-VISIT OUR OTHER FORUMS- OB-GYN-L Ultrasound Ultrasound History Fibroid Forum Physicians-in-Training Tech Talk OBSTET-L (portuguese) OBGIN-L (spanish) Nursing

Re: Factor V Leiden & Contraception From: Joanne Bulley, MD (islesannie@gmail.com) Thu Jul 31 13:24:40 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Larry Glazerman: "Re: Factor V Leiden & Contraception" Previous message: Andrew Folley: "Re: Ascus management question" In reply to: allanho@aol.com: "Re: Factor V Leiden & Contraception" Next in thread: Ginny Lee: "Re: Factor V Leiden & Contraception" Reply: Ginny Lee: "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 if she is in a stable relationship.? Then again I had in discussion just last week with a colleague who refused to give IUD's to anyone who was not "married".? We had a debate about the definition of multiple sexual partners.??Are people with?serial 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. Next message: Larry Glazerman: "Re: Factor V Leiden & Contraception" Previous message: Andrew Folley: "Re: Ascus management question" In reply to: allanho@aol.com: "Re: Factor V Leiden & Contraception" Next in thread: Ginny Lee: "Re: Factor V Leiden & Contraception" Reply: Ginny Lee: "Re: Factor V Leiden & Contraception"

Return to

Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Wed Dec 2 05:11:47 2009

The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.