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This chapter presents a case study of a 42 year old female (Alison), who suffered from heavy painful periods. Alison's situation is far from unusual for this age group, where the risk of relationship breakdown is high. It is apparent that Alison's first priority is a highly effective contraceptive method. However, she requires much more from her method: effective control of bleeding and dysmenorrhoea; restoration of menstrual predictability and/or amenorrhoea. A bimanual examination for Alison is undertaken to assess for uterine enlargement (fibroids, adenomyosis), uterine mobility and adnexal masses and/or tenderness. Alison was advised about how the levonorgestrel-releasing intrauterine system (LNG-IUS) works by profound endometrial glandular and stromal suppression, cervical mucus changes and a foreign body effect within the endometrium. Progestogen-only pills (POPs) would be an option for Alison if she has contraindications to taking oestrogens.
Synthetic derivatives of progesterone are variously known as progestogens, progestagens or progestins and have a key role in hormonal contraception, either alone or in combination with oestrogen. Progestogen-only methods of contraception include pills, subdermal implants, injectables and the intrauterine system. There are several different types of subdermal implant licensed for contraceptive use across the world. The Nexplanon implant contains etonogestrel and is the most widely available subdermal contraceptive implant. Other progestogen-only contraceptive implants are licensed or being developed and include Jadelle, a two-rod implant containing levonorgestrel, and Capronor, a biodegradable single-rod implant also containing levonorgestrel. The two types of progestogen-only injectable contraception, both of which are long-acting reversible contraception (LARC) methods, are depot-medroxyprogesterone acetate (DMPA) and norethisterone oenanthate (NETEN). The most commonly used progestogen-releasing intrauterine system in most countries is the levonorgestrel-releasing intrauterine system (LNG-IUS) known as Mirena.
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