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Contraception

Book description

Planned parenthood - and its associated reproductive and sexual healthcare issues - has massive socioeconomic and demographic consequences worldwide. Modern contraception played a major role in the emancipation of women and has huge potential for a sustainable future world population. Yet it is a medical topic which always raises controversy, with serious ethical, religious and cultural overtones. This is an authoritative guide for all those working in reproductive healthcare. Highly practical, evidence-based, with enough detail to inform effective clinical practice, the book is structured on a lifestage approach, mirroring everyday experience of practitioners. All forms of contraceptives are covered in detail, with guidance on prescribing, the advantages and disadvantages of various techniques, and possible complications. The wider field of reproductive healthcare including subfertility and sexual assault are also covered. An ideal guide to contraception for trainees in obstetrics and gynaecology, primary care physicians and nurse-practitioners.

Reviews

'Essential reading for any health professional working in sexual and reproductive health, as well as those training and those needing to refresh their knowledge in this area.'

Source: Journal of Family Planning and Reproductive Health Care

'This should have been titled ‘All you ever wanted to know about the issues around contraception’. This is a relatively unique book in that it is the first book I have read that covers libido and sexual drive as well as discussing the issues around sex and contraception at different stages of life … I found this book very interesting and will keep it to use as a handy reference book for the facts behind contraception, some of which are not usually covered.'

