contraception

Question 1

The coil advantages

Answer 1

Over 99% effective.
It works as soon as it’s put in.
Can stay in for 5-10 years depending on the type.
Doesn’t contain or release any hormones.
Easily removed by your GP when needed.
When the coil is removed your fertility (ability to get pregnant) will return to normal.

Question 2

The coil disadvantages

Answer 2

it may not be suitable for women at risk of getting a sexually transmitted infection.
It may not be suitable for women who have been told they have an unusual-shaped womb
It might cause heavier, longer periods.
There is a very small risk of infection after insertion.
Falls out in 1-20 women
ectopic pregnancy

Question 3

what are types of IUD

Answer 3

mirena (progesterone)
(starts working after 7 days, helps HRT, heavy periods, 5Y)
copper IUD - 5Y-10Y

Question 4

what will a gp ask before fitting of IUD

Answer 4

no unprotected sex from your last period
light meal before fitting
30 minute appointment for fitting
expect cramping afterwards

Question 5

implant

Answer 5

Small, flexible rod put under the skin of the upper arm, inserted using local anaesthetic which makes the area numb.
Releases the hormone progestogen. This stops you ovulating, thickens the mucus in the cervix (neck of the womb) to prevent sperm reaching the egg and thins the lining of the womb so that a fertilised egg can’t implant.
protected up to 3 Y

Question 6

advantages implant

Answer 6

Over 99% effective.
Works for 3 years.
Easily removed by a doctor or nurse when needed
When it’s removed your fertility (ability to get pregnant) will return to normal.

Question 7

disadvantages implant

Answer 7

Periods may stop, be irregular or last longer.
You may get acne or acne might become worse.
You will need a small procedure to remove it.

Question 8

injectable contraception

Answer 8

There are 2 forms of injectable contraception and both last 13 weeks. One can be self-injected and this means you can usually get a prescription for 4 injections (a year’s supply) so less visits to the clinic/GP surgery.

The other is given every 13 weeks by a health care professional, for people who prefer this option.

With typical use, is 96% effective (around 4 in 100 women will become pregnant in 1 year)
Lasts for 13 weeks.
Not affected by other medicines, diarrhoea or vomiting.

Question 9

disadvantages injection

Answer 9

Periods may stop, be irregular or last longer.
Fertility (ability to get pregnant) may take time to return after stopping injections.
Injection can’t be removed from the body, so any side effects may continue for as long as the injection works.
Some women may gain weight.

Question 10

combined pill

Answer 10

It contains the hormones estrogen and progestogen. These hormones stop you ovulating, thicken the mucus in the cervix (neck of the womb) to prevent sperm reaching the egg and thin the lining of the womb so that a fertilised egg can’t implant.
There are many different pills and many different brands. The instructions for most pills advise you to take one tablet every day for 3 weeks and then have a 1 week break when you will get a bleed. However, you can choose to shorten this break to 4 days, or to miss it and not have a bleed. For options on how to take the pill

Question 11

advantages of the combined pill

Answer 11

It can make periods regular, lighter and less painful.
Reduces the risk of cancer of the ovaries, uterus and colon.

Fertility (ability to get pregnant) returns to normal when you stop taking it.

Question 12

disadvantages of the combined pill

Answer 12

There is a very small risk of serious side effects such as blood clots, breast and cervical cancer.
There may be temporary side effects such as headaches, breast tenderness or feeling sick.
Missing pills, vomiting or diarrhoea can make it less effective: with typical use 9 in 100 women will become pregnant. If you have missed a pill or are late to start a pack, click here for more information as to what to do.
You may get some irregular bleeding in the first few months.

Question 13

contraceptive patch

Answer 13

It’s a small patch stuck on to the skin, it releases the hormones estrogen and progestogen. These hormones stop you ovulating, thicken the mucus in the cervix (neck of the womb) to prevent sperm reaching the egg and thin the lining of the womb so that a fertilised egg can’t implant.

one patch every week for 3 weeks and then have a 1 week break when you will get a bleed. However, you can choose to shorten this break to 4 days, or to miss it and not have a bleed

Question 14

advantages of the patch

Answer 14

When used perfectly, it can be over 99% effective.
It’s easy to put on and remove.
It’s not affected if you vomit or have diarrhoea.
It can make periods lighter and less painful.
It improves acne for some women.

Question 15

disadvantages of the patch

Answer 15

There is a very small risk of serious side effects such as blood clots, breast and cervical cancer.
There may be temporary side effects such as headaches, breast tenderness or feeling sick.
You may get some irregular bleeding in the first few months.
Some medicines can make it less effective.
It’s important to follow the instructions for use and remember to reapply it, or it won’t work effectively and you could become pregnant. With typical use, 9 in 100 women will become pregnant in 1 year.
It might cause skin irritation

Question 16

contraceptive vaginal ring

Answer 16

It’s a small, flexible plastic ring that you put into your vagina - it releases the hormones estrogen and progestogen. These hormones stop you ovulating, thicken the mucus in the cervix (neck of the womb) to prevent sperm reaching the egg and thin the lining of the womb so that a fertilised egg can’t implant.

