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So, hi, everyone. My name is Pana. I'm one of the fourth year medical students at Leicester. And uh this is the first session in our Obs and Gyne spotlight, which is run by our Ob Andy Society and the Lester Scrubs. So society. So we'll have a couple of sessions every Monday from 7 to 8. Uh and all of these will be run on metal. So the same way you registered for this event, you can register for the others and we will send out the registration form kind of a couple of days beforehand. Um And it will all be on Mondays from 7 to 8. Um And we'll get started with contraception. So in this session, we're gonna talk about the indications um the different types of contraception, emergency, contraception, and postnatal contraception. So this is just a disclaimer that all of this was put together by students. So use it for your revision but also use textbooks and and whatever other resources you normally use. So using the chat function or just unmute yourself, if you can, why would you recommend or prescribe contraception to a patient? You can just write one liners about why someone would want to use contraception or why you would recommend someone to use it. Yeah. Yes. At least that's great. Yes, exactly. So you, the main one is to prevent pregnancy and then there are several medical conditions where using contraception can help with that con uh condition. So, managing heavy menstrual periods is one of them. Um Yes, teratogenic meds. Very good. Yeah, geriatric pregnancy. Very good. So I collected a couple of them. So the main one, as you guys said to prevent pregnancy and then besides that, to prevent S TI S and then some people use it to just regulate their menstrual cycle. People with PCO S um use it to help with their menstrual cycle as well. People with endometriosis, dysuria, menorrhagia, acne just to name a couple of them. So what methods can you think of that are not systematic that are kind of natural? Yeah. Yeah. Yeah. So you have abstinence which is run a couple uh just does not engage in sex, which is 100% effective. Uh But it's no fun. You have fertility monitoring which involves tracking body temperature, cervical secretions and other symptoms. Um The advantages of this are that you're not really introducing any new hormones and because of that, there are no side effects and there's no transition time to becoming fertile again. But at the same time, it's very, very time consuming and extremely unreliable, if not done well. And then, as you mentioned, uh you also have lactational amenorrhea. Uh And the mechanism here is that breastfeeding, delay is ovulation for up to six months postbirth. But this is only if the mom is exclusively breastfeeding and uh she's not having any periods whatsoever. So, again, the advantages are similar that there, you're not introducing any hormones or any kind of foreign bodies into, into your body. And because of that, there are no side effects. But again, this is quite unreliable as well. So you also have barrier, which can be uh a physical and or ama chemical barrier against sporing the cervix. Um So it's quite reliable, easy to use. Also gives you s ti protection. Um If you're, if, if the patient is not allergic to latex, then it has no side effects. If they are, then they can use a latex free version. Um On the other hand, it can be quite inconvenient. And again, uh you have to consider latex allergy. So first a of the night you have a 30 year old female who books an appointment with the GP to discuss contraception options. She's interested in taking cop first question. What would you ask her to make sure it's safe for her to take? And then what examinations would you perform before prescribing anything? Yeah, these are all really good downstairs. So you wanna check migraines, you want to check family history, uh smoking. Yes. So BMI, you would want to examine how much she weighs very good with the disorders. Previous VT yes, breast cancer. Amazing. And yeah. So basically these are the ones I collected. So as you guys mentioned BT history in the family, breast cancer in the family and also personal history of these um how up to date they are with their cervical smears uh cardiovascular history in the family. And then you wanna know about headaches, migraines, whether they are with a aura or not. And then you want to know about kind of a general um gynecological history in terms of menstrual history, smoking, and then previous emergency contraceptive use and uh S TI S as well. And then in terms of examinations, so as you mentioned, um you would want to check the BM I as well as the BP as well. So I have uh big tables about the hormonal pills. If you guys uh fill out the feedback form, we will send out the slides for you. So you can use it for your revision. It is quite a dry subject. So I will kind of run through it and then we'll do a couple of questions about them. But basically uh two main kinds of um hormonal pills. You have the combined oral contraceptive pill and then you have the progesterone only pill. So with the C OCP, you're introducing synthetic estrogen and progestogen uh for 21 days and then you have a seven day uh break. And the, the main goal of this medication is to