7 CONDOMS Most commonly used non-hormonal Pearl Index 3-20 Beware certain topical productsProtection against STI’s
8 FEMALE BARRIER METHODS FemidomDiaphragmCervical cap
9 IUDs Banded copper device =gold standard More effective in older women Main problemsDuration of use 10 yearsCan be used for emergency contraceptionPearl index 1-3
10 IUS Periods shorter and lighter Licensed for 5 years Can cause spotting and irregular bleeding for up to 6 monthsPearl Index < 1(included in non-hormonal methods as effects are local)
11 HORMONAL CONTRACEPTION COCPPearl index 1-5Mode of actionNon contraceptive benefitsStarting regimeLate pills/missed pillsDiarrhoea/vomiting/ antibiotics
12 EVRA transdermal combined hormonal contraception Yasmin contains drospirenone, has diuretic and antiandrogen propertiesNuvaRing
13 Potential HarmsAll COCP’s increase the risk of VTE, MI, ischaemic stroke, absolute risk is smallAny associated increased risk of breast cancer likely to be small
14 Non contraceptive Benefits Decreased pain and blood lossRisk of ovarian and endometrial cancer decreased by at least 50% during useDecreased risk of colorectal cancerDecreased incidence functional ovarian cysts
15 Not Recommended (UKMEC category 4) Smokers >35 years (>15 a day)Migraine with aura at any ageKnown thrombogenic mutationsBMI >40BP consistently > 160/100Current breast cancerLiver tumoursHx VTE/Stroke/MIValvular and congenital heart disease
16 PRESCRIBING Record BMI and BP Take a full history, check smoking statusUse a monophasic pill first line eg microgynonCounsel re risks and side effectsDiscuss non-contraceptive benefits
17 POP Thickens cervical mucus Pearl index 0.3- 4 Late pills Cerazette (desogestrel) more effective, blocks ovulation in 97% of cyclesAdvantagesSide effectsStarting regime
18 DEPOT PROVERA Deep IM every 12 weeks Pearl index 0.3- 1 Preinjection counsellingUnwanted effectsCan lower bone density in long-term users
19 IMPLANON Contraceptive implant etonogestrel Pearl index 0.8 Lasts for 3 yearsFitting and counsellingPros and cons
24 CASE ONECarly 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.
25 CASE TWOLinda 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?
26 CASE THREEEve 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.
27 CASE FOURSam 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?
28 CASE FIVEPippa 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.
29 Useful websites Fpa.org.uk (formerly Family Planning Association) BNF onlinePrescriber.comAttractProdigy (good for guidelines)
30 REFERENCESFaculty of Family Planning and Reproductive Health Care Clinical Guidance: First prescription of combined oral contraception (July 2006)Guillebaud, J. Contraception Today. 5th ed. Martin Dunitz, 2005