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Contraception Update

Contraception Update. To know what forms of contraception are available and when they are necessary To know the contraindications for each and how to identify them What to check for on f/u consultations To know how to access information for ourselves and patients

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Contraception Update

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  1. Contraception Update

  2. To know what forms of contraception are available and when they are necessary • To know the contraindications for each and how to identify them • What to check for on f/u consultations • To know how to access information for ourselves and patients • To know how to approach a consultation for : • A teenager • A >35 y.o • The rest!

  3. To be able to discuss the main pros and cons for different types of contraception. • To know which are the most effective methods of contraception • To know why some are less good for different patient groups • To be aware of important issues for different age ranges

  4. Brainstorm!

  5. What forms of contraception are there?

  6. Quiz! • If 1000 women were to use these methods of contraception…. How many pregnancies would arise in the first year of use?

  7. The answers!

  8. Pros and Cons of each method • Groups/Pairs…. discuss

  9. What are the benefits?

  10. What are the benefits? • Any one want to fill this in?

  11. What are the real risks? • VTE • Cancer • Stroke

  12. VTE with COCP

  13. VTE with COCP:Effect of weight….

  14. Other risks… • Which is more likely to happen? • Dying from a thrombosis from a third generation COCP • Or • Dying in a RTA

  15. Cancers… • Is there an increase in risk of breast cancer with the COCP? • RR increased by: • 0% • 1-9% • 10-19% • 20-49% • >50%

  16. Is there an increase in risk of breast cancer with the COCP? • RR increased by: • 25%

  17. What is the absolute risk increase? • 0.01% • 0.1% • 0.5% • 1% • 2-10%

  18. Absolute risk is 0.01% • Actual baseline risk <30 1:1900 30-40 1:200 • Risk increase is 12/100,000

  19. Let’s have some cases!

  20. Special considerations • Depot and osteoporosis, if young woman careful, depot causes bone mineral density to decrease at a time when it should be increasing • This is not true for implanon • Consider cerazette/other pops, >70kg rule

  21. Frazer/Gillick competence • <13yrs not legally capable of consenting to sexual activity • 13-16 discuss and consider

  22. Missed pills • New rules • Can miss one anywhere in pack no prob even if extend pill free interval to 8 days • If std dose 30 can miss 2/3**** • If low dose oestrogen (20) can miss ***

  23. Special considerations • Depot and osteoporosis, if young woman careful, depot causes bone mineral density to decrease at a time when it should be increasing • This is not true for implanon • Consider cerazette/other pops, >70kg rule

  24. Special considerations • Depot and osteoporosis, if young woman careful, depot causes bone mineral density to decrease at a time when it should be increasing • This is not true for implanon • Consider cerazette/other pops, >70kg rule

  25. Enzyme inducers • Women with epilepsy • Injectable/IUD • Oral contraceptives with 50mg oestrogen • Tricycle with 4 days break • Double emergency contraceptive dosage

  26. Migraine • Migraine with aura =absolute CI (WHO 4) • Migraine +ergots=absolute GI • Migraine +tryptan = relative CI • Migraine +1 other RF=relative CI • Migraine + No Aura +no additional stroke risk factors = OK

  27. Migraine • Migraine with aura =absolute CI (WHO 4) • Migraine +ergots=absolute GI • Migraine +tryptan = relative CI • Migraine +1 other RF=relative CI • Migraine + No Aura +no additional stroke risk factors = OK

  28. Enzyme inducers • Women with epilepsy • Injectable/IUD • Oral contraceptives with 50mg oestrogen • Tricycle with 4 days break • Double emergency contraceptive dosage

  29. When should contraception be started? • IUCD within 12 days of period onset • Mirena day 1-7 or if no risk preg at other time • Depot-? • COCP?

  30. GP activity *** swopping pills/hrt • Side effects can be oestrogenic/progestogenic • Guillain book (pill ladder) • *******Photocopy, brainstorm complaints on the pill ****** • Spots, w gain, mood swings, bleeding, migraing increased weight inc >70kg ?can have 20mcg oestrogen? • Choose an approp pill *******

  31. C19 derivatives E.g Norethisterone Levonorgestorel More androgenic More likely to cause side effects C21 derivatives E.g Medroxyprogestogen acetate Dydrogesterone Less androgenic Progestogens

  32. Oestrogenic Fluid retention Bloating Breast tenderness Nausea Headache Dyspepsia (take with food) Consider changing dose, changing oestrogen or changing delivery Progestogenic (In a cyclical pattern) Fluid retention Breast tenderness Mood swings Depression Acne Backache Reduce progestogen duration to 10 days per cycle, change progestogen c19/21 derivatives, delivery Side Effects

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