Note: Combined oral contraceptives, which also
contain a progestin, are preferred over estrogens
alone (Alvarez-Sanchez et al 1996).
 Hemostatics
♦ Tranexamic acid 500mg TID for 5 days
♦ Sylate 500mg TID for 5 days
 Provide iron tablets for anemia. Reassure the
client; bleeding is not harmful.
 Withdraw the method if bleeding persists.
Counsel her for another method.

29. Management Cont…
Note
 NSADs i.e. Ibuprofen, works to block
prostaglandin synthesis, decreases uterine
contractions and blood flow to the
endometrium (Angle, Huff and Lea 1991).
 Combined oral contraceptives (COC)
control or stop bleeding by rebuilding the
endometrium.
 Irregular bleeding/heavy bleeding is not
managed by EVACUATION when the cause
is associated with FP complications.

30. QUESTIONS

31. List of References
Jadelle Training Manual, (n.d). Available at:
https://www.k4health.org/sites/default/files/TM _
MoHCDGEC, (2016). National comprehensive
postpartum family planning: a reference
manual. Dar Es Salaam: Author.
MoHCDGEC, (2016). O job reference manual
for implanon NXT and other methods. Dar Es
Salaam: Author.