Family Planning Or Odd PC for Contraception Dr Bruce Davies

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 Too many areas for one tutorial

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

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

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

Types Hormonal Combined oral contraceptive Progestogen only Depot injections Implants Emergency oral

Types Intrauterine devices Copper coils Intrauterine systems ( Mirena ) Emergency contraception

Types Barrier methods Diaphragm Cap Condoms Female condoms Spermicides

Types Natural Methods Sterilisation Male Female

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

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

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

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

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

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

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

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

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

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

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

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

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

Combined Pills Heart valve disease Porphyria Chorea Pemphigoid

Combined Pills Precautions Hypertension Raynauds Diabetes Asthma Varicose veins

Combined Pills Severe depression Chronic renal disease MS Dialysis Hyperprolactinaemia

Combined Pills Troubleshooting Failure Weight gain BP Migraine Breakthrough bleeding Spotting PMT symptoms Malaise

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

Progestogen only pills Reliability Timing of use Leaflets needed

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

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

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