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eryn_smiles
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Hi Scarleteen. Do you guys know whether urine preg tests are accurate in breast feeding women? What about if the woman hasn't had a period yet after delivering? Someone asked me today, and I thought they must be accurate, but actually I have no evidence to support that.... thanks [Smile]

Edited to add another question: I wondered about your thoughts on new guidelines suggesting that women who are overweight or obese take a double dose of emergency contraception, compared to the usual 1.5mg levonorgestrel? Is this followed in US and Canada? One of our local GYNs was talking about how women weighing >60kg, should be taking double doses. Again though, I can't really find evidence for this, except in studies with small numbers and a few confounding factors.

[ 04-16-2012, 03:26 AM: Message edited by: eryn_smiles ]

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"Caring for myself is not self-indulgence, it is self-preservation and that is an act of political warfare."

Audre Lorde

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Karybu
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hCG levels, as I'm guessing you know, don't go back to non-pregnancy levels immediately after giving birth, but as far as I know, that's not related to breastfeeding. So I don't see why a pregnancy test wouldn't be accurate for someone who was breastfeeding, period or no, as long as it wasn't used within a few weeks of delivery.

Honestly though, I'm not 100% sure of that, so hopefully someone else has some other insight!

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"Another world is not only possible, she is on her way. On a quiet day, I can hear her breathing." -Arundhati Roy

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eryn_smiles
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The woman who was asking me had a 5 month old baby, so urine PT would definitely be accurate for her, lol! But then I was wondering what if you had a baby like 8 weeks ago?

Do you have ideas about second question? thanks [Smile]

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"Caring for myself is not self-indulgence, it is self-preservation and that is an act of political warfare."

Audre Lorde

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Karybu
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From what I can find, it seems that hCG levels return to normal within about a month, usually, of giving birth. So a PT at 8 weeks would very likely be accurate.

Unfortunately, I hadn't heard of those guidelines with EC - is this something official? (Recommending that anyone over 60 kg take a double dose seems....extreme, to say the least: the majority of women would likely weigh more than that.)

[ 04-16-2012, 03:44 AM: Message edited by: Karybu ]

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"Another world is not only possible, she is on her way. On a quiet day, I can hear her breathing." -Arundhati Roy

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eryn_smiles
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No, not official. I believe these are "off-licence" uses. Initially came across part of a women's health textbook which said that "Women who weigh > 70kg may have reduced contraceptive cover on the progesterone only pill, and should be advised to take two POP's a day (off licence)." When I asked a GYN about it, she said there was "no harm" in using the POP that way (but maybe no evidence for it either?). My friend asked a different GYN about it, who said there was no need to use POP that way regularly, but that it was safer to use double dosing of emergency contraception for overweight people.

These are some UK guidelines who say that some clinicians may use double doses, but that study evidence doesn't support it (yet?):
http://www.fsrh.org/pdfs/CEUGuidanceProgestogenOnlyPill09.pdf
http://www.fsrh.org/pdfs/CEUguidanceEmergencyContraception11.pdf

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"Caring for myself is not self-indulgence, it is self-preservation and that is an act of political warfare."

Audre Lorde

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Kachina
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Woah... 60kg is only 132lbs. I'd say that the majority of women weigh more than that. According to the BMI method, that would only be considered "overweight" if you are under 4'10" tall. Average height for women in first world countries is around 5'4". So if this recommendation were to be followed it should really just be changing the normal dose to twice as much and reducing it by half for underweight or short women, don't you think? Since the studies to come up with the normal dose as it is were likely done for average people, this makes no sense to me at all.

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~Kat
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Humans are allergic to change. They love to say, "We've always done it this way." I try to fight that. That's why I have a clock on my wall that runs counter-clockwise. - Grace Hopper

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eryn_smiles
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Yes, I don't know why they talk about an absolute weight rather than BMI, you make a good point.

One of the references talks about BMI:
"Obese women (BMI >30) using LNG were at greater risk of pregnancy compared with those using LNG with a normal or low BMI. Whilst an increased risk was also noticed amongst UPA users, the difference was not statistically significant. The numbers of women falling pregnant using either
method was small (n = 60) and even smaller among obese women (n = 20, 6/227 UPA,
14/242 LNG). It is not clear whether confounding factors such as multiple episodes of UPSI,
indication for EC or subsequent episodes of UPSI played a role in the findings. More evidence is needed before specific recommendations can be made for obese women."

But then, the other one talks about weight:
"It has been suggested that the efficacy of traditional POPs may be reduced in women weighing >70 kg. It has been practice for some clinicians in the UK to advise women weighing >70 kg to take two traditional POPs per day instead of the licensed regimen of one pill per day. Direct
evidence to support this practice is limited. Moreover, a large observational study found no association between body weight and accidental pregnancy in POP users. Indirect evidence from studies in women using a levonorgestrel implant or combined hormonal vaginal ring suggest that efficacy is reduced with increasing bodyweight.
As ovulation is sporadic in levonorgestrel-only implant users data have been extrapolated to
traditional POPs, which are also less reliable at ovulation inhibition. Current evidence does not support the unlicensed use of two traditional POPs per day for women weighing >70 kg"

Anyway, just a bit of interesting night time reading [Smile] . Seems like too much conflicting evidence for clinicians to start doubling doses yet.

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"Caring for myself is not self-indulgence, it is self-preservation and that is an act of political warfare."

Audre Lorde

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