Dr Foran is a sexual health physician and lecturer at the School of Women’s and Children’s Health, UNSW, and Professor Deborah Bateson is a clinician, researcher and educator in sexual and reproductive health and Professor of Practice at The Daffodil Centre in the Faculty of Medicine and Health at The University of Sydney.
Here are some more highlights.
Q. How do you choose the right pill and what age should it be started?
A. Professor Bateson:
“It’s important to think about what the characteristics of the pill are and what people want in a pill.
“We may choose certain pills if someone’s got acne, for instance, but if they want contraception, then … generally we’ll start with one of the gold standard, tried and trusted pills with levonorgestrel.”
The usual starting dose is 30 micrograms.
She says: “there’s no pill that’s more effective than those pills. And in fact, they’re gold standard when it comes to safety as well.”
Lower doses, however, may result in breakthrough bleeding, she says.
Professor Bateson says it’s important to determine that the person is competent to understand the pros and cons of the different options and determine that there are no child protection issues.
She adds the current advice is not to start the pill until the first menarche.
“Obviously, sometimes that first ovulation may happen before the first period. But I think that’s a good rule of thumb.”
Q. What about the risk if the person has a family history of breast cancer?
A. Dr Foran:
“I think that’s an important one because many women are worried about it. Again, I think my go to is always the Faculty of Sexual and Reproductive Healthcare, and it says … although the background risk of breast cancer is increased, it’s not increased sufficiently to outweigh the benefits of effective contraception.
“So, if you have a first degree relative, I would be very reassuring.
If someone has a BRCA mutation or is known to have BRCA gene then there are probably better options.
The amount of increased risk is said to be 1.3 cases per 10,000.
In the end it’s a process involving “a negotiation with the woman, and looking at the evidence and presenting that to her. And she makes the final decision.”
Both Dr Foran and Professor Bateson will be speaking at The Annual Women’s & Children’s Health Update in Adelaide, Brisbane, Melbourne, Sydney and Perth. Register now to an event near you and hear many more important topics affecting women and children.
Q. How do you apply the WHO’s “Medical Eligibility Criteria for Contraceptive Use” in practice?
A. Professor Bateson:
Professor Bateson says the system was first started by the World Health Organisation, but we use the one from the Faculty of Sexual and Reproductive Healthcare in the UK.
She says it matches a potential user of contraception, based on their medical history with the contraceptive most suited to them.
“We can look things up in a jiffy … and it just gives us that reassurance that we’re following these evidence-based guidelines for safe prescribing.”
The Medical Eligibility Criteria (MEC) has four prescribing categories:
MEC 1: free to use.
MEC 2: the advantages outweigh the risks
MEC 3: the risks outweigh the benefits – so careful consideration is required
MEC 4: contraindicated.
Q. When to review after starting/changing contraception?
A. Dr Foran:
“I think it probably varies, but my rule of thumb for something like an oral contraceptive pill or a ring is usually around about the three-month mark,” when most of the teething problems should have been ironed out.
If they have any symptoms of a VTE or severe mood issues, Dr Foran tells them to ring in as soon as possible.
With an IUD she advises to come in if there is heavy bleeding or cramping, and for the implants, she doesn’t schedule a follow up. She advises the patients to come in if they have any problems.
To read Part 1 of this series on OCPs click here. You can also complete the OCP masterclass here.
Both Dr Foran and Professor Bateson will be speaking at The Annual Women’s & Children’s Health Update in Adelaide, Brisbane, Melbourne, Sydney and Perth. Register now to an event near you and hear many more important topics affecting women and children.
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