prevent ovulation, but it also reduces endometrial receptivity by thinning the endometrium and thickening the cervical mucus. If you compare it with the pop, it's a low dose of progesterone that they take daily. And um because of this, um the window in which they have to take, it is much shorter as well. So they have to be much more on top of taking this medication. It works by thickening the cervical mucus and reducing the celiac activity in the fallopian tubes. So both of them have uh advantages. They are both very effective if they are taken. Well, um and then C OB can help with menstrual disorders such as P CS and it's also prescribed for Acne. Um and then pop, um it can be used if cop is contraindicated. So for example, in patients with uh migraines with aura, you can still prescribe pop. So, um these are hormone medications. So they will have disadvantages. Um with C OCP, you have massive contraindications. So if their BMI is 35 plus, um you wouldn't really want to prescribe it. And then if they have migraines with aura, if they have breast cancer, if they are older than 35 and smoking more than 15 cigarettes a day, and then you also have a list of side effects. Um besides the side effects, you have the cancer risks as well as the CVS uh risks. So you have increased risk of cardiovascular diseases. Strokes with these s breast cancer and uh cervical cancer and then with pop. So as I said, you have to keep the timing really strict and it can cause menstrual irregularities. And there's also an increased risk of active big pregnancy at this point. Do you guys have any questions about these? Again, I will send this out. I think it's a good provision tool that you can kind of look back at. So without birth control, you have your hormones going up and down in the cycle. And with birth control, it's kind of capped with CO CB, it's capped um at a set level and you don't have ovulation. So if you look without uh birth control, you have the LH surge causing the ovulation and then because there is no LH surge, um you don't have the ovulation basically. So some people do not like or cannot really take pills re uh reliably. So for them, we can offer long term interneural contraception options. These are also called larks. So um you have kind of the implants and the uh uterine systems. So with the progesterone implant, these are all by the way extremely effective. Um they last years depending on the type. Uh and they all have certain side effects, certain risks and certain um effects on fertility. And that's how you kind of decide which one you would recommend to which patient. So with the progesterone implant, um it works by stopping ovulation thickening cervical mucus and thinning endometrium side effects. Um people generally tend to have either a lot of side effects or not really anything. So some people love it and some people really don't like it. So side effects can be mood changes, menstrual irregularities, effects on libido kind of anything really. Um The upside of it is that once it's taken out, there's no delay on fertility, it's uh placed into the arm, usually using local anesthetic with the ius, which is another progesterone uh system used in the uterus. Um It works by preventing implantation and thinning the endometrium and thickening the cervical mucus. So this one doesn't really affect the ovulation. It can cause irregular periods, headaches and mood changes and the fertility can be delayed by months. And um the insert is quite painful. Um and it comes with certain risks such as infection and rejection, damage to the wound and it's the same for the copper IUD. So, kind of the difference is that again, depending on the brand that they use, uh you have to check the length of the um of how long it can be in and how long it works for. Uh So that depends on the brand rather than whether it's progesterone or copper. So the copper works by preventing implantation as well, but it works by um uh killing the sperm and eggs and thickening the cervical mucus. So, side effects, it can cause heavier and more painful periods. But it doesn't have any delay in fertility and then you have um injection um which is uh again, very effective if timed correctly. So, it's an im injection every 12 weeks normally and it stops ovulation, thickening cervical mucus, thinning endometrium. It is the best option for women with epilepsy. Um in terms of side effects, it can last, the periods can cause weight change, headaches, acne mood changes and uh can be uh a cause of differences in sex drive. Um And it causes a significant delay in fertility once it's stopped, and then you have vasectomy and female tubal ligation. These are also quite um effective but they are quite permanent solutions. So, uh vasectomy works by uh cutting the vas difference which prevents sperm from reaching the seminal fluid. Um It's um kind of a local anesthetic you're in and out um kind of procedure, but it can cause temporary bruising and swelling. And then with fe female tubal ligation, the fallopian tubes are blocked or sealed. Um The issue with this is that sometimes they can join back. And because of that, there is an increased risk of activ big pregnancies. Um And it's uh a much kind of more serious procedure than