Family Planning
Or
Odd PC for Contraception
Dr Bruce Davies
www.bradfordvts.co.uk
Important
70% plus of women get their
contraceptive advice from GPs
An area where GPs may be the
real experts
Specialists in FP are available in
some areas
Big Issues
Too big for one
tutorial
Too many areas
for one tutorial
Big Issues
Too big for many 10
minute
consultations
Spread the load !
Patient information
sheets
Possible Topics
The IOS payments – managing
and maximising.
Gillick competance.
Follow-up consultations.
Audit of care.
Scope of services.
Peri-menopausal contraception.
Possible Topics
Postnatal women.
Women with learning problems.
Emergency contraception.
Cultural considerations.
Pre-conceptual counselling.
Return of fertility / infertility.
Etc etc.
Types
Hormonal
Combined oral contraceptive
Progestogen only
Depot injections
Implants
Emergency oral
Types
Intrauterine devices
Copper coils
Intrauterine systems ( Mirena )
Emergency contraception
Types
Barrier methods
Diaphragm
Cap
Condoms
Female condoms
Spermicides
Types
Natural Methods
Sterilisation
Male
Female
First Requests
People often have pre-conceived
ideas of what they want
…other methods may be more
suitable
GPs need up to date knowledge and
current “scares”
Need to know where to refer for
specialised contraceptive care
First Requests
Issues regarding choice
Age
Efficacy required
Ease of use
Smoking status
First Requests
Topics to cover for each method
Efficacy
Individual suitability
Absolute contra-indications
Side effects
Adverse reactions
First Requests
Advantages other than contraception
Mode of use
Onset of action
Follow-up arrangements
Timing of return to fertility
Protection against sexually
transmitted disease
First Requests
History
Existing medical problems
Regular medication
Family history
Menstrual history
Obstetric history
Previous contraceptive use
First Requests
Often too much for one consultation
Useful to have packets and coils to show
Comparative leaflets useful
Should aim for a joint decision
Combined Pills
The most popular
method.
Relatively few
contraindications.
Risks of stroke and
MI reduced by
measuring BP
before and during
use.
Combined Pills
Highly effective
Increased risk of venous thrombosis
Not for use in smokers over 35 years
May raise blood pressure
Cannot be used while breast feeding
Caution with liver enzyme inducers
Caution with broad spectrum
antibiotics
Combined Pills
Reduces ovarian cancer
Reduces endometrial cancer
Reduces benign breast disease
Accelerates the presentation of
breast cancer but probably does not
increase absolute risk
RCGP study results
Combined Pills
Complicated starting instructions
Seven day rule
Etc etc
Backup of leaflets essential
Combined Pills
Non-contraceptive uses
Acne
Polycystic ovaries
Cycle control
Menorrhagia
Dysmenorrhoea
Combined Pills
Contraindications
Previous DVT etc
Breast or gynaecological cancer
Any liver disease
Any ischaemic heart or
Cerebrovascular disease
Gross obesity
Combined Pills
Pulmonary hypertension
Sickle cell disease
Otosclerosis
Focal migraine
Haemolytic uraemic syndrome
Combined Pills
Heart valve disease
Porphyria
Chorea
Pemphigoid
Combined Pills
Precautions
Hypertension
Raynauds
Diabetes
Asthma
Varicose veins
Combined Pills
Severe depression
Chronic renal disease
MS
Dialysis
Hyperprolactinaemia
Combined Pills
Troubleshooting
Failure
Weight gain
BP
Migraine
Breakthrough bleeding
Spotting
PMT symptoms
Malaise
Progestogen only pills
Reversible
Needs to be taken
daily
May cause menstrual
irregularity
May be used in
hypertension
May be used while
breastfeeding
Progestogen only pills
Reliability
Timing of use
Leaflets needed
Depot progestogens
Every 2-3 months
Very effective
Delay fertility return
May cause weight
gain
May cause menstrual
irregularity
IUD / IUS
Contraindications
Unexplained vaginal
bleeding
PID or recent PID
Uterine distortion
Risk of endocarditis
(I.E. Murmurs etc)
IUD / IUS
Heavy periods
Specialist skills needed
Counselling re problems
IUS costs
IUS initial symptoms
IUS loading device diameter