Source: The Obstetrician and Gynaecologist

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Page 1 of 2


  • 8 - Thecontraceptive consultation
    pp 66-77
  • https://doi.org/10.1017/CBO9781107323469.010
  • View abstract
    Summary
    Contraceptive methods have social images or social stereotypes which may vary over time and may be strongly influenced by single events like a serious complication in a young woman. Wishes regarding the role and/or involvement of the partner vary largely. The knowledge and understanding of what the individual woman wants is an important part of contraceptive counselling. Healthcare professionals seem to be very focused on the objective characteristics of the woman seeking advice, rather than what the woman actually wants and is comfortable with. One way of assessing the subjectivity of the woman is asking, either during the dialogue in the consultation room or by using a questionnaire in the waiting room, about her expectations and experiences regarding the criteria, like efficacy, safety, side effects, relation to sexual activity, duration of action, control, cost, involvement of partner or other family members and additional health benefits.
  • 9 - Menarcheand associated problems
    pp 78-89
  • https://doi.org/10.1017/CBO9781107323469.011
  • View abstract
    Summary
    Sexuality in all times has been surrounded by myths and misconceptions that reflect sexual norms and values of that specific time and culture. The majority of these myths and misconceptions stem from norms, values and beliefs aimed at controlling sexuality, women's sexuality in particular. Masturbation in women was regarded as an even graver problem, mainly because from the Middle Ages onwards women were seen as 'raging volcanos of desire' because of the semen sucking capacities of their uteri. With regard to combined oral contraceptive (COCs), the most important myth is that there are serious health risks associated with long-term use and that, therefore, one should not take the pill for too long a period. The most striking myths and misconceptions about sexuality are remnants of the long-lasting denial of the importance of arousal for sexual functioning of women and of bizarre post-Freudian concepts of infantile and adult sexual functioning.
  • 10 - Adolescence:contraception in the teenage years
    pp 90-98
  • https://doi.org/10.1017/CBO9781107323469.012
  • View abstract
    Summary
    There is evidence of contraception from the land of the pharaohs. Mantras were believed to produce sterility in both men and women, just like prayers of intercession in the Christian Church in Europe. A major change in approaches to contraception came about as an accidental result of venereal disease. From the mid-nineteenth century, the arrival of rubber meant the first condoms were produced of the new material. Sexual health became an important part of consideration for companies producing contraceptives and suddenly condoms could be bought in most places in the world from open shelves in chemists and supermarkets, sold in brightly coloured packets. The invention of a female condom has also enabled a woman to make yet another form of choice if she wished to prevent both pregnancy and disease. Vasectomy and sterilization operations are available and accessible across the globe.
  • 11 - Contraceptionin the20-somethings
    pp 99-105
  • https://doi.org/10.1017/CBO9781107323469.013
  • View abstract
    Summary
    Understanding menstrual physiology is the basis of understanding the whole concept of fertility, including the mechanism of action of contraceptives. It is also the basis for understanding natural family planning (NFP) methods. The corpus luteum has an inherent life span of about 14 days, and as it succumbs, in the absence of a pregnancy, the levels of oestrogen and progesterone decline. To maximize the chance of fertilization, sperm need to be deposited into the vagina prior to ovulation. It is believed that sperm will survive for two to three days in the mucus environment, so couples who want to conceive are advised to undertake intercourse at least every second day from when menstruation finishes until ovulation is thought have occurred. There have been a number of modifications of NFP as the understanding of reproductive physiology has improved.
  • 12 - Contraception in the 30-somethings
    pp 106-110
  • https://doi.org/10.1017/CBO9781107323469.014
  • View abstract
    Summary
    In the area of contraception, especially combined oral contraceptives (COCs), ethinyl oestradiol (EE) has been the clear market leader for many decades. This chapter sets out the rather peculiar background to the inclusion of oestrogens in contraception as well as reviews some simple pharmacology. The classic mechanism of action for all steroid hormones is to bind to specific intracellular receptors and induce change in their shape, encouraging dimerization (two pairs of hormone/receptor complexes forming a single unit) and leading to recruitment of co-regulators. The complexes formed through this route are able to influence gene transcription and hence the production of proteins with biological activities. Until the last few years a prescriber discussing contraceptive options with a woman could bring in issues such as the route of administration of contraceptive steroids, their doses and dosing schedules and the type of progestogen.
  • 13 - Contraceptionin the 40-somethings
    pp 111-119
  • https://doi.org/10.1017/CBO9781107323469.015
  • View abstract
    Summary
