Contraception counselling

Question 1

background for contraception

Answer 1

sexually active?
regular partner/multiple partners?
recent UPSI/any chance of pregnancy/preg. test
emergency contraception?
STI screen

Question 2

hx in contraception

Answer 2

quick gynae hx - fibroids // (undiagnosed) vag bleeding
quick menstrual hx - heavy bleeding
quick obs hx - recent pregnancy & BREASTFEEDING
PMH - **migraine w/ aura // VTE // stroke // heart disease // HTN // dyslipidaemia // thrombophilia (antiphospholipid syndrome // (breast) cancer // previous/recent STIs/PIDs // severe asthma
surgical hx - gastric operations
DHx/allergies - CP450 inducers: carbamazepine, phenytoin, rifampicin, St John’s // copper allergies
FH - BRCA1
SH - smoking, alcohol, occupation, social support
weight & height // BP

Question 3

summary of <16

Answer 3

Gillick competence
pt will not tell parents of actions
pt likely to have sex without
best interests to receive contraception

Question 4

COCP +ves

Answer 4

reduce menorrhagia
protective against ovary/endometrial cancer

Question 5

COCP -ves

Answer 5

thromboembolic
breast/cervical cancer risk
SEs: N/breast tenderness/spotting
no STI protection

Question 6

starting COCP

Answer 6

1st 5 days –> protection right away
outside –> barrier for 7 days

pill, patch (weekly), ring (3-weekly)

Question 7

COCP main contraindications

Answer 7

> 35 + >15 cigs/day
migraine with aura
breastfeeding 1st 6w postpartum
50
BMI>35

Question 8

COCP 1 pill missed

Answer 8

take asap even with next one
no emergency needed

Question 9

COCP 2 pills missed

Answer 9

take last one asap even if with next one
use barrier for next 7 days
if had UPSI during missed pills in:
1st week - emergency
2nd week - no action (if took pill prior 7 days)
3rd week - omit pill-free week

Question 10

POP contraindications

Answer 10

breast cancer
live problems

Question 11

starting POP

Answer 11

1st 5 days –> protection right away
outside –> barrier for 48 hrs
TAKE EXACT SAME TIME EACH DAY

Question 12

Missed pill POP

Answer 12

> 3 hrs late (12hrs for degesterol)
take next one (even if two together)
barrier for 48hrs
emergency if UPSI during missed interval

Question 13

IU contraceptions CIs

Answer 13

PID <3 months ago
small uterine cavity
uterine distortion (fibroids)
undiagnosed PV bleed
gynae cancer
copper allergy (IUD)
iscahemic heart disease (IUS)

Question 14

IUD SEs

Answer 14

coil insertion risks (bleeding, infection 1st 3m)
heavy periods
ectopic preggo

Question 15

IUS SEs

Answer 15

coil insertion risks
spotting in 1st 6m
ectopic

Question 16

before IU insetion

Answer 16

check STI
check string monthly

Question 17

implant (prog. only) +ves & -ves

Answer 17

• 3 years, no maintenance needed, most effective form
• progesterone SEs, insertion risk, IRREGULAR BLEEDING, will feel it

Question 18

deppo (prog. only) +ves & -ves

Answer 18

• 3 months, no maintenance needed
• WEIGHT GAIN, prog SEs, irregular periods, slow return of fertility, osteoperosis (esp in >50)

Question 19

general structure of contraceptives

Answer 19

• name
• contraindication
• components
• method of action
• treatment course
• +ves & -ves
• missed pills (if applicable)