Contraception

Question 1

A 24-year-old female comes to your GP practice and asks about different contraceptive methods. Discuss how you would counsel the patient.

Answer 1

Impression
young patient of reproductive age seeking advice for contraception. Would want to engage in discussion regarding different options and identify patient centred approach and decision making.

Before having any further discussion, need to take thorough Hx/Ex/Ix. Reassure confidentiality, invest in rapport and therapeutic alliance.

Question 2

Contraception - History

Answer 2

History

• PC: contraception, reasons for, why now
• sx: any current STI sx: abdo/pelvic pain, vaginal discharge, fevers, urinary sx, bowel sx, etc
• sexual history: partners, STI’s, any screening (six P’s)
• menstrual history: regularity, length, etc
• gynae hx: CST, past pathology, treatment
• Obstetric: GTPAL
• contraindications to COCP: any past VTE, Complex migraines, breast cancer, SLE/APLS,
• SNAP

Question 3

Contraception - Examination

Answer 3

Examination

- only indicated if active pathology identified during history

Question 4

Contraception - Investigations

Answer 4

Investigations

- only necessary if indicated on the basis of findings from history and examination

Question 5

Contraception - Management/Counselling

Answer 5

Management/Counselling
topics of discussion
- Safe sex practice
o vaccination
o regular STI screening
o barrier protection with new partners
- Contraception; current patient understanding and preferences, things to consider, options
o ask about current understanding, and preferences for types
o highlight different types: hormonal, implanon, IUD, depot, other non-hormonal (barrier, FABM)
o pros and cons of each
o identify patient lifestyle, discuss which is going to work best for them, timing (hormonal options have delayed onset
o discuss A/E of each option

• Missed pill counselling
• emergency contraceptive options
• permanent options