    This chapter reviews the estimated thrombotic risks associated with the oestrogen content of combined hormonal contraception. Thrombotic diseases discussed in this chapter are arterial thrombosis and venous thrombosis. The risk of arterial thrombosis, including stroke and myocardial infarction, is reported to be increased in users of combined hormonal contraception. Such events may be fatal, or lead to disabling sequelae. While oestrogen may play a role in arterial thrombosis, the effect is primarily related to an interaction with traditional, and to some extent modifiable, risk factors for arterial disease. Venous thrombosis mostly manifests in the deep veins of the leg, but may occur in other sites, such as the upper extremities, cerebral sinus, liver and portal veins or retinal veins. The risk of venous thromboembolism (VTE) is strongly associated with age, obesity and in users of oral contraceptives (OCs). Pregnancy is a far more profound thrombophilia risk.
  • 14 - Contraception in the50-somethings
    pp 120-131
  • https://doi.org/10.1017/CBO9781107323469.016
  • View abstract
    Summary
    Synthetic derivatives of progesterone are variously known as progestogens, progestagens or progestins and have a key role in hormonal contraception, either alone or in combination with oestrogen. Progestogen-only methods of contraception include pills, subdermal implants, injectables and the intrauterine system. There are several different types of subdermal implant licensed for contraceptive use across the world. The Nexplanon implant contains etonogestrel and is the most widely available subdermal contraceptive implant. Other progestogen-only contraceptive implants are licensed or being developed and include Jadelle, a two-rod implant containing levonorgestrel, and Capronor, a biodegradable single-rod implant also containing levonorgestrel. The two types of progestogen-only injectable contraception, both of which are long-acting reversible contraception (LARC) methods, are depot-medroxyprogesterone acetate (DMPA) and norethisterone oenanthate (NETEN). The most commonly used progestogen-releasing intrauterine system in most countries is the levonorgestrel-releasing intrauterine system (LNG-IUS) known as Mirena.
  • 15 - Whatis the risk of cancer with hormonal contraception?
    pp 132-141
  • https://doi.org/10.1017/CBO9781107323469.017
  • View abstract
    Summary
    The contraceptive consultation differs across international healthcare systems in relation to the setting, scope of practice, provider-responsibility and the available time frame. The key to a successful consultation is to ensure that the patient leaves with their contraceptive needs met, either with the immediate provision of a contraceptive method or a plan for initiation at a specified future date. This chapter provides guidance on how to fulfill this outcome. In a generalist setting, posters inviting patients to discuss sexual health issues, brochures on contraception and information on confidentiality may be of assistance in setting the scene for the consultation. Where time is limited, an effective contraception consultation lies in its shaping. There are a variety of tools ranging from websites to models that can be useful to support a contraceptive consultation. The chapter presents cases, which illustrate approaches and principles in a sample of contraceptive consultations across the reproductive lifespan.
  • 16 - Newdevelopments in female sterilization
    pp 142-148
  • https://doi.org/10.1017/CBO9781107323469.018
  • View abstract
    Summary
    A review of the qualitative literature on young women's experiences of menarche revealed that menarche had a major impact on lives physically, psychologically, socially and culturally. Pubertal development before the age of eight and menarche before the age of nine should be investigated by an endocrinologist. Early menarche is associated with an increase in all cancer mortality, whereas late menarche is associated with increased risk of osteoporosis and fractures. Sometimes girls will continue to have heavy bleeding on combined hormonal contraception (CHC). A recent addition to treatment options is oestradiol valerate with dienogest (Qlaira) with a license to treat heavy menstrual bleeding. The authors have found it useful in the treatment of peri-menarchal dysfunctional uterine bleeding (DUB) and also useful for young girls who find it difficult to tolerate oestrogenic side effects including headache and nausea.
  • 17 - Malesterilization
    pp 149-158
  • https://doi.org/10.1017/CBO9781107323469.019
  • View abstract
    Summary
    This chapter focuses on the adolescence years, a time of change for young people when they are entering sexual relationships, dealing with peer pressure and the possible tensions from school and home. It was suggested in the Teenage Pregnancy Strategy that one way of reducing teenage conceptions was the provision of good sex and relationship education within schools and colleges. Without advice and treatment, the young person's physical or mental health or both would suffer. The reaction to the unplanned pregnancy depends on the support or not of the partner, parents and friends and it can be a time of conflict for the young person. When a young person has an abortion, it might be the first real opportunity for her to discuss contraception and it is an opportunity to explore her views about methods with a health professional.
  • 18 - Emergency contraception
    pp 159-169
  • https://doi.org/10.1017/CBO9781107323469.020
  • View abstract
    Summary
    This chapter focuses on the non-oral combined hormonal contraceptive options, including the patch and more specifically the vaginal ring, which are underused in the UK and Australia. The clinical effectiveness unit of the faculty of sexual and reproductive healthcare developed a guideline to facilitate appropriate investigation of women presenting with unscheduled bleeding. For women with breakthrough bleeding in association with the use of hormonal contraception, lasting longer than three months, it is important to view the cervix. A pelvic examination should be undertaken to exclude pelvic pathology including ovarian cysts, fibroids and gynaecological cancers. In clinical trials, most users have been satisfied with the combined hormonal ring. The greatest barrier to this method is promoting the vagina as an ideal organ in which to place hormonal contraception and this remains a challenge to all providers of contraception.
