Websites on first-time contraception

Surfing various websites on contraception, Dr Keith Barnard reviews the best Thromboembolism risk

So much has been said about the risk of thromboembolism and oral contraception that it is difficult to see the wood for the trees. In both lay and professional media there is a plethora of conflicting advice.

This well-considered abstract only takes five minutes to read and looks back over four decades of Pill.

The relative merits of drug-sponsored and independent studies and the reasons for bias in both directions is discussed. It is also emphasised that in the worst case scenario, mortality rates are increased only by about two per million.

The point is well made that women in developing countries continue to die of pregnancy-related causes and many deaths could be prevented by effective contraception.

Why go there: thought provoking.
Downside: plain presentation.
Information from: Drug safety journal.
Address: Click here

Emergency contraception
The first encounter you have with a patient asking for contraception may well be an emergency request.

These pages are written for pharmacists, but it is one of the most comprehensive accounts I’ve come across on how to deal with this situation.

Here you will find the questions to ask, drug interactions, contraindications, useful counselling points, side-effects and follow-up advice.

Why go there: covers the field.
Downside: lengthy.
Information from: Royal Pharmaceutical Society
Address: www.rpsgb.org/pdfs/ ehcguid.pdf

Non-hormonal options
I really liked this article because it was presented as a concise, colourful and easy-to-read PDF.

It is aimed at the GP and it guides us on how to explain the advantages and disadvantages of non-hormonal methods of contraception to our patients.

It is written in a way that encourages you to read on.

All the areas are covered, from natural methods, through to barrier methods, coils and Mirena.

There is also a paragraph about possible religious and moral concerns.

Why go there: easy reading.
Downside: not enough detail about injectables.
Information from: Prescriber
Address: www.escriber.com/Assets/EscriberDownloads/Images/Nonhormon%20contracept.pdf

Using Depo-provera
Opinions vary considerably in the use of medroxyprogesterone acetate in microcystsalline solution, otherwise known as Depo-Provera.

My experience of patients with troublesome irregular bleeding and weight gain might  have put me off, but there is no doubt that it is popular because it is a ‘give and forget’ solution to contraception.

It certainly has its place, but I still believe the use of Depo-Provera is not that straightforward.

I would also recommend anyone using it to read this excellent PDF, which gives a balanced view, discusses such issues as use in obese women, the osteoporosis question, assessing suitable candidates, long-term use, and how to deal with the delayed follow-up visit.

Although it is seven pages long, it’s all really spread out, so don’t be put off — this is only a five-minute read.

Why go there: well presented overview.
Downside: none.
Information from: The Sandyford Initiative, Glasgow NHS.
Address: www.sandyford.org/sandyford/profpages/protocols/pdfs/SIprotocols2004-2005-2.5.pdf

Dr Barnard is a former GP in Fareham, Hampshire

Website of the week

This is Contraception Awareness Week (12–18 February), and to find out more about it there is no better place to go than the Family Planning Association’s website.

Having said that, although there is a big splash on the home page about it, if you want more routine detail about contraception you have to search the site carefully. Contraceptive advice appears hidden away because the FPA is anxious to ensure visitors do not get the impression that family planning is their only interest.

Sexual health seems to be their number one priority.

I think contraception should be given more prominence.

It is to the forefront this week and as well as being a good place to send your patients for information, there is a section on reproduction designed specifically for professionals.

Why go there: well-established and knowledgeable.
Downside: some information is hard to find.
Information from: Family Planning Association.
Address: www.fpa.org.uk

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