Contraception Made Easy, revised edition

Laura Percy, Diana Mansour

• Publisher: Scion Publishing
• Year: 2016
• ISBN:
  9781907904936
• Edition: 1
• Topic: Medicine
• Subtopic: Family Medicine & General Practice

Highly Commended in the 2016 BMA Medical Book Awards!

From reviews:

"…undoubtedlythe best feature is the user-friendly and consistent nature of the format. Eachmethod of contraception has a dedicated chapter with an identical outlineshowcasing factual and practical content using bulleted text, tables andpictograms…. The book would be useful for medical students that are 'new' tothe subject as the outline of the chapters lends itself to seamless grasping ofnew information. However, the practical application of the factual informationis ideal for both gynaecological and family planning trainees, nurses that workwithin the field and general practitioners." Ulster Medical Journal 2016:85(3):211

This revised edition has been updated to include the 2016 UK MedicalEligibility Criteria for contraceptive use, as well as other updates. It helpshealthcare professionals to provide up to date and practical guidance on allthe commonly used contraceptive methods:

• combined oral contraceptive (COCs), patches, andvaginal rings
  
  

• progestogen-only pills (POPs), progestogen-onlyinjectables and implants
  
  

• copper intrauterine devices (IUDs) and the levonorgestrelIUS
  
  

• diaphragms, cervical caps, and male and femalecondoms
  
  

• natural fertility awareness advice/kits
  
  

• emergency contraception
  
  

• male and female sterilisation.
  
  

ContraceptionMade Easy is the ideal practical reference guide for GPs and otherhealthcare professionals involved in the provision of contraceptive advice.

Laura Percy is a Specialist Registrar in Community Sexual and Reproductivehealth. Diana Mansour is a Consultant in Community Gynaecology and ReproductiveHealthcare and Head of the Integrated Sexual Health Services for Newcastle uponTyne, UK. She is also a Faculty Officer and Treasurer for the Faculty of Sexualand Reproductive Health Care, UK.

Chapter 1

Introduction

1.1 Introduction

This short book provides up-to-date information, often in note form, about the commonly used contraceptive methods available in high resource countries and is aimed at healthcare professionals working in primary, community and secondary services. The book’s content is based on guidance from the Faculty of Sexual and Reproductive Healthcare’s Clinical Effectiveness Unit and the National Institute for Health and Care Excellence. References will appear at the end of each chapter when specific studies or reviews are mentioned.

Chapter 2, covering the consultation, explores the necessary points to discuss when seeing couples about contraception, including their ideas, concerns and expectations. Chapter 3 looks in more detail at the provision of contraception to special groups such as young people and those with learning difficulties. Each method will then be examined in turn, with information identifying potential users of the method, how it works, its efficacy, the advantages and disadvantages, how to start and stop the methods (where appropriate) plus the management of troublesome side-effects. The book concludes with two chapters on screening women for asymptomatic sexually transmitted infections (STI) and managing unplanned pregnancies.

1.2 Unplanned pregnancy

Keeping up to date in this field is difficult, especially when contraception is not a special interest of the nurse or doctor. Yet men and women will seek advice from approachable healthcare staff who are non-judgemental and can give non-directional support. Hopefully being better prepared will help couples plan their pregnancies. However, at the current time it is estimated that almost 50% of pregnancies worldwide are unplanned. One in three women from high resource countries experiences an abortion during their lifetime, with a third requiring a repeat procedure (see Figure 1.1).

Figure 1.1. Age-standardized abortion rate in women aged 15–44 in England and Wales.

Over 80% of abortions take place in women aged 20 or over, not the teenagers that are so often vilified. At the time of the abortion, at least 60% of women report using a contraceptive method. However, the mostly commonly cited methods are oral contraceptives or condoms, which require correct and consistent use. This high number of unplanned pregnancies may reflect poor contraceptive knowledge in the population. There may be issues related to funding of contraceptive services in primary and community care which limit access to and availability of contraceptive choice. Time pressures during consultations reduce the ability to explore fears and concerns surrounding some methods. This can result in couples choosing a contraceptive that fails to fit their lifestyle, for example an inability to adhere to daily regimens, leading to high typical failure rates for pills, condoms and natural methods when compared with perfect use (Table 1.1).

1.3 Provision of contraceptive services

For England and Wales recent years have seen a small fall in the age-standardized abortion rate (see Figure 1.1). Many other European countries show a similar trend, but this will only be sustained if there is political commitment to invest in contraceptive choice and easily accessible services. Effective provision of, and access to, contraception improves the health of women and children. Investing in this area of healthcare is cost-effective, with every £1 spent in the UK on contraceptive provision resulting in a cost benefit of £11.09. This rises to £13.42 for every £1 invested in long-acting reversible contraceptive methods (LARCs).

1.4 UK Medical Eligibility Criteria for contraception

Sixteen contraceptive methods are available free at the point of access in the UK and these include:

• emergency contraception

• combined oral contraceptives (COCs), patches, and vaginal rings

Table 1.1. Summary table of contraceptive efficacy – percentage of women experiencing an unintended pregnancy during the first year of typical and perfect use of contraception, and the percentage continuing use of that contraceptive at the end of the f...