OSCE Key Points

Question 1

Contraception Counselling Quick History

Answer 1

Why need contraception
Relationship status
Menstrual history (any undiagnosed PV bleeding- only COCP/get it seen to)
Chance of pregnancy/previous contraception
Post-partum/pregnancy
PMH inc. STI’s/obstetrics
DH
Contraindications to COCP (smoking and 35+, migraine with aura, history of VTE, breast or cervical cancer)

NB- when taken history, ask them do they have any ideas of what they would like/would they like you to go over some methods

Question 2

Emergency Contraception Quick History

Answer 2

Details of encounter eg. when, partners age, consent etc.
Current contraception
Menstrual history (fertile period is day of ovulation and 5 days before it (2 weeks before next menstrual period is due))- but can get pregnant at any time
Have they had emergency contraception this cycle
Advise STI screen where appropriate
PMH- can’t give ellaone/ulipristal if asthmatic (or below 18)

NB- safety net ie. pregnancy test in 3 weeks, if vomit in 3 hours, come back and we will give you another dose with an antisickness tablet, restart normal contraception immediately after levonelle, but wait 5 days for ellaOne (then there are rules for restarting contraception ie. 2 days for POP/7 days COCP)

Question 3

HRT Counselling

Answer 3

Discuss why they want HRT/what they already know
Discuss symptoms
Bleeding (LMP/PV/post-coital bleeding etc.)
PMH-VTE/cancer/uterus or not
Explain what they would like to know/what they want to discuss
Explain menopause/what HRT does etc.
Risks/benefits/side effects
Types of HRT ie. route/preparations
Contraception
Alternatives (don’t necessarily have to take HRT)

Question 4

Background HRT knowledge

Answer 4

Contraindications- undiagnosed PV bleeding, pregnancy/breastfeeding, previous breast or current cancer, liver disease, previous VTE, CVD (angina,stroke etc.)

Benefits- vasomotor symptoms, physiological symptoms (libido and mood), urogenital atrophy, reduced osteoporosis

Risks- VTE (not with transdermal), stroke, breast cancer (combined only, not oestrogen on its own), ovarian cancer, endometrial cancer if oestrogen only HRT, CHD

SE’s- breast tenderness, nausea, PMS, leg cramps

Route- systemic (patch or tablet) or vaginal oestrogen

Type of systemic therapy- no uterus: oestrogen only, uterus: combined (with progesterone), perimenopausal=cyclical HRT (have a bleed every month), post-menopausal (not had a bleed for 1 year)=continuous HRT