Progestogen-only Injectable (POI) Contraception

Progestogen-only injectable contraception is a hormonal type of contraception that is given through an injection. It contains a synthetic form of the hormone progesterone, known as progestin or progestogen. They provide protection against pregnancy for up to 8 to 14 weeks.

Types

  • Medroxyprogesterone acetate (DMPA)
  • Norethisterone enanthate (NET-EN)

Mechanism of action

  • This hormone works primarily by suppressing ovulation (preventing the release of an egg from the ovaries).
  • It also thickens cervical mucus, making it more difficult for sperm to reach and fertilize an egg.
  • It can thin out the uterine lining, making it less suitable for the development of the fertilized egg.

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Progestogen only pill (POPs)

This type of pill does not contain oestrogen and the dose of progestogen is significantly lower than in those used in combined oral contraceptive pills (COC). It is also called the “mini-pill” and is useful for women who do not want pills that contain oestrogen or in situations where the oestrogen is not suitable for medical reasons. They are a highly effective method of birth control when taken correctly.

Formulation – Available formulations are:

  • Norethisterone 350 ug (NET) – (Noriday)
  • Levonorgestrel (LNG) 30 μg
  • Desogestrel (DSG) 75 μg – (Cerazette)

Levonorgestrel (LNG) and norethisterone (NET) are grouped as “traditional’ POPs”

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Admission for surgery – what to bring to the Hospital

This article will help you to prepare the essential items that you need to bring to the hospital for your admission. The list here is just a suggestion or a guide only, and you may make your own adjustment, based on your own preference. Decide which items you will need for a comfortable stay and recovery. However, you should not over-pack so as to inconvenience everyone, including yourself during your admission or discharge. The items will also depend on the expected length of stay in the hospital.

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Bartholin glands disorders (Bartholin cyst / Bartholin abscess)

The Bartholin gland is located on either side of the vaginal opening, on the inner aspect at about 5 and 7 o’clock position. The glands secrete a fluid (mucus) that keeps the vagina moist and helps lubricate the vaginal area during sexual activity. The gland is not visible or palpable unless it is swollen.

Common disorders of the Bartholin glands are:

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Home Pregnancy Tests

The currently used method to confirm pregnancy depends on the detection of the hormone human chorionic gonadotropin (hCG), which is present in the blood and urine of a pregnant woman. The hCG hormone is produced by the placenta in increasing amounts within 10 days after fertilization. The home pregnancy test kit detects this hormone in the urine of the pregnant woman.

An absence of a menstrual period in a sexually active female is usually the first reason to do a pregnancy test. Many women may experience some symptoms and signs of pregnancy as early as 5 to 6 weeks after the first day of their last menstrual period, provided she has a regular menstrual cycle.  These may include:

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Cervical Polyps

A cervical polyp is a benign fleshy growth on the cervix. The cervix is the part of the uterus that is visible during the speculum examination. It is also called the neck of the uterus. Cervical polyp arises from cells, either from the cervical canal (this type is also called an endocervical polyp) or from the outer surface of the cervix.

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Dysmenorrhea (period pain / menstrual cramps / menstrual pain)

Dysmenorrhea refers to lower abdominal pain felt during menstruation. It is divided into two broad categories, which are primary and secondary dysmenorrhoea.

  1. Primary dysmenorrhea refers to the presence of pain during menses without any obvious gynaecological disease that could account for these symptoms. The pain is typically recurrent, crampy pain that starts just before or with the onset of menses and then gradually reduces over the next 24 to 72 hours. It is more often seen in adolescents and young females. Physical examination and an ultrasound scan of the pelvis is usually normal.
  2. Secondary dysmenorrhea refers to the pain before and/or during menstruation in females with a gynaecological disease that could explain the symptoms. These could be endometriosis, adenomyosis, or uterine fibroids. The cramping pain can be in the lower abdomen, lower back or radiates to the inner thighs. The pain may even persist after menstruation has stopped.

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Infertility investigations

The woman and her partner should be present at the initial evaluation for infertility. The doctor will obtain a full clinical history from the couple and then proceed on to a physical examination. The initial investigations that need to be performed will be based on these assessments. Sometimes, the cause of the infertility may be found at this visit. Further evaluation and clinic visits may be necessary for other couples. It may take several weeks. This is because some of the tests may have to be repeated for verification at different specific times in her menstrual cycle. The initial workup of a man usually can be done faster, because men have no monthly cycles and because there are fewer tests for men.

COMMON INVESTIGATIONS IN FEMALE

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