Contraceptive Efficacy Pearl Index Effectiveness rates depend on age and motivation of user Most effective? A method that stops ovulation and is independent of user compliance
Withdrawal Mentioned in the Bible No side effects Pearl index of 8
Natural Family Planning/Persona Complex to explain Calender method Temperature method Cervical mucus Combine all three Pearl Index 8-10 FPA can provide local teachers
PERSONA Pearl Index 6 BREAST FEEDING Pearl Index 2
CONDOMS Most commonly used non-hormonal Pearl Index 3-20 Beware certain topical products Protection against STIs
FEMALE BARRIER METHODS FemidomDiaphragm Cervical cap
IUDs Banded copper device =gold standard More effective in older women Main problems Duration of use 10 years Can be used for emergency contraception Pearl index 1-3
IUS Periods shorter and lighter Licensed for 5 years Can cause spotting and irregular bleeding for up to 6 months Pearl Index < 1 (included in non- hormonal methods as effects are local)
HORMONAL CONTRACEPTION COCP Pearl index 1-5 Mode of action Non contraceptive benefits Starting regime Late pills/missed pills Diarrhoea/vomiting/ antibiotics
EVRA transdermal combined hormonal contraception Yasmin contains drospirenone, has diuretic and antiandrogen properties NuvaRing
Potential Harms All COCPs increase the risk of VTE, MI, ischaemic stroke, absolute risk is small Any associated increased risk of breast cancer likely to be small
Non contraceptive Benefits Decreased pain and blood loss Risk of ovarian and endometrial cancer decreased by at least 50% during use Decreased risk of colorectal cancer Decreased incidence functional ovarian cysts
Not Recommended (UKMEC category 4) Smokers >35 years (>15 a day) Migraine with aura at any age Known thrombogenic mutations BMI >40 BP consistently > 160/100 Current breast cancer Liver tumours Hx VTE/Stroke/MI Valvular and congenital heart disease
PRESCRIBING Record BMI and BP Take a full history, check smoking status Use a monophasic pill first line eg microgynon Counsel re risks and side effects Discuss non-contraceptive benefits
POP Thickens cervical mucus Pearl index Late pills Cerazette (desogestrel) more effective, blocks ovulation in 97% of cycles Advantages Side effects Starting regime
DEPOT PROVERA Deep IM every 12 weeks Pearl index Preinjection counselling Unwanted effects Can lower bone density in long-term users
IMPLANON Contraceptive implant etonogestrel Pearl index 0.8 Lasts for 3 years Fitting and counselling Pros and cons
LEVONELLE Licenced for u to 72 hours after UPSI Prevents 86% of pregnancies Levonogestrel 1500ug Contraindications and drug interactions
EMERGENCY IUD 99.8% effective for postcoital use Copper IUD most effective Contraindications Insert up to 5 days after UPSI If regular cycle can insert up to 5 days after expected date of ovulation
CASE ONE Carly is 18 years old. She has just had a TOP due to pill failure. She is off to university soon. She is not in a regular relationship. She admits that she sometimes forgot to take her pill. She really wants to avoid another pregnancy. She wants your advice.
CASE TWO Linda is forty years old, married with three children. She is a non smoker and has been taking the COCP for 7 years. She stopped taking it last week because her younger sister has been admitted to hospital with a DVT. She does not really want any more children. What are her options?
CASE THREE Eve is 25 years old. She is in a stable relationship. She has been using condoms but wants something safer. She smokes 10 cigarettes a day.
CASE FOUR Sam is 35, she has recently got divorced. She has one child. She has had a coil for the last 9 years. She knows her coil will need changing soon. She is not sure if she wants another one. What is your advice?
CASE FIVE Pippa has come in for her 6 week postnatal check. She is 29 years old. She has a six week old baby and a fifteen month toddler. She is mainly breastfeeding, but gives some formula at night. She feels exhausted. Although her and her partner may want some more children they would like a decent gap next time. She wants your advice.
Useful websites Fpa.org.uk (formerly Family Planning Association) BNF online Prescriber.comAttract Prodigy (good for guidelines)
REFERENCES Faculty of Family Planning and Reproductive Health Care Clinical Guidance: First prescription of combined oral contraception (July 2006) Guillebaud, J. Contraception Today. 5 th ed. Martin Dunitz, 2005