GP- Contraception Flashcards
What is microgynon?
A combines hormonal contraceptive
Case:
Claire- aged 23 comes to see you to request a repeat prescrption of her contraceptive pill. SHe is taking microgynon, a combine hormonal contraceptive
What questions would you ask as a student doctor?
Has she found it easy to use/remember?
Has she noticed any adverse effects?
Doe sshe understand how to take it?
Doe she know how to manage missed pills?
Has the pattern of withdrawal bleeds been regular?
Has there been any breakthrough bleedign?
Have there been developments in her medical history (eg new medication) or scial history (eg age and smoking whch need to be considered )
What are the common adverse effects fo microgynon ?
Breakthrough bleeding - MC
Weight gain
other temporary adverse effects may include breast tenderness, headaches and nausea
May cause an inrease in blood pressure
how do you take microgynon?
Take your pill at the same time every day.
Start by taking a pill marked with the correct day of the week.
Follow the direction of the arrows on the strip. Take one pill each day, until you have finished all 21 pills.
Swallow each pill whole, with water if necessary.
What days are pills usually missed?
Day 1 and 2 because women forget after the 7 day interval of not taking it
What are some other ways of taking the pill (off licence but supported by my sexual health faculty)
Tricycling- running three packets back to back. So only haveing that hormone free interval once every three packets
Continuous use- Never having a hormone free interval
Flexible extended use- Pill packets are run continuously until a breakthrough bleed occurs. At the point the breakthrough bleed starts you should stop taking the pill and give herself a hormone free interval for about 3/4 days before starting it again.
Take a packet each month but having the 4 day free interval instead of 7
What happens if you miss one pill?
if you only miss one pill then thats not likely to be a problem. You should just take the pill when you remember.
What happens if you miss two pills in succession?
What is important to check in the medical history of women who is using contraception.
Specifically enquire about:
- Migrane
- smoking
- HTN
- Thrombophilia
- Previous VTE and FHx of VTE
- Hyperlipidaemia
- New medications- anticonvulsants, rifamoicin, St Johns Wort
Record BP and BMI
What is the UKMEC criteria?
UK medical elgibilty criteria
Set of criteria that is written by the faculty of sexual and reproductive health.
They look at every medical diagnosis and they say whether or not for each of those medical diagnoses, each type of contraception is okay or not to use.
WHat is the groups you UKMEC criteria uses
UKMEC 1 - there is no restriction to use. Absolutely fine to use that contraception in that medical condition
UKMEC 2 - There may be some risks but actually the advantages of that method of contraception seem to outweigh the risks of it
UKMEC 3- risks now of that contraceotion are probably outeweighing the advantages of it. So the use is generally not recommended although it can still be used if needs to be
UKMEC 4 - Use of that contraception with that medical condition will result in unacceptable risk to health and should not be used
Migranes while taking contraceptive pill can lead to?
Can lead to ishcameic stoke and so should be stopped
What is the next option if a person cant take contraceptive pill microgynon?
Probably a progesterone only pill (POP)
How do you take POP?
Who should not take POP
Active breast cancer patients
Can you use POP during breast feeding
yes
Is POP safe to use in women who are about to undergo major surgery or surgery on their legs?
Yes
Case 2
Bethany, aged 17 comes to see you. She tells you that she was prescribed microgynon by the sexual health clinic, but she has now run out.
She’s a bit quiet. She’s on her own
What questions would you ask?
Has she found it easy to us/remember?
Has she noticed any adverse effects?
Does she understand how to take it?
Does she know how to manage missed pills?
Has the pattern of withdrawal bleeds been regular?
Has there been any breakthrough bleeding (BTB)?
Have there been developments in her medical history (eg new medication) or social history (eg age and smoking) which need to be considered
Is she in a steady relationship? Are they any issues?
Has she thought about STIs?
Is her parent or guardian on board?
If the patient keeps forgetting to take the pill what are the alternatives?
Coil
DEPO injection
Implant
What informtion is important to give about the implant?
- inhibits ovulation and thicken cervical mucous
- licensed for three year
- most effective contraception we have. Failure rate of less than 1<1000 women in three years use
- Few contraindication to use
- Inserted (and removed) under local anaesthetic
Benefits of the implant
- safe and convenient
- dysmenorrhoea usally improves
- there is no evidence of delay n return to fertility on removal
- there is no evidence of reduced bone mineral density
- there is no evidence of increased VTE risk
Diadvantages of medical input?
Need medical input
Bleeding is a common problem 1/3 have infrequent bleeding
S/E - nausea, vomiting, acne, mastalgia
No cover against STIs
Case 3
Lucy, aged 36, comes to surgery following your request to review her microgynon prescription
She tells you that she has been taking it for 6 months, following the birth of her second child who is now 12 months old.
Has she found it easy to us/remember?
Has she noticed any adverse effects?
Does she understand how to take it?
Does she know how to manage missed pills?
Has the pattern of withdrawal bleeds been regular?
Has there been any breakthrough bleeding (BTB)?
Have there been developments in her medical history (eg new medication) or social history (eg age and smoking) which need to be considered
- No absolute “upper age kimit” at which the combined pill become scontraindicated. In practice it is not prescribed above the age of 50
- worth exploring long acting reversible contraceptive options (LARC)
- have considered longer acting methods?
- Is the family complete?
- Are you planning for more children?
- past experience of contraception
What are coils?
Common progesterone containing coil
mirena
Common non hormonal coil
T Safe
Differences in IUS and IUD coils?
What key points to say a patient decides they want a coil fitted if she is currently on the pill?
Cautions?
- Need to exclude pregnancy before fitting
- outside of day 1-7 of cycle, extra precaution needed for 7 days
- easiest way to do this is to continue microgynon for 7 days.
Can fitting the coil be painful?
Can be
more umcomfortable than a smear
You can you have sex staright after fitting the coil?
Yes