vasectomies. So this is the first pole of the night. So you can read the. So hopefully it's come up, let me know if it hasn't. So you have a 27 year old woman presenting to her GP requesting contraception. She is in a new relationship and she would like to prevent pregnancy. She wants something that she can stop at any point. Her past medical history includes depression and migraines with aura. Her BMI is 23. What's the best option for her? So take your time, have a think. Um And pick one of the answers. I have no idea how many of you are actually in but I'm seeing 23 of you chose All righty. So most of you chose Pop, which is the correct answer. Um For others. Um The reason why it's not cop is because she has migraines with aura. Um And then with the Mirena Coil and the IUD, she says that she wants something that she can stop at any point. Whereas the Mirena and the ID, it's not something that you can stop at any point. You have to book an appointment to like have it taken out. So that's why the pop is, is the best answer. I hope that makes sense if it doesn't let me know it's another um S AQ. So you have a 37 year old female who would like to start taking cop. Her past medical history includes controlled hypertension, previous gallstones, migraines with no aura and anxiety. She has a BMI of 39 and smokes 30 cigarettes a day, drinks one bottle of wine per week. What part of his history is an absolute contraindication? And what parts of her history caution you So use the chat box uh to answer the questions. So there is the questions are, what part of her history is an absolute contraindication? And then what parts of her history caution you? Yeah, I great answer guys. So as you said, uh she is over 35 and she does smoke more than 15 cigarettes a day. So that's an absolute contraindication. So is the fact that her BMI is more than 35. It's a great job. Um And then what parts of her history caution you? Yes, and the migraine does caution you. Is there anything else that you're thinking of hypertension grade? Yeah, good job guys. So yeah. Um so you have, you have the sorry, the BMI should go to the absolute contraindication. But yeah, good job guys. Another one. So you have a 22 year old dancer who wants to switch from her progesterone implant as it makes her periods erratic. She also experiences spotting throughout her cycle. This interferes with her work and wants to switch to something that regulates her periods. Her past medical history is acne for which she uses topical retinal. She is a nonsmoker and has normal BP, no migraines and no family history. What is the best option for her? She's interested at like, yeah, let's, let's start with what is the best option for her? Yeah, I agree. So she wants your CP, she doesn't really have any um contraindications. So she is interested but concerned about the cancer risks. What can you tell her about the cancer risks uh involved with C OCP? Yeah. Great increases risk of uh breast cancer and cervical but decreases risk of endometrial. Yes, that's great. Yeah. Yes. So CSP uh as you guys said, is decreases risk of ovarian endometrial. Uh oh, sorry, that's a type I supposed to say cancer rather than anger um increased risks of breast and cervical cancer. So what you will also want to tell her is that the increased risks decrease after the pill is no longer taken? Ok. So what kind of advice can you give her about starting the pill? And what about missed pills? So if you just kind of whatever is on your mind about missed pills, about how to start a pill, you can just put it in the chart. Yeah, very good. So if they miss a pill, take the next one ASAP, yes. Even if it makes it do. Yeah. Anything else, any conditions where they haven't actually missed the pill that but they need to take another one. Yeah, great. Yeah, very good answers. So as you guys said, if it's taken from the first day of menstruation, it prevents pregnancy straight away any other day. Really? It takes seven days. So you should advise them to use abstinence or barrier contraception uh to make sure that they're not getting pregnant. Um and then um in terms of missed pills. So if the pill is missed in the first week emergency contraception, in case of unprotected sex. If missed pill is in week two, there's no need for emergency contraception. And then if missed pill is in week three, I'll miss the pill free interval. These, in these cases, like the, the 24 hours have paused. So they didn't take the second pill. But if they kind of, let's say they're supposed to take it at eight and they notice it at like 5 p.m. they haven't taken it. They can still take that second pill and it will be fine way. So these missed pill week, one week, two, week, three are all about when they missed that 24 hour period. So if they also vomited or had severe diarrhea within two hours of taking the pill and you should advise them to take another pill. Ok. And then we have another pool. So you have a 35 year old female, attends, uh, the preoperative assessment clinic for elective laparoscopic cholecystectomy in eight weeks. She's on cop, what is the best advice regarding the pill and her surgery? So, choose an option, uh, about what you think they should do. So I'll wait a bit more for more of you to