1. Contraception Update

2. To know the contraindications for each and how to identify them
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. <1 1-10 11-50 51-100 100+ Cocp Pop Depo Ius Iud Patch Condom
Diaphragm/Spermicide
Condom
Female condom
withdrawal
Male sterilisation
Female sterilisation

8. The answers!

9. First year of Use Perfect Use Cocp 50 3 Pop 20? Depo Ius/iud 1 implant
Patch 80
Diaphragm/Spermicide
160 6
Condom
150 20
Female condom
210
withdrawal
270 40
Male sterilisation
Female sterilisation ~5 5
No method
850

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

11. What are the benefits?

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

13. What are the real risks?
VTE
Cancer
Stroke

14. VTE with COCP Risk of VTE per 100.000 Healthy, non pregnant, no COCP
5 per yr
Cocp with levonorgestrol
15 per year
Cocp with gestodene or desogestrol
25 per year
Pregnant
60 per year

15. VTE with COCP:Effect of weight….
BMI>30
2 x risk
BMI >39
4 x risk
Healthy,no COCP 5 10 20
Cocp with levonorgestrol 15 30 60
Cocp with gestodene or desogestrol 25 50
100
Pregnant
120
240

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

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

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

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

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

21. Let’s have some cases!

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

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

30. 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 ***

31. 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

32. 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

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

34. 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

35. 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

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

37. 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?

38. 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 *******

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

40. Side Effects 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