Contraceptive in Young People FSRH Mar 2010

Question 1

“Contraceptive Choices for Young People”
Legal and Ethical Framework
- How to assess a young person’s competence to consent to treatment.

Answer 1

Assessing competence
● Understand the treatment, its purpose and nature, and why it is being proposed
● Understand its benefits, risks and alternatives
● Understand in broader terms what the consequences of the treatment will be
● Retain the information for long enough to use it and weigh it up in order to arrive at a decision.

• should be assessed and documented at each
  visit <16-year-olds.

Question 2

“Contraceptive Choices for Young People”

Contraceptive Options for Young People

Answer 2

• Inform: about all methods, highlighting the benefits of LARC. ( ≥20 years ? )
• Advise: to return for follow-up within 3 months of starting hormonal contraception. (side effects / concerns/ correct use )
• Return at any time if problem.
• Age alone should not limit contraceptive choices, including intrauterine methods.
• Awareness: different types of EC available, when and how accessed.
• Even if presenting for EC within 72 hours of UPSI,
  all ages should be offered copper-IUD or how access.

Question 3

“Contraceptive Choices for Young People”
Legal and Ethical Framework
Child protection

Answer 3

• All sexual and reproductive health care services a person identified as local lead for child protection.
• All staff involved in contraceptive services for young people should receive appropriate training to alert them to possibility of exploitation or coercion.
• Staff should know who they can contact for advice and how to act on child protection issues in accordance with local policy and procedures.

Question 4

“Contraceptive Choices for Young People”
Legal and Ethical Framework
Confidentiality

Answer 4

Young people should always be made aware of the confidentiality policies for the service they are attending, including the circumstances in which confidentiality may need to be breached.

Question 5

“Contraceptive Choices for Young People”
what law to be informed in relation to sexual activity.
13-16 years

Answer 5

• age of consent to sexual activity in UK 16 years, ( 1/3 already by this age)
• unlawful but mutually agreed sexual activity b/w < 16-year-olds of similar age- not to prosecuted unless evidence of abuse or exploitation.

Question 6

“Contraceptive Choices for Young People”
what law to be informed in relation to sexual activity.
< 13 years

Answer 6

Different legislation on sexual activity England and Wales, Northern Ireland and Scotland.

• In England, Wales & Northern Ireland, < 13 years unable to legally consent to sexual activity.
• In Northern Ireland, no statutory duty under law to report to police cases of sexual activity involving children <16 years unless the child is < 13 years or the other party is aged 18 years or over.
• Sexual Offences Scotland Act 200917 - sexual activity with a male or female aged < 13 years - “rape of a young child”.

Question 7

“Contraceptive Choices for Young People”
Fraser Guidelines/criteria
- use checklists (e.g. Fraser Guidelines) to assess
competence and risk.

Answer 7

● young person understands professional’s advice.
● young person cannot be persuaded to inform their parents.
● young person is likely to begin, or to continue sexual intercourse with or without contraceptive treatment.
● Unlessyoung person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer.
● young person’s best interests require them to receive contraceptive advice or treatment with or without parental consent.

Question 8

UKMEC categories based on age

Combined hormonal contraception (combined oral contraception, vaginal ring, patch)

Answer 8

• Menarche to <40 years - 1

- ≥40 years - 2

Question 9

UKMEC categories based on age

Progestogen-only pill

Answer 9

• Menarche onwards - 1

Question 10

UKMEC categories based on age

Progestogen only implant

Answer 10

• Menarche onwards - 1

Question 11

UKMEC categories based on age

Progestogen-only injectable (DMPA or NET-EN)

Answer 11

• Menarche to < 18 years - 2
• 18–45 years - 1
• > 45 - 2

Question 12

UKMEC categories based on age
Barrier methods (condoms, diaphragms, cervical caps)

Answer 12

• Menarche onwards- 1

- CEU recommends that condoms can be used before menarche if required.

Question 13

UKMEC categories based on age

Copper-bearing intrauterine device

Answer 13

• Menarche to <20 years - 2

- ≥20 years - 1

Question 14

UKMEC categories based on age

Levonorgestrel-releasing intrauterine system

Answer 14

• Menarche to <20 years - 2

- ≥20 years - 1

Question 15

“Contraceptive Choices for Young People”
Addressing Young People’s Health Concerns and Risks
Weight Gain

Answer 15

• no evidence of weight gain with CHC use
• BUT can with DMPA
• but there is little evidence of a causal association b/w other progestogen-only methods and weight gain.

Question 16

“Contraceptive Choices for Young People”
Addressing Young People’s Health Concerns and Risks
Acne

Answer 16

• COC use can improve acne if fails to improve with COC may consider switching to less androgenic progestogen or one with a higher estrogen content.
• Co-cyprindiol (Dianette®) is indicated to treat severe acne that has not responded to oral antibiotics.
• with less severe symptoms it should be withdrawn 3-4 months after condition has resolved.
• For women with known hyperandrogenism, longer
  use with specialist review may be warranted.
• progestogen-only implant may be associated with improvement, worsening or onset of acne.

Question 17

“Contraceptive Choices for Young People”

Addressing Young People’s Health Concerns and Risks Mood Changes and Depression

Answer 17

• hormonal contraception may be associated with

mood changes but there is no evidence that hormonal contraceptives cause depression.

Question 18

“Contraceptive Choices for Young People”

Addressing Young People’s Health Concerns and Risks Fertility

Answer 18

• no delay in return of fertility following discontinuation of the progestogen-only pill or CHC and IUS or progestogen - only implant.
• can be delay of up to 1 year in return of fertility after discontinuation of DMPA.

Question 19

“Contraceptive Choices for Young People”
Addressing Young People’s Health Concerns and Risks Bleeding Patterns and Dysmenorrhoea
.

Answer 19

• altered bleeding patterns can occur with hormonal contraception use.
• Primary dysmenorrhoea may improve with CHC.

Question 20

“Contraceptive Choices for Young People”

Addressing Young People’s Health Concerns and Risks Bone Health

Answer 20

• use of progestogen-only injectable contraceptive is associated with a small loss of BMD, usually recovered after discontinuation.
• DMPA can be used in < 18 years after consideration of other methods.
• Women who wish to continue using DMPA should be reviewed every 2 years to reassess benefits and risks.

Question 21

“Contraceptive Choices for Young People”

Addressing Young People’s Health Concerns and Risks Thrombosis

Answer 21

• inform: that although the risk of VTE is increased with CHC, absolute risk is very small.

Question 22

“Contraceptive Choices for Young People”
Addressing Young People’s Health Concerns and Risks
Cancer

Answer 22

• advised that COC use is not associated with an overall
  increased risk of cancer.
• advise: that COC use reduces risk of ovarian cancer and that protective benefit continues for 15 or more years after stopping.
• advise: that any increase in breast cancer with hormonal contraception use is likely to be small and to reduce after stopping.
• advise: that there may be a very small increase in the risk of cervical cancer with prolonged COC use.

Question 23

“Contraceptive Choices for Young People”
Addressing Young People’s Health Concerns and Risks
Sexually Transmitted Infections and Young People

Answer 23

• advise: correct & consistent use of condoms to reduce the risk of transmission of STIs.
• inform: about correct use of condoms and lubricants, different sizes, types and shapes of condoms, and how to access further supplies, STI screening and EC.
• STI tests 2 and 12 weeks after an incident of UPSI.