natural family planning Flashcards
The major clinical indicators of fertility are:
changes in the cervical mucous
changes in the cervix
changes in basal body temperature
A 19-year-old woman presents to her GP practice for contraception advice. She gave birth 3 weeks ago and wishes to resume sexual activity. Her menstruation has not recommenced postpartum, and she is mostly breastfeeding, supplementing with formula once daily. She would prefer to use an oral contraceptive, but is insistent that she wants to start as soon as possible. Her antenatal course and delivery were uneventful, she has no other medical history of note and does not smoke.
What contraceptive should be initiated?
Combined oral contraceptive pill
Copper coil
Levonorgestrel intrauterine system
None required until 6 months post-partum
Progesterone-only pill
Progesterone-only pill
Lactational amenorrhoea is a reliable method of contraception as long as amenorrhoeic, baby <6 months, and breastfeeding exclusively
Progesterone-only pill is correct. The patient requires a pharmacological method of contraception as she is not exclusively breastfeeding. She does not have any contraindications to the progesterone-only pill, which is classified as UKMEC 1 for breastfeeding women, indicating no restrictions for its use. All other contraceptive methods listed are assigned either UKMEC 3 or 4, establishing the progesterone-only pill as the most suitable choice for her.
Combined oral contraceptive pill is incorrect. Although the patient previously tolerated the combined oral contraceptive pill without complications before pregnancy, it is contraindicated (UKMEC 4) during breastfeeding for the first 6 weeks postpartum. This is due to the potential transfer of hormones to the child through breast milk and an elevated risk of venous thromboembolism in the mother. The combined oral contraceptive pill may be considered after six weeks postpartum.
Copper coil is incorrect. The insertion of implantable contraceptives such as the copper coil is discouraged (UKMEC 3) from 48 hours up to four weeks post-childbirth due to an increased likelihood of expulsion during this period.
Levonorgestrel intrauterine system is incorrect for similar reasons as stated above; implantable contraceptives like the Mirena coil are not recommended (UKMEC 3) between 48 hours and four weeks following childbirth because of a heightened risk of expulsion.
None required until 6 months post-partum is incorrect. Lactational amenorrhoea can serve as an effective form of contraception exclusively under certain conditions: when a woman has delivered within the past six months, remains fully amenorrhoeic, and practices exclusive breastfeeding. Since this patient supplements with formula feeding, lactational amenorrhoea cannot be considered a dependable method of contraception for her.
A 4-week postpartum woman presents to the GP seeking advice on contraception. She is interested in understanding the effectiveness of lactational amenorrhoea as a contraceptive method and whether she fulfils the criteria for its efficacy.
She reports an uncomplicated vaginal delivery and is exclusively breastfeeding her healthy infant. Additionally, she has not experienced a return of her menstrual periods since giving birth.
What is the most appropriate information to provide this woman regarding lactational amenorrhoea as a contraceptive option?
Another form of contraception is always required even if criteria for lactational amenorrhoea is met
Lactational amenorrhoea is not a reliable form of contraception
She cannot become pregnant whilst amenorrhoeic
She currently fulfils the minimal criteria for lactational amenorrhoea to be effective as a reliable method of contraception
She does not fit the criteria as her baby is too old and therefore requires a further form of contraception
She currently fulfils the minimal criteria for lactational amenorrhoea to be effective as a reliable method of contraception
Lactational amenorrhoea is a reliable method of contraception as long as amenorrhoeic, baby <6 months, and breastfeeding exclusively
‘The correct answer is she currently fulfils the minimal criteria for lactational amenorrhoea to be effective as a reliable method of contraception. The patient in question is four weeks postpartum, experiencing amenorrhoea, and exclusively breastfeeding. Lactational amenorrhoea can be considered a reliable method of contraception when these criteria are met.
Another form of contraception is always required even if the criteria for lactational amenorrhoea is met is incorrect. When the specific criteria for lactational amenorrhoea are satisfied, it serves as a reliable contraceptive method, and an additional form may not be necessary.
Lactational amenorrhoea is not a reliable form of contraception is also incorrect. It is a reliable form of contraception provided that the stipulated criteria are fulfilled.
She cannot become pregnant whilst amenorrhoeic is also incorrect. There remains a possibility of pregnancy during the postpartum period even if menstruation has not resumed.
She does not fit the criteria as her baby is too old and therefore requires a further form of contraception is incorrect. The age of the baby does not preclude the use of lactational amenorrhoea as a contraceptive measure in this case; it remains effective provided that the woman is amenorrhoeic, exclusively breastfeeding, and the infant is less than six months old.’
