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Re: Factor V Leiden & Contraception From: Ginny Lee (kaupilimakoa@hotmail.com) Thu Jul 31 16:31:30 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: verner nellsch: "Re: type of incision?" Previous message: Larry Glazerman: "Re: Factor V Leiden & Contraception" In reply to: Joanne Bulley, MD: "Re: Factor V Leiden & Contraception" Next in thread: Larry Glazerman: "Re: Factor V Leiden & Contraception" I would suggest IUD as well, maybe Paragard just for the sake of longer term contraception since she is so young. I have never pulled IUDs for folks with a partner change. I think the more recent literature suggests the biggest risk for infection/PID is during insertion so if their culture is negative it should be fine. Mirena may actually help lower risk of PID with effect on cervical mucus.... > Date: Thu, 31 Jul 2008 13:26:33 -0500> From: islesannie@gmail.com> To: ob-gyn-l@mail.obgyn.net> Subject: Re: Factor V Leiden & Contraception> > Hi Allan> > I *used* to suggest that an IUD was a "one partner" option - and that> yes it should be pulled and left out for a month if there is a change in> relationships. But recently one of the local gyns did a CME for the> general med staff about current contraceptive options (to include> Implanon and Mirena and Essure for those that never heard of them)> > He presented data that says the risk of infection is so low that you> don't need to require that "permanent LTR"> > This patient is 100% committed to condoms. She has not shown any> interest in rapid changes in partner(s) that I see in many others in her> age group. And she is committed to continuing them no matter what else> she is using for contraception.> > I also *used* to not put IUDs in nulliparous patients. But I think in> this situation it is likely the ideal option.> > As for NuvaRing - it gets "guilt by association" for VTE. I would> definitely NOT extrapolate from the menopause data - but the estradiol> patch (no first pass through liver) shows no difference in VTE from> placebo patch. So the *theory* would be that the incredibly low> estrogen levels and no first pass through liver *might* make the> NuvaRing acceptable. I would not yet prescribe it to this patient. But> the concept of the physiology makes me hope there will be some data> someday.> > Joanne> > At Thu, 31 Jul 2008, allanho@aol.com wrote:> >> >Without knowing more about her sexual history, I would say Implanon would be my choice.? NuvaRing is contraindicated for someone with thrombophilia.? I would give Paraguard or Mirena too monogamy considered as having multiple sexual partners?? If one was married and then divorced, are we obligated to pull their IUD's?> >> >Allan Ho> >> > --> Joanne Bulley, MD> solo gyn> Keene, NH> > My 25 yo daughter just became engaged to a WONDERFUL young man - they got engaged> in a 13th century castle in Tuscany. 072008 Next message: verner nellsch: "Re: type of incision?" Previous message: Larry Glazerman: "Re: Factor V Leiden & Contraception" In reply to: Joanne Bulley, MD: "Re: Factor V Leiden & Contraception" Next in thread: Larry Glazerman: "Re: Factor V Leiden & Contraception"

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