Contraception Today

John Guillebaud

• Verlag: CRC Press
• Jahr: 2019
• ISBN:
  9781351188456
• Auflage: 9
• Thema: Medizin
• Thema: Familien- & Hausarztpraxis

The fully updated ninth edition of this bestselling handbook summarizes concisely but fully the methods of contraception, of which there are more now than were ever available to previous generations.

This is a practical guide and includes newly launched intrauterine contraceptives. It also explains why new regimens for oral contraception should replace the standard 21/7 ritual that is suboptimal, despite being the norm for the past 60 years. Incorporating relevant WHO and national guidance documents, Professor Guillebaud's writing is appreciated because he describes best practice not only when there is a good evidence-base but also when there is not. He guides clinical judgement in real-world situations, where there often are unknowns yet the healthcare provider is facing a person who needs practical help now, in making their choice of method according to their own priorities. The easy-to-read format includes bulleted text and colour summary boxes that present information at a glance.

Contraception Today is the ideal guide to contraceptive advice for general practitioners and practice nurses.

1

Introduction

Contraceptive care within sexual and reproductive health (SRH) in the United Kingdom is provided by both nurses and doctors, more often the former in fact, and this book addresses both. Yet English usage has no good generally agreed generic term for the two, despite the considerable overlap in responsibilities and despite – recently and rightly so – following identical training pathways to obtain the letters of competence (LoCs) of the faculty of SRH in the fitting and aftercare of long-acting reversible contraceptives (LARCs) or the full Diploma qualification. In this book I have chosen to use HCP as the abbreviation for any trained health care provider/practitioner, whether nurse or doctor, and in either General or Community practice.

Unplanned pregnancies that are ‘iatrogenic’ (HCP-caused) are a reality. They result from avoidable errors or omissions in the consultation, above all the omission of sufficient time. The first contraceptive consultation requires considerably more than the usual ten minutes offered in most surgeries. I fully agree with the Faculty’s view, as forcibly stated at www.fsrh.org/documents/service-standards-for-workload-in-sexual-and-reproductive/ that “The minimum recommended time for a new consultation is 30 minutes” Many in the 21st century NHS may dismiss this as a daunting if not laughable aspiration – yet convincing grounds are given there and below, in this book. Time must be there for questions, promoting informed user-choice, often sharing the time between two HCPs either of whom is a practice nurse. Much time can then be saved later on by substituting the “Open house” policy (pp. 79, 99, 117, 149) for needless routine visits.

Choice of Method

Most women who seek contraception are healthy and young, and they present fewer problems than those who are more than 35 years old, teenagers and those with intercurrent disease. There is a tendency for sterilization procedures to be demanded at too early an age. This is partly because the Pill is routinely seen as synonymous with contraception and, when it has been tried and found wanting for whatever reason, we HCPs have not been informing women about the new or improved reversible alternatives to it which have arrived in the last 50 years (see Figure 1). Ignorance, confusion, and sometimes mythology about these are fostered ever more now by social media, so it is important to use the same Internet to inform accurately and refute as appropriate. An excellent example is the website www.contraceptionchoices.org created by colleagues at University College London and Margaret Pyke Centre since the last edition of this book. This allows “user-choosers,” woman or couple, to select according to their own priorities – as they themselves rank them – such as improvement in acne, ease of remembering, desire for pregnancy in the next few months, absence of hormones and controlling periods. The decision aid on the site adds up the scores for each to suggest three best-fit choices. As there stated: “There are no perfect choices – the decision aid weighs up different priorities…to make suggestions.”

Figure 1

Choice of contraceptive methods in the United Kingdom (2019). (Courtesy of Professor Anne MacGregor and Colin Parker of Durbin PLC.) More about each method is to be found later in this book (use index as required).

In Figure 1, the methods at bottom left are known collectively as the LARCs: the intrauterine systems IUSs), the banded copper intrauterine devices (IUDs) (collectively, now, IUCs), implants and injectables. These are indubitably the most effective methods for all age groups, indeed as we shall see the efficacy of the first three justifies the term “reversible female sterilization.”

The Young

I am opposed to “sex education”! Yes, really: since I support – as we all should – sex and relationships education (SRE). When seeking advice on sex, relationships, contraception,...