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CONTRACEPTION for GPs

CONTRACEPTION for GPs. Dr Lisa Jayne Adams November 2007. AGENDA. Non-hormonal contraception Hormonal contraception Cases. Contraceptive Efficacy. Pearl Index Effectiveness rates depend on age and motivation of user

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CONTRACEPTION for GPs

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  1. CONTRACEPTIONfor GPs Dr Lisa Jayne Adams November 2007

  2. AGENDA • Non-hormonal contraception • Hormonal contraception • Cases

  3. 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

  4. Withdrawal • Mentioned in the Bible • No side effects • Pearl index of 8

  5. 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

  6. PERSONA • Pearl Index 6 • BREAST FEEDING • Pearl Index 2

  7. CONDOMS • Most commonly used non-hormonal • Pearl Index 3-20 • Beware certain topical products • Protection against STI’s

  8. FEMALE BARRIER METHODS • Femidom • Diaphragm • Cervical cap

  9. 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

  10. 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)

  11. HORMONAL CONTRACEPTION • COCP • Pearl index 1-5 • Mode of action • Non contraceptive benefits • Starting regime • Late pills/missed pills • Diarrhoea/vomiting/ antibiotics

  12. EVRA transdermal combined hormonal contraception • Yasmin contains drospirenone, has diuretic and antiandrogen properties • NuvaRing

  13. Potential Harms • All COCP’s increase the risk of VTE, MI, ischaemic stroke, absolute risk is small • Any associated increased risk of breast cancer likely to be small

  14. 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

  15. 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

  16. 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

  17. POP • Thickens cervical mucus • Pearl index 0.3- 4 • Late pills • Cerazette (desogestrel) more effective, blocks ovulation in 97% of cycles • Advantages • Side effects • Starting regime

  18. DEPOT PROVERA • Deep IM every 12 weeks • Pearl index 0.3- 1 • Preinjection counselling • Unwanted effects • Can lower bone density in long-term users

  19. IMPLANON • Contraceptive implant etonogestrel • Pearl index 0.8 • Lasts for 3 years • Fitting and counselling • Pros and cons

  20. EMERGENCY CONTRACEPTION • Levonelle • Copper IUD insertion

  21. LEVONELLE • Licenced for u to 72 hours after UPSI • Prevents 86% of pregnancies • Levonogestrel 1500ug • Contraindications and drug interactions

  22. 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

  23. CASE HISTORIES

  24. 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.

  25. 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?

  26. 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.

  27. 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?

  28. 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.

  29. Useful websites • Fpa.org.uk (formerly Family Planning Association) • BNF online • Prescriber.com • Attract • Prodigy (good for guidelines)

  30. REFERENCES • Faculty 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

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