Progesterone Vaginal Ring PVR Session 1 Characteristics of

Progesterone Vaginal Ring (PVR) Session 1: Characteristics of PVR

PVR Module Learning Objectives As a result of actively participating in this training, the learner will be able to: 1. Describe the progesterone vaginal ring (PVR) to a woman seeking a family planning (FP) method using simple and clear language that she can understand 2. Explain the criteria for selecting/using the PVR 3. Demonstrate how to screen women for eligibility to use the PVR 4. Demonstrate how to counsel a woman about using the PVR as her contraceptive method (including using counseling cards) 5. Demonstrate how to insert and remove the PVR using a pelvic model (if available)

Overview of the PVR • The Progesterone Vaginal Ring (PVR) is a safe and highly effective family planning (FP) option for many women in the following situation: • The woman has a baby at least 4 weeks old. • She is breastfeeding the baby at least 4 times per day and plans to continue. • Her menses have not returned. • This module provides an overview of the PVR and provides training on how to counsel clients who are interested in using this method.

Rationale for Including the PVR in Family Planning • Expands the range of available family planning methods • No extensive training or complicated new techniques • User-friendly • Easy to explain and counsel

Session Objectives At the end of this session, the learner will be able to: 1. Describe the PVR to a woman seeking a family planning method, using simple and clear language that she can understand. 2. Explain the criteria for selecting/using the PVR.

What is the progesterone vaginal ring? Contraceptive method for postpartum women who breastfeed at least 4 times per day Smooth, soft, flexible, silicone ring containing natural progesterone Easily inserted and removed from the vagina by the woman

How does it work? The PVR delivers 10 mg of progesterone locally in the vagina, which works in two ways:

How does it work? (cont. ) • Breastfeeding naturally interferes with the hormones that cause ovulation. PVR’s progesterone reinforces this and suppresses ovulation. • Progesterone extends postpartum amenorrhea: lack of menstruation. • Must continue breastfeeding at least 4 times a day. • Progesterone creates a mucus around the cervix, blocking sperm from reaching egg.

Who can use it? • Women who are 4 weeks after childbirth and whose menses have not returned • Women who are breastfeeding at least 4 times a day • Baby is less than 1 year old • Women who are not pregnant • No other health conditions

How do you use it? • The woman inserts the ring high in her vaginal canal. • Each ring is effective up to 3 months and she should leave it in the vagina for the entire time. • After 3 months, the woman easily removes the ring and inserts a new one. • She can use this method successively up to 1 year (4 rings in 1 year). • The ring can be left in vagina during intercourse or removed for no more than 2 hours.

PVR Insertion: Preparation • Wash hands • Open package and take out PVR • Hold the PVR between the thumb and forefinger and press the sides together.

PVR Insertion: Insertion Methods Use your fingers and gently push the ring deep into the vagina—as far as it will go. Laying down Squatting Standing The exact position is not important. If inserted correctly, you should not feel it.

PVR Removal Insert forefinger into the vagina until it has hooked around the ring and gently pull.

PVR: Health Benefits • Reduced number of unintended pregnancies • Improved birth spacing • Increased breastfeeding rates This leads to better child nutrition and decreasing maternal and newborn mortality rates.

Effectiveness of PVR • On this chart of effectiveness, where would you place the PVR? Most effective Implants Male/Female Sterilization IUD Injectable Oral contraceptives Progesterone Vaginal Ring Male condoms Least effective Fertility awareness methods Diaphragm

Effectiveness of PVR (cont. ) Family Planning Method First Year Pregnancy Rate No method 85 Spermicides 16 Diaphragm with spermicide 16 Standard Days Method 5 Male condoms 2 PVR 1. 5 Female Sterilization 0. 5 Copper IUD 0. 6 Progestin-only pills 0. 3 Progestin-only Injectables 0. 2 Implants 0. 1

PVR: Normal Possible Side Effects Changes in bleeding patterns: • Spotting • Irregular bleeding • No menstrual bleeding Mild cramping Breast tenderness

PVR: Rare Possible Side Effects Rare, but return to clinic if experience: • Severe pain • Unusual, bad smelling discharge • Genital lesions

PVR: Advantages and Disadvantages Advantages Disadvantages • Safe for mother and baby • Partner may be able to feel the ring • 98. 5% effective • Only for up to one year • Easy to use • Removal for over two hours reduces • No effect on breastfeeding • Fertility returns without delay when removed • Safe for a woman living with HIV/AIDS, even if she takes antiretroviral medicines efficacy • Provides no protection from sexually transmitted infections, including HIV • Has some side effects

Key Points for Providers and Clients Important to remember: • Can be stopped at any time without a provider’s help. • Removing the ring for any period of time may reduce efficacy. • If removed, reinsert within 2 hours to maintain efficacy • If more than 2 hours, reinsert immediately and use EC or condoms for 24 hours after reinsertion, or abstain for 24 hours after reinsertion. • Seek another method if not breastfeeding at least 4 times/day. • Use condoms to protect against sexually transmitted infections, including HIV/AIDS.

Key Points for Clients It’s as easy as… 4 Breast feed 4 times a day 3 Wear each ring for 3 months 2 Reinsert ring within 2 hours if removed 1 Use until your child’s 1 st birthday, then talk to provider to seek a new method