Chapter
Misconception: the objective of contraception is the prevention of pregnancy
Myths about con(tra)ception
Myths and misconceptions about the clitoris, the G-spot, orgasm and dyspareunia
3 The history of contraception
4 Physiology of the menstrual cycle and natural family planning
Hormonal control of ovulation
Development of the Graafian follicle
The effect of oestrogen and progesterone on the endometrium
Ovulation of the follicle
The corpus luteum and pregnancy
Cervical mucus changes and the basis of the Billings method of NFP
Early embryonic development and implantation
The Billings (mucus) method
Practical messages from this chapter
The mechanism of action of the combined hormonal contraceptives
5 The oestrogen component of currently used steroidal contraceptives
The development of oestrogen as a contraceptive component
Currently used contraceptive oestrogens
Oestradiol valerate (E2V)
6 The risk of oestrogens in contraceptives
Women with a personal history of venous thrombosis
Biological mechanism of oestrogen-induced thrombosis risk
7 Progestogens used in contraceptives
Progestogens in contraceptive usage
Third-generation progestogens
Fourth-generation progestogens
Progestogen-only contraceptive methods
Safety concerns and medical eligibility for prescribing
Initiation of contraception
Progestogen-only implants
Safety concerns and medical eligibility for prescribing
Insertion and removal of Nexplanon®
Problems associated with removal
Changes to bleeding pattern
Other hormonal side effects
Progestogen-releasing intrauterine system
Common side effects and reasons for discontinuation
Tips for clinical practice with progestogen-only contraception
8 The contraceptive consultation
Role of the healthcare practitioner
General principles of a consultation
Consideration of medical contraindications and drug interactions
Medical Eligibility Criteria system
Important information to include in contraceptive consultations
Dual protection with condoms
Screening for other conditions
Available time: shaping the consultation
Issues raised by the consultation
Consent, parental involvement and confidentiality
Efficacy, access, costs, LARC methods and emergency contraception
Issues raised by the consultation
LARC methods, missed pills and maintaining an ongoing supply
Review of continued medical eligibility for the method
Side effects and reversibility
Opportunistic health promotion
Issues raised by the consultation
Postnatal assessment and screening for other conditions
Side effects and past contraceptive experience
Contraceptive effectiveness and concealment
Issues raised by the consultation
Additional benefits of hormonal contraception at the peri-menopause
Opportunistic contraception consultations and broadening the options
9 Menarche and associated problems
Peri-menarchal dysfunctional uterine bleeding
Less common conditions to watch out for
10 Adolescence: contraception in the teenage years
Government solution to teenage pregnancy
The contraceptive needs of young adolescents
Communicating with young people
Sexually transmitted infections in association with casual sex
Progestogen-only implants
Counselling of young women in relation to the implant
Assessment of capacity to consent to sexual activity and treatment
Contraception following abortion
11 Contraception in the 20-somethings
Management of unscheduled bleeding
The challenge of facilitating a contraceptive choice consultation
Counselling for the combined vaginal ring, NuvaRing®
What will happen regarding her ‘periods’?
How often will she need to attend the clinic to receive her rings?
Benefits and risks associated with combined hormonal contraception
User satisfaction rates and the effect on unplanned pregnancy and abortion
12 Contraception in the 30-somethings
13 Contraception in the 40-somethings
What are Alisons preferences and expectations from her contraceptive method?
The levonorgestrel-releasing intrauterine system (Mirena®)
Other non-contraceptive benefits
Other non-contraceptive benefits of CHCs
Progestogen-only implants
Barrier methods with tranexamic acid
Female/male sterilization with endometrial ablation
14 Contraception in the 50-somethings
When can a woman in her 50s stop using contraception?
Hormone replacement therapy
Assessing symptoms of menopausal hormone deficiency
Progestogen-only implant: Nexplanon®
Prevention of sexually transmitted infections
Psychosocial considerations and erectile dysfunction
The menopause, testosterone and declining sexual interest
15 What is the risk of cancer with hormonal contraception?
Overall balance of cancer risks and benefits
16 New developments in female sterilization
Prevalence of female sterilization
Counselling prior to sterilization
Various approaches to tubal occlusion
Laparoscopic Filshie® clips
The Essure® microinsert (Essure® Permanent Birth Control System, Conceptus Inc., San Carlos, CA, USA)
The Adiana device (Adriana® Permanent Contraception System (Hologic, Inc., Bedford, MA, USA)
Comparison of Essure® and Adiana®
Laparoscopic or hysteroscopic approach?
Sterilization reversal by laparotomy versus laparoscopy
Pre-vasectomy counselling
Alternatives to vasectomy
Possible points for discussion
18 Emergency contraception
Emergency contraception options
The menstrual cycle explained
Advising on whether there is an indication for EC
So which method should be offered to which woman?
19 Sexually transmissible infections and pelvic pain: what you really need to know
Sexually transmissible infections
The sexually transmitted sliding scale
Predictive values of tests for STIs
Multiple, painful superficial ulcers
Undiagnosed genital ulceration
Vaginal symptoms and balanitis
Upper genital tract symptoms
Pediculosis pubis and scabies
Glandular fever-like illness
20 Medical termination of pregnancy
Development of medical abortion
Overview of the legal situation in Europe
Introduction of medical abortion in Europe
Medical abortion regimens
Interval mifepristone-misoprostol
Absolute contraindications
Relative contraindications
Medical abortion and breastfeeding
Expected effects, side effects and complications
Gastrointestinal side effects
Shivering, increased body temperature
Clinical assessment and laboratory investigations
Second visit or home administration
Post-abortion contraception
The future - towards increased access to safe abortion services
21 Surgical termination of pregnancy
What do primary care clinicians and women need to know about this very common procedure?
The pre-assessment consultation
Risks (and myths of risks)
Haemorrhage (blood loss >500ml or bleeding requiring transfusion)
Upper genital tract infection
Future reproductive health
What signs and symptoms should women be looking out for?
22 Primary care treatment of subfertility and what every health professional needs to know about assisted reproductive technology
Fertility evaluation by the GP
Sperm: evaluation of the production and delivery of sperm
Eggs: detecting and evaluating ovulation
Tubes: evaluation of the pelvis and Fallopian tubes
What if sperm, eggs and tubes appear ‘OK’ and there is still no pregnancy?
Treatment of tubal abnormalities and endometriosis
Treatment of endometriosis
Treatment of unexplained subfertility
Case scenario 1: Caroline
Case scenario 2: Henry and Margo
Section 1 (Statutory definition of rape)
Section 5 (Statutory definition of rape of a child under 13 years)
Disclosure of sexual assault
Historic and or chronic abuse
Capacity, consent and confidentiality
Capacity and the Mental Capacity Act
Case scenario 1: Caroline
Key points to note for any injury
Child sexual exploitation
Sexual Assault Referral Centre
24 Future developments in contraception
Combined oral contraceptives
Oral contraceptives with a non-steroid substance added
Contraceptive gel to be applied on the skin
Progestin-only vaginal rings
Vaginal rings releasing a combination of an oestrogen and a progestin
Copper-intrauterine devices
Anti-progestin-releasing IUSs
Spermicides and microbicides
Contraceptive vaccines for women
Fertility awareness methods
Male hormonal contraception
Contraceptive vaccines: immunocontraception
Reversible inhibition of sperm under guidance
Contraception
：A Casebook from Menarche to Menopause
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