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Contraception

Clinical Discipline(s)/Organ System(s)
General Practice, Obstetrics & Gynaecology, Reproduction & Development
Progress Test Topic(s)
Women's health
Description
A 36 year old NZ European woman, with three children, comes to her GP because she wants to know what contraceptive options are available to her. She smokes 15 cigarettes a day.
Applied Science for Medicine 
   - Physiology of the normal menstrual cycle
   - Physiology of conception and implantation
   - Mechanism of action of the methods of contraception
   - The role of exogenous oestrogens on cardiovascular and gynaecological oncology risk factors
   - Pharmacology of ethinyl estradiol, progestogens (norethisterone, levonorgestrol,medroxyprogesterone), emergency contraceptive pill
   - Adherence to medication; drug interactions
Clinical and Communication Skills 
   - Elicit a full gynaecological history including past medical and family history
   - Appropriate examination for contraceptive prescribing
   - Counsel a patient about contraceptive options and give them the information to decide what would be safe, effective options for them
   - Contraceptive options for men and women (barrier, pills, intrauterine devices (IUDs), implants, injections, vaginal ring, Essure and tubal ligation/vasectomy)
   - Categorise contraceptive options according to their reversibility and effectiveness, as well as timeline for return to fertility
   - Awareness of evidence-based side effects of and medical complications of contraception
   - Explore the reasons for seeking contraception and ensure there is no coercion to women's choices
   - Appropriate and safe prescribing of contraception with reference to WHO/UK Medical Eligibility Criteria risk stratification for contraceptive choices
   - Prescribing to under 16 year olds and vulnerable women groups with reference to the principles of Gillick Competency
   - Awareness of prevention of sexually transmitted infections with condoms
   - Indications for and effectiveness of emergency contraceptive pill and postcoital IUD
   - Management of common side effects of each contraceptive
   - Prescribing the emergency contraceptive pill
Personal and Professional Skills 
   - Communicating the risks and benefits of contraceptive methods; discussing prescribing options with patients
   - Communicating about safe sexual practice and screening for sexually transmitted diseases
   - Appreciate the reproductive and sexual health needs of women in same sex relationships
   - Appreciate the different religious and cultural approaches to contraception
   - Smoking cessation counselling
Population Health 
   - Implications and prevalence of unplanned pregnancies
   - Epidemiology and prevention of sexually transmitted infections
   - Legal guidelines for prescribing contraception particularly to under 16 year olds or vulnerable women groups or those incapable of informed choice
   - Awareness of WHO/UK Medical Eligibility Criteria risk stratification for contraceptive choices
   - Smoking cessation programmes
Conditions to be considered relating to this scenario
Common
unplanned pregnancy, sexually transmitted infection
Less common but 'important not to miss'
ectopic pregnancy, venous thromboembolism
Uncommon
breast cancer, HIV
Resources

Family Planning: www.familyplanning.org.nz