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Family Planning

Family Planning. Or Odd PC for Contraception Dr Bruce Davies www.bradfordvts.co.uk. Important. 70% plus of women get their contraceptive advice from GPs An area where GPs may be the real experts Specialists in FP are available in some areas. Big Issues. Too big for one tutorial

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Family Planning

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  1. Family Planning Or Odd PC for Contraception Dr Bruce Davies www.bradfordvts.co.uk

  2. Important • 70% plus of women get their contraceptive advice from GPs • An area where GPs may be the real experts • Specialists in FP are available in some areas

  3. Big Issues • Too big for one tutorial • Too many areas for one tutorial

  4. Big Issues • Too big for many 10 minute consultations • Spread the load ! • Patient information sheets

  5. Possible Topics • The IOS payments – managing and maximising. • Gillick competance. • Follow-up consultations. • Audit of care. • Scope of services. • Peri-menopausal contraception.

  6. Possible Topics • Postnatal women. • Women with learning problems. • Emergency contraception. • Cultural considerations. • Pre-conceptual counselling. • Return of fertility / infertility. • Etc etc.

  7. Types Hormonal • Combined oral contraceptive • Progestogen only • Depot injections • Implants • Emergency oral

  8. Types Intrauterine devices • Copper coils • Intrauterine systems ( Mirena ) • Emergency contraception

  9. Types Barrier methods • Diaphragm • Cap • Condoms • Female condoms • Spermicides

  10. Types Natural Methods Sterilisation • Male • Female

  11. First Requests • People often have pre-conceived ideas of what they want • …other methods may be more suitable • GPs need up to date knowledge and current “scares” • Need to know where to refer for specialised contraceptive care

  12. First Requests Issues regarding choice • Age • Efficacy required • Ease of use • Smoking status

  13. First Requests Topics to cover for each method • Efficacy • Individual suitability • Absolute contra-indications • Side effects • Adverse reactions

  14. First Requests • Advantages other than contraception • Mode of use • Onset of action • Follow-up arrangements • Timing of return to fertility • Protection against sexually transmitted disease

  15. First Requests History • Existing medical problems • Regular medication • Family history • Menstrual history • Obstetric history • Previous contraceptive use

  16. First Requests • Often too much for one consultation • Useful to have packets and coils to show • Comparative leaflets useful • Should aim for a joint decision

  17. Combined Pills • The most popular method. • Relatively few contraindications. • Risks of stroke and MI reduced by measuring BP before and during use.

  18. Combined Pills • Highly effective • Increased risk of venous thrombosis • Not for use in smokers over 35 years • May raise blood pressure • Cannot be used while breast feeding • Caution with liver enzyme inducers • Caution with broad spectrum antibiotics

  19. Combined Pills • Reduces ovarian cancer • Reduces endometrial cancer • Reduces benign breast disease • Accelerates the presentation of breast cancer but probably does not increase absolute risk • RCGP study results

  20. Combined Pills • Complicated starting instructions • Seven day rule • Etc etc • Backup of leaflets essential

  21. Combined Pills Non-contraceptive uses • Acne • Polycystic ovaries • Cycle control • Menorrhagia • Dysmenorrhoea

  22. Combined Pills Contraindications • Previous DVT etc • Breast or gynaecological cancer • Any liver disease • Any ischaemic heart or Cerebrovascular disease • Gross obesity

  23. Combined Pills • Pulmonary hypertension • Sickle cell disease • Otosclerosis • Focal migraine • Haemolytic uraemic syndrome

  24. Combined Pills • Heart valve disease • Porphyria • Chorea • Pemphigoid

  25. Combined Pills Precautions • Hypertension • Raynauds • Diabetes • Asthma • Varicose veins

  26. Combined Pills • Severe depression • Chronic renal disease • MS • Dialysis • Hyperprolactinaemia

  27. Combined PillsTroubleshooting • Failure • Weight gain • BP • Migraine • Breakthrough bleeding • Spotting • PMT symptoms • Malaise

  28. Progestogen only pills • Reversible • Needs to be taken daily • May cause menstrual irregularity • May be used in hypertension • May be used while breastfeeding

  29. Progestogen only pills • Reliability • Timing of use • Leaflets needed

  30. Depot progestogens • Every 2-3 months • Very effective • Delay fertility return • May cause weight gain • May cause menstrual irregularity

  31. IUD / IUS Contraindications • Unexplained vaginal bleeding • PID or recent PID • Uterine distortion • Risk of endocarditis (I.E. Murmurs etc)

  32. IUD / IUS • Heavy periods • Specialist skills needed • Counselling re problems • IUS costs • IUS initial symptoms • IUS loading device diameter

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