Ruth Adams Clinical Practice Educator LLR Sexual Health LARC Update Ruth Adams Clinical Practice Educator LLR Sexual Health

Why use LARC?

Introducing Sayana Press

About Sayana Press S/C injection of 104mg in 0.65ml Medroxyprogesterone Acetate Product licence is for 13 weeks Has licence for self-administration In women with deep adipose tissue in the gluteal area, standard-length needles may not reach the muscle layer and SC DMPA or deltoid administration of IM DMPA should be considered. SC DMPA should be injected into the abdomen or anterior thigh.

Self Administration Saves women having to attend surgery every 3 months. Missing appointments can put women at risk of pregnancy Self-administration may reduce this risk. Women need training and must be supervised by a HCP when administering the first dose. They can then be given supply of three further injections and reviewed in surgery every year. Who is suitable?

Video http://www.sayanaanswers.co.uk/guide-to-self-injection

Practicalities of Self Administration HCP guides etc can be ordered at www.medisa.com Patient specific website www.sayanaanswers.co.uk Patient website allows to sign up for text reminder Sharps bins will be required at home

Introducing Jaydess

Comparison with Mirena 28mm width Silver Ring 30mm length 6 micrograms/24 hours Up to 3 years contraceptive cover Smallest IUS Insertion tube diameter 3.8mm levonorgestrel 20 micrograms/24 hours Up to 5 years contraceptive cover Treatment for HMB HRT for up to 4 years Insertion tube diameter 4.4mm 32mm width 32mm length

About Jaydess 90% of women with Jaydess have monthly menses No difference in reported hormonal side effects compared to Mirena. Found to be less painful to fit than Mirena Increasingly popular with young women who are nulliparous. Popular with women who want regular periods. Product license is for contraception only Includes risk management, programme management, different approach to complaints Next phase of board development being designed

Ectopic pregnancy with IUD/IUS Previous ectopic is UKMEC 1 Because risk of pregnancy is very low, risk of ectopic is also very low approx. 1 in 1000 at 5 years However of those pregnancies a higher proportion are ectopic some studies suggest 9% whilst others up to 53% Ectopic rate of Jaydess is currently 50% but expected to reduce due to small number of pregnancies in study

Any Questions?

Anecdotal evidence that history of one expulsion increases risk of subsequent expulsion Risk of ectopic pregnancy with any IUC at 5 years is approx. 1:1000