reply. Yeah. So almost all of you picked, uh, c which is the correct one. So the pill interferes with clotting and with any kind of major operation, you would want them to be off of it. Uh, for four weeks before the surgery. Um, and then also for a time after the surgery. And the important thing here is that you can't just leave them with no contraception. You should advise them about taking like using another form of contraception such as barrier contraception in that four week period before the surgery. I hope that makes sense. If not, please send a, uh, a text into the chat. So we have another S AQ. So you have a 15 year old girl who presents to the GP alone to ask for contraception. She has been in a relationship with a uh for a year with a boy who is the same age as her. So the boy is 15 as well. They are ready for a sexual relationship. Um And she does not feel pressured in any way and understands the consequences of unprotected sex and the benefits and the risks of the pill. She asks you not to tell her parents when I asked, she admits that she would have sex even if she is not prescribed the pill. Would you prescribe the pill? And why? Yes. Great Aunt Alice. You would. Ok. Ok. Yes, great. So as you guys are saying, so you would uh prescribe it. Uh She's known uh she shown that she fits the fraser guidelines. Um So she is under 16 os contraception, um knows about kind of S TI S in pregnancy and the freezer guidelines are the following and um as you guys are saying the g competency, so she is showing g competency as well and if she followed the guidelines, so um she has sufficient maturity and intelligence to understand the nature and implications of proposed treatments. So the, the uh text said that she understands the risks and benefits of the pill and then she cannot be persuaded to tell her parents or to allow the doctor to tell them. So she asked the doctor not to tell them she's likely to begin or continue having sexual intercourse without, without contraceptive treatment. So she said that she would um and then physical or mental health is likely to suffer unless she received advice, treatments. So you can kind of say that about anyone or anything. Um And then the treatment is in the best of interest. So I would say it is so yeah, good job another SBA. So you have a 35 year old breastfeeding mom who wants to go on contraception. She's not sure but probably will want to have more Children in a couple of years time. So she wants a long term solution. What would you recommend? Ok. So most of you have answered already. So I think the correct answer is an ID. Um And the reason for that is that uh she is breastfeeding. Um So kind of the injection like the IUD costs less for the NHS than the injection. So you would, you would kind of want that for patients because with the injection, you have to set up an appointment every three months with someone who will administer that shot. So that's, that's a lot of um kind of money going into one patient when she's very happy with the long term solution. So that's kind of pointing towards IUD and then implant for society with the IUD, the progesterone is quite local compared to the implant. Um And then with the implant and the fertility would be, I think less affected with the IUD. So, yeah, um so we're gonna talk about emergency contraception and then postnatal contraception. Um If you guys have any questions in the meantime, let me know. Um I did run a bit quickly. So we will finish sooner than, than an hour. So with emergency contraception, it's all about the timeline. So, and they had unprotected sex. Um If they come to you within 72 hours, you can give them levonogestrel, which is a high dose progesterone and it inhibits ovulation. If it's uh more than that, you can either give the copper ID or ulipristal with your perative. Um Basically, it inhibits or delays ovulation and the import important bit about this is that you have to wait five days before continuing hormonal contraception. So let's say they take it and rather than OK, immediately you go on pop or C OCP rather than that you want wait five days before they start any hormonal treatment because it can interfere with your crystal acetate and um they might not like they might actually ovulate. Um And then with the copper IUD, so it prevents fertilization and it's a long term solution. So um that's a big um pro side of it for some people. And then with postnatal contraception. So if it's straight after the birth, um you can give the implant injection, you can start them on pop ui us within 48 hours or after four weeks of the birth. And then if it's later, so they can, they can still breastfeed with all of this if it's later, um they can start on C OCP pa vaginal ring if they're not breastfeeding, then three weeks following the birth, if they are breastfeeding, then six weeks following the birth. So that was it. Um we covered indications, we covered different methods in terms of methods. We, we covered mechanism of action, advantages, disadvantages and then we covered emergencies and postnatal contraception as well. Um Do you guys have any questions at all? If not? Um Thank you very much for attending uh this revision session. Please email the slide. Yes. So with that.