Contraception Special Patient Groups

Question 1

What is the difference between the Gillick principle and the Fraser guidelines?

Answer 1

Gillick is applicable to all medicine, Fraser is specifically referring to contraception.

Question 2

What are the Fraser guidelines?

Answer 2

<16 year olds can be prescribed contraception if patient can understand advice, cannot be persuaded to inform parents, are likely to have sex anyway, and physical/mental health with suffer. And it is in their best interests.

Question 3

What is important to ask when using the Fraser guidelines?

Answer 3

How they met, power dynamic, age differences, gifts, drugs, alcohol, coercion.

Question 4

Under what age can you not give contraception?

Answer 4

Under 13 years as it is statutory rape. Involve social services/police.

Question 5

Which contraceptive should you avoid in teens and why?

Answer 5

1. Depo-Provera

2. Bone density decreases in first 2-3 years of use before stabilising.

Question 6

What is the effect of IBD on oral contraception and what is the viable alternative?

Answer 6

1. Malabsorption decreases efficacy of oral preparations.

2. Use patches, injectables, implants, IUD/IUS, barrier methods.

Question 7

What is a 98% effective contraception after childbirth and why?

Answer 7

1. Breastfeeding

2. Lactational amenorrhoea <6 months post-partum

Question 8

For how long does unprotected sexual intercourse not need contraception post-partum?

Answer 8

21 days

Question 9

How long is COCP contraindicated for post-partum?

Answer 9

1. Absolute - first 21 days (reduced milk volume)

2. Relative - 1.5-6 months

Question 10

What are the alternatives to COCP post-partum?

Answer 10

1. POP can be used in first 6 weeks

2. IUD can be inserted from 4 weeks

Question 11

How long should you continue contraception for an menopause if:

1. LMP <50 years
2. LMP >50 years

Answer 11

1. Continue for 2 years after LMP

2. Continue for 1 year after LMP