  • 19 - Sexuallytransmissible infections and pelvic pain: what you really need to know
    pp 170-180
  • https://doi.org/10.1017/CBO9781107323469.021
  • View abstract
    Summary
    Age alone is not a contraindication to any method of contraception. A reasonably common scenario in the mid-30s is that women who reach the age of 35 and smoke have to stop taking the combined oral contraceptive (COC) pill. A woman needs to consider whether to use a hormonal or non-hormonal method, whether she can commit to methods requiring daily, weekly, monthly or less frequent attention and which potential side effects she finds acceptable. The seven day pill-free interval (PFI) was chosen to ensure that the majority of women would start to bleed before they were due to start their next packet. In the context of postponing periods (as opposed to withdrawal bleeds), it is worth noting that new information has been incorporated into the Summary of Product Characteristics of PrimolutN, a commonly prescribed formulation of norethisterone 5mg, used for the postponement of periods in women not using COCs.
  • 20 - Medicaltermination of pregnancy
    pp 181-191
  • https://doi.org/10.1017/CBO9781107323469.022
  • View abstract
    Summary
    This chapter presents a case study of a 42 year old female (Alison), who suffered from heavy painful periods. Alison's situation is far from unusual for this age group, where the risk of relationship breakdown is high. It is apparent that Alison's first priority is a highly effective contraceptive method. However, she requires much more from her method: effective control of bleeding and dysmenorrhoea; restoration of menstrual predictability and/or amenorrhoea. A bimanual examination for Alison is undertaken to assess for uterine enlargement (fibroids, adenomyosis), uterine mobility and adnexal masses and/or tenderness. Alison was advised about how the levonorgestrel-releasing intrauterine system (LNG-IUS) works by profound endometrial glandular and stromal suppression, cervical mucus changes and a foreign body effect within the endometrium. Progestogen-only pills (POPs) would be an option for Alison if she has contraindications to taking oestrogens.
  • 21 - Surgicaltermination of pregnancy
    pp 192-198
  • https://doi.org/10.1017/CBO9781107323469.023
  • View abstract
    Summary
    The woman presenting for contraceptive advice in her 50s is in a different position to younger women. Although the peri-menopause is a stage of life when a woman has lowered fertility, the consequences of an unplanned pregnancy are serious, and contraception is still important, particularly when the additional associated non-contraceptive benefits of hormonal use are considered. A woman in her 50s, or during the menopause transition, may need her contraceptive options re-evaluated. The levonorgestrel-releasing intrauterine system (LNG-IUS) is one of the long-acting reversible methods of contraception (LARC) which has the benefit of being highly effective whilst requiring minimal compliance once inserted by a trained practitioner. Women in their 50s requesting contraception often have additional needs, particularly regarding the management of menopausal symptoms. Consultations such as this offer the opportunity to provide balanced information regarding contraception, management of the menopause, relationship issues and erectile dysfunction (ED).
  • 22 - Primary care treatment of subfertility and what every health professional needs to know about assisted reproductive technology
    pp 199-211
  • https://doi.org/10.1017/CBO9781107323469.024
  • View abstract
    Summary
    Over the past 50 years, there have been hundreds of clinical studies investigating whether hormonal contraception changes the risk of cancer among users. Most of the epidemiological evidence comes from observational case control and cohort studies examining cancer risk among users of combined oral contraceptives (COCs). Although women may be at increased risk of several cancers (breast, cervix, liver and thyroid) whilst using this contraceptive method, the effects appear to be transient, disappearing within a few years of stopping. Conversely, COCs protect against several other cancers (ovary, endometrium and colorectum), with the benefits persisting for many years after stopping. This sustained protection may produce major public health benefits over time, through reduced overall cancer incidence and mortality. Limited data suggests that users of progestogen-only contraceptives (especially injectables and implants) experience a similar pattern of cancer risks and benefits as COC users.
  • 23 - Sexualassault
    pp 212-225
  • https://doi.org/10.1017/CBO9781107323469.025
  • View abstract
    Summary
    In females, sterilization can be achieved by hysterectomy or tubal occlusion. In the USA, female sterilization is the second commonest method of contraception overall, and the most common method used by married women and women aged over 30. Prior to deciding on a sterilization operation, the woman or preferably the couple should be given information about alternatives, especially long-acting reversible method of contraception (LARC) and also vasectomy. They should understand that vasectomy has a lower failure rate and fewer complications than tubal sterilization. Various approaches to tubal occlusion described in this chapter are laparoscopic filshie clips, and hysteroscopic approach. Women choosing laparoscopic sterilization are more likely to have a successful procedure. Approximately 5% of women who have a failed hysteroscopic attempt declined further sterilization. The options for women who have been sterilized and wish to restore fertility are to undergo sterilization reversal or to attempt in vitro fertilization (IVF).

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