This will be a thorough update of Topical Issues in Family Planning. Here are some cryptic quotes and themes – all to be amplified and explained on the day
HORMONAL CONTRACEPTIVES: combined and progestogen-only
The standard 21/7 combined oral contraceptive (COC) Pill is outdated; it should now be “history”.
Withdrawal bleeds on the COC have no known health benefits; indeed, menstruation is obsolete.
Migraine aura, according to Prof Anne MacGregor, can be diagnosed by asking the woman to describe what happens in her eyes before her headaches start, and then watching how she moves her hands.
– Q: How might you risk being sued if using norethisterone (NET) 5 mg tds to postpone period(s)?
– A: Only if you did not assess the relevance of NET’s metabolism in your patient’s case and she were to suffer a severe thromboembolic event.
– Q: How might you be sued for prescribing the COC to a well-controlled woman with epilepsy?
– A: If, being on lamotrigine, she has a seizure as a result – and is a taxi-driver.
– What, essentially, are the old-style POPs?
– They are “barrier methods that you swallow”.
LONG-ACTING REVERSIBLE CONTRACEPTIVES (LARCS – implants, injectables & intrauterine contraceptives)
LARCs are almost never not the most effective contraceptives – for teenagers or older couples, educated or uneducated, developing or developed countries.
In assessing ‘breakthrough bleeding’ (BTB) in users of hormonal contraception, all the causes to be considered begin with the letter “D”….
IUCs, are probably the best of the best among LARCs. Wrongly accused of much, it’s a myth they should usually be avoided by nulliparae.
IUCs tend to make female sterilization “yesterday’s method”: banded Cu IUDs and IUSs both have similar efficacy to it, yet with reversibility.
Might the word ‘coil’ tend to scare off potential users? It sounds like something mechanical that the doctor or nurse has to screw into you… There are ‘Practical tips’ to make insertions more comfortable.
EXTREMES OF REPRODUCTIVE LIFE
– Q to teens in a Focus Group: who should supply your contraception?
– A: “someone with a SMILE would be your best bet!”
– Q: Given that exogenous hormones mask the menopause, can one even so establish loss of fertility?
– A: Yes, three helpful protocols will be explained (Plans A, B and C).
Most methods need no routine follow-ups: put the money saved from those unnecessary visits into an effective “Open House” policy.
– Q: What to do about starting a method when there is no LMP?
– A: Use the “Proving not Pregnant Protocol”.
You need a good reason not to “Quick-start” or “Bridge” hormonal contraceptives. It should be the new norm NOT to delay till the next period.
Emergency contraception by copper is an order of magnitude more effective than any “morning after pill” – annoyingly, as it’s so much less convenient for both parties.
JG’s variant of the WHO Eligibility Scale [= UKMEC 1, 2, 3 or 4], as applied to various conditions:
A for ‘Always usable’;
B for ‘Broadly usable’;
C for ‘Cautiously usable’ (an alternative would be better, so special Counselling pre-use);
D for ‘Don’t use’.
EXTRAS & ODDITIES
“EGRYPURB” is JG’s acronym to ensure unlicensed use of licensed products, where indicated by good evidence, is done in a fully GMC-approved way.
“Most accidents are caused by humans – AND an awful lot of humans are still caused by accidents!”
The future of contraception? “Would a male pill make a vas deferens?”