1 / 26

Contraception Update

Contraception Update. Jo Swallow ST1s October 2011. Objectives. 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

dezso
Download Presentation

Contraception Update

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Contraception Update Jo Swallow ST1s October 2011.

  2. Objectives • 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 contraception request • An emergency contraception request

  3. Brainstorm! • What forms of contraception are there? • Rank them now in order of efficacy, (most effective at the top)

  4. Pearl index Method Failure %rates per hundred women years • Sterilisation male 0.0 to 0.2 • Sterilisation female0.0 to 0.3 (1.8% at 10 years) • Implanon0.0 • Mirena0.0 to 0.2 • Depo-Proverax0.0 to 0.2 • Combined oral contraceptive pill0.2 to 3 (3 with poor compliance) • Progestogen-only pill (second generation)0.3 to 4 (0.5 over age 35) • IUDs 0.3 to 2 • Diaphragm/cervical • Cap 5 to 20 • Condom (male, female) 5 to 15 • Coitus interruptus 8 to 17 • Natural methods 5 to 25 • Spermicides 5 to 25

  5. Case 1-Lois A • Lois 15yrs attends asking to go on the pill. In groups of 3, History factors? Examination factors? ?Pill choice

  6. COCP/POP • What did you think?

  7. A reminder, re child protection.Frazer/Gillick competence • <13yrs not legally capable of consenting to sexual activity • 13-16 discuss and consider

  8. Pros/cons of cocp

  9. Important things to worry about with the COCP? • VTE • Cancer –breast/ovarian • Stroke • Use the BNF cautions contraindications list… 2 strikes and you’re out!

  10. VTE with COCP

  11. VTE with COCP:Effect of weight….

  12. Dianette/Yasmin • Heard the news?

  13. Cardiovascular Risk • Absolute risk of MI in non smoking age <35 very low irrespective of COCP use • Excess risk <35 approx 3/1,000,000/yr • >35 Excess risk approx 400/1,000,000/yr • 10x risk if smoke

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

  15. Case 1 -Lois B • Lois returns to see you with symptoms of a urine infection, • She reports that although she is quite good at remembering her pills, she does forget occasionally, is this ok?

  16. Antibiotics and the pill • But ILL rules, (D/V still apply, and abx can induce these!)

  17. 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 ***

  18. Case 1 –Lois C • Lois returns, 4 months later, she is now 16. • Her parents has been complaining about her mood swings and she wonders if the pill is to blame. She hasn’t told them that she takes it. • What might you consider?

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

  20. 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

  21. Case 2- The condom split • Michelle 15 yrs attends asking for ‘the emergency pill’ • Groups of 3 • What do you need to ask? • What other issues does this present?

  22. Emergency contraception • What actually happened? • ?regular partner or one off • STI risk? • Menstrual cycle and current position, other contraception? (?earliest ovulation) • When was the accident? • Any other upsi in this cycle • ?used before • ?consensual, age of partner, ?Frazer competant

  23. Case 2 - Michelle B • It transpires that the condom split yesterday evening around 11pm, • They also had sex 3.5 days ago using the withdrawal method • What is the most effective measure for her now? • What other options are there?

  24. Levonelle is effective up to 72 (120 hrs) • If >48-72 hrs consider Ella One, (ullipristal) • Always consider copper iud (up to 5 days or, up to 5 days> earliest ovulation) • Levonelle efficacy: • 95% - 1st 24hr, 85% 48, 70% 72 • Ella one efficacy: • ….. • Remember pt’s on enzyme inducers may require double dosing of MAP

  25. Things to discuss: • Mode of action • Vomiting • Enzyme inducing drugs • Next Period -87% within 7 days of expected: may be early or late, Most of rest 7-14d late • ?Preg test • ? Quickstart FUTURE contraception, • Condoms have a 5% failure rate when used PERFECTLY

  26. Emergency Contraception • IUCD (not IUS) • Up to 5 days after date of UPSI or expected ovulation • Failure rate <1%

More Related