Progesterone Vaginal Ring Session 3 Providing the PVR

Progesterone Vaginal Ring Session 3: Providing the PVR Session III, Slide #1

Learning Objectives • Demonstrate how to counsel a woman about using the PVR as her contraceptive method. – Respond correctly to client questions about the PVR. – Address client concerns and misconceptions about the PVR. – Instruct her about how and when to insert and remove it. Session III, Slide #2

When to Start the PVR (A Review) What if this client wants to initiate PVR? Session III, Slide #3

Key Counseling Topics for PVR Users • Safety and efficacy • How PVR works • Health benefits • Possible side effects • No protection from STIs/HIV • Inform provider she uses PVR in case of serious new health problem • Reasons to return: questions, concerns or experiencing any warning signs Session III, Slide #4

Additional Key Topics: Instructions for Use • Explain how to insert and remove. • Explain the length of protection and when to change it out. • Describe reasons to return for follow-up. Session III, Slide #5

Common Rumors and Misunderstandings about the PVR Rumor Correct The PVR keeps working after it is removed, and so the woman will have trouble getting pregnant. The PVR stops working once it is removed. Its hormone do not remain in a woman’s body. PVR stops monthly bleeding, and blood is building up inside the woman. The PVR prevents monthly bleeding, but this is not harmful. It is similar to not having monthly bleeding during pregnancy. Blood is not building up inside the woman. PVR makes a woman infertile. The PVR does not make women infertile once she stops using it. PVR moves to other parts of the body. The PVR does not move to other parts of the body. It will remain in the vagina. Session III, Slide #6

Counseling About Side Effects • Common side effects: – Changes in bleeding patterns (spotting, irregular bleeding) – Mild cramping – Breast tenderness • Explain that side effects: – Are mild and do not usually require medical treatment – Are not signs of illness – Often go away with time • Reassure the client and encourage her to come back if she has questions or concerns Session III, Slide #7

Management of PVR Side Effects Counseling and reassurance are key. Problem Action/Management Spotting or Irregular Bleeding • Reassure the client that this is common and not harmful. Amenorrhea • Reassure client that this is common and not harmful. Mild Cramping • Reassure client that this is common and not harmful. Breast Tenderness • Reassure client that this is common and not harmful. • Suggest pain medication. • Recommend a supportive bra or compresses. Source: CCP and WHO, 2011. Session III, Slide #8

Supporting Method Continuation • Tell her: – No routine visit is required, except to pick up another PVR. – She may return any time for any reason. – She can switch to another method at anytime • If she returns, ask: – Is she satisfied with the method? – Does she have questions? – Does she remember the key points about using the PVR? Session III, Slide #9

Serious Complications from PVRs Are Uncommon or Rare If she experiences any of these symptoms: – Severe pain – Unusual, bad smelling discharge – Genital lesions … she should return to the clinic for examination. Source: CCP and WHO, 2011. Session III, Slide #10

Problems That May Require Switching from PVR to Another Method (Part 1) Problem Unexplained vaginal bleeding Action/Management • Remove the PVR • Refer or evaluate by history and pelvic exam • If an STI is diagnosed, treat with PVRs in place • If no cause can be found, consider removing PVRs to make diagnosis easier Migraines • Blood clots, liver or heart disease, stroke, or breast cancer Source: WHO and CCP, 2018. • If the client develops migraines with aura after PVRs are inserted, the PVRs should be removed Help client choose a method without hormones • • • Remove PVRs Help client choose a method without hormones Treat or refer to a specialist for treatment Session III, Slide #11

Problems That May Require Switching from PVRs to Another Method (Part 2) Problem Action/Management Heart disease due to A woman who has one of these conditions can safely start PVRs. If, however the condition develops while she is using PVRs: blocked or narrowed • Remove the PVRs or refer for removal arteries (ischemic • Help her choose a method without hormones heart disease) Suspected pregnancy • Refer for diagnosis and care if not already under care • • • Assess for pregnancy, including ectopic pregnancy Remove the PVRs or refer for removal if she will carry the pregnancy to term There are no known risks to a fetus conceived while a woman has PVRs in place Source: WHO and CCP, 2018. Session III, Slide #12

Disposal of the PVR After Use To dispose of a PVR (after she has used it for 3 months), the woman should: • Throw it in the garbage with other waste. • Do not flush down the toilet • Do not throw it into rivers, lakes, ponds or other water • Do not reuse as the PVR. • Do not share with others. Session III, Slide #13

PVR: Summary The PVR: • A new option that fulfills an unmet need for many women • Effective protection from unintended pregnancy when used correctly • Safe for baby and mother • Used by a new mother beginning 4 weeks after birth, if she is breastfeeding her baby at least 4 times per day and will continue to do so • Each ring effective for 3 months; replaced up to 3 times • Easy to use—inserted and removed by the woman • Very few side effects, generally mild Session III, Slide #14