Family Planning Referrals from Primary Care

Intra-uterine contraceptive copper or levonorgestrel device

Implants

Injectable contraception

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INTRA-UTERINE CONTRACEPTIVE COPPER OR LEVONORGESTREL DEVICE

General Measures

ICD-10 code: N92.0-1 + (Z30.5)

Where there is excessive bleeding after insertion of IUCD or levonorgestrel device:

• Exclude perforation of the uterus.

Irregular bleeding and/or cramping for >3 months:
ICD-10 code: N92.1/N92.5-6/N94.5-6/R25.2 + (Z30.5)

• Exclude cervical or pelvic infection, partial expulsion, intrauterine or ectopic pregnancy (rare) or other pathology.

If no pathology is detected:

• Counsel women that irregular bleeding can take up to 6 months to resolve.

Medicine Treatment

If no pathology is detected:

• NSAID, e.g.:
  • Ibuprofen, oral, 400 mg 8 hourly with or after a meal for 5 days.
    Use for every cycle for 1–3 months.
    • Follow up after three months and if bleeding/cramping is unacceptable, offer alternative contraception and remove intra-uterine device.

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IMPLANTS

ICD-10 code: T85.9 + (Z30.4)

Failure to locate an implant (in the arm) by palpation:

• Ultrasound guided removal of deep implants must be done by specially trained providers at regional hospitals.

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INJECTABLE CONTRACEPTION

General Measures

ICD-10 code: N92.0-1 + (Z30.4/Z30.8-9)

Heavy or prolonged bleeding despite adequate treatment with combined oral contraceptives:

• Do thorough gynaecological examination to exclude other pathology.
• Check haemoglobin and prescribe iron if needed. See Anaemia, iron deficiency.

Medicine Treatment

• Ethinylestradiol, oral, 50 mcg daily for 3 months.

LoE:IVb

OR

• Combined oral contraceptive, containing 50 mcg ethinylestradiol, oral, for 3 months.

If no response to high dose ethinylestradiol, replace with:

• NSAID, e.g.:
  • Ibuprofen, oral, 400 mg 8 hourly with or after a meal for 5 days. 

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If no response to NSAID, replace with:

• Tranexamic acid, oral, 500 mg 8 hourly for 4 days.

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If there is no response to above-mentioned treatment:

• Change to another method of contraception. See Primary Health Care Standard Treatment Guidelines: Family planning.

Click here for the pdf

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Standard Treatment Guidelines and Essential Medicines List for South Africa Adult Hospital _Chapter 5: Gynaecology; Version 1.0, 2020-4_June 2024