The instructions for the vaginal ring advise you to use one ring for 3 weeks and then have a 1 week break when you will get a bleed. However, you can choose to shorten this break to 4 days, or to miss it and not have a bleed.

Question 17

advantages vaginal ring

Answer 17

When used perfectly, it can be over 99% effective
It’s easy to put in and remove.
It’s not affected if you vomit or have diarrhoea.
It can make periods lighter and less painful.

Question 18

disadvantages vaginal ring

Answer 18

There is a very small risk of serious side effects such as blood clots and breast and cervical cancer.
There may be temporary side effects such as headaches, breast tenderness or feeling sick.
You may get some irregular bleeding in the first few months.
Some medicines can make it less effective.

Question 19

The pill progesterone only pill

Answer 19

It contains the hormone progestogen. This stops you ovulating, thickens the mucus in the cervix (neck of the womb) to prevent sperm reaching the egg and thins the lining of the womb so that a fertilised egg can’t implant.

Question 20

advantages progesterone only pill

Answer 20

Can be taken by women who can’t take the hormone estrogen.
Fertility (ability to get pregnant ) returns to normal when you stop taking it.

Question 21

disadvantages progesterone only pill

Answer 21

You must remember to take 1 pill at the same time of day every day. If you are taking the desogestrel pill, it is not effective if taken over 12 hours late. Other progestogen only pills are not effective if taken over 3 hours late.
Vomiting or diarrhoea can also make it less effective: with typical use 9 in 100 women will become pregnant. If you have missed a pill or are late to start a pack, click here for more information as to what to do
Periods may stop, become irregular, lighter or more frequent.
There may be temporary side effects such as headaches, breast tenderness or acne.

Question 22

emergency contraception options

Question 23

gillick competency and Fraser guidelines

Answer 23

When practitioners are trying to decide whether a child is mature enough to make decisions about things that affect them, they often talk about whether the child is ‘Gillick competent’ or whether they meet the ‘Fraser guidelines’.

Question 24

when should healthcare workers take gillick competency into consideration

Answer 24

if a young person under the age of 16 wishes to receive treatment without their parents’ or carers’ consent or, in some cases, knowledge.

If the young person has informed their parents of the treatment they wish to receive but their parents do not agree with their decision, treatment can still proceed if the child has been assessed as Gillick competent.

Question 25

how do we assess gillick competence

Answer 25

the child’s age, maturity and mental capacity

their understanding of the issue and what it involves - including advantages, disadvantages and potential long-term impact

their understanding of the risks, implications and consequences that may arise from their decision

how well they understand any advice or information they have been given

their understanding of any alternative options, if available

their ability to explain a rationale around their reasoning and decision making.

Question 26

when are the Fraser guidelines used

Answer 26

apply specifically to advice and treatment about contraception and sexual health. They may be used by a range of healthcare professionals working with under 16-year-olds, including doctors and nurse practitioners.

Question 27

Practitioners using the Fraser guidelines should be satisfied of the following:

Answer 27

the young person cannot be persuaded to inform their parents or carers that they are seeking this advice or treatment (or to allow the practitioner to inform their parents or carers).

the young person understands the advice being given.

the young person’s physical or mental health or both are likely to suffer unless they receive the advice or treatment.

it is in the young person’s best interests to receive the advice, treatment or both without their parents’ or carers’ consent.

the young person is very likely to continue having sex with or without contraceptive treatment.

Question 28

When using Fraser guidelines for issues relating to sexual health, you should always consider any potential child protection concerns:

Answer 28

Underage sexual activity is a possible indicator of child sexual exploitation and children who have been groomed may not realise they are being abused.

Sexual activity with a child under 13 should always result in a child protection referral.

If a young person presents repeatedly about sexually transmitted infections or the termination of pregnancy this may be an indicator of child sexual abuse or exploitation.

Question 29

what is the spotting the sign tool

Answer 29

The Spotting the Signs Tool (2023) is designed to help professionals ask the right questions to identify potential abuse or exploitation in children and young people. Rather than acting as a checklist of questions, the Tool is designed to facilitate a conversation with the child or young person to help understand their situation better.

Question 30

what is CSE and CCE

Answer 30

CSE and CCE are both complex forms of abuse which can be difficult for children, young people and professionals to identify. They often involve coercion, manipulation and threats to engage in sexual activity and/or to carry out criminal acts for the benefit of others. Children and young people are groomed into CSE and CCE which can make it hard for the victim to be aware that what is happening is abuse and/or exploitation. Where they are aware, fear, shame and guilt can be barriers to seeking help.