Table of Content

Content of each session

CHC I

  • Background of steroid hormones
  • Clinical relevant metabolic effects of ethinylestradiol (EE)
  • The variations in individual steroid plasma levels and potential clinical consequences
  • The difference between the mostly used progestins in CHCs
  • Typical properties of progestins
  • Types and dosages of CHCs
  • Clinical effects of a lower EE dosage
  • Difference between pills with estradiol /estradiolvalerate and EE

CHC II

  • How to take a history before contraceptive counseling
  • Special risk screening for use of CHCs (higher risks/ lower risks and WHO MEC category 4 criteria criteria)
  • There are two types of risks one affecting the arterial system and one the venous system
  • VTE risk in healthy young women without contraception and in pregnancy
    • EMAS recommendation: VTE risk according to progestin type and method of application
    • VTE risk according to estrogen dose and type of estrogen
    • Understand what is meant by a positive family history and what it means for risk counselling
    • VTE risk in women with thrombophilia
    • Overview risk for VTE in numbers and multiplication of risks
    • VTE risk with age, obesity and duration of CHC use
  • Arterial risk: stroke and myocardial infarction in numbers, in relation to age and obesity
  • Balancing risks against other contraceptive options and benefits during counselling

CHC III

  • Contraceptive health benefits of CHCs
  • Minor harmless side effects
  • Treatment of side effects
  • Major side effects / breast cancer / depression / reasons to stop pill immediately
  • VTE risk in newstarters and counselling for symptoms associated with DVT and PE
  • Pill return visit
  • Measurement of blood pressure

CHC IV: CVR,CTP

  • Description and formulation; Application
  • Pharmacokinetics; Regimen of use
  • Similarities ring, patch and pill; Advantages ring and patch > pill
  • Contraceptive failure rates
  • Dosing errors; Extended use
  • Concurrent use
  • Cycle control; Acceptability; Compliance; Side effects compared with pill
  • Device-related problems; Acceptability ring vs patch
  • Venous and arterial thromboembolism
  • Counselling

POC Overview

  • Progestin types
  • Working mechanism
  • Contraceptive efficacy and safety of POC
  • Use in women with medical conditions
  • Health benefits
  • Adverse events: bleeding, breast tenderness, weight, acne, BMD

POC Implant

  • General characteristics of the ENG-releasing implant
  • Mechanism of action
  • Contraceptive efficacy
  • Health benefits
  • Contraindications
  • Side effects and treatment, continuation
  • Summary

POP and DMPA

POP

  • General characteristics of the desogestrel 75 µg POP
  • Mechanism of action
  • Contraceptive efficacy
  • Health benefits, migraine
  • Side effects, bleeding
  • Emergency contraception
  • Breastfeeding
  • Summary

DMPA

  • General characteristics of DMPA
  • Contraceptive efficacy and duration of use
  • Mechanism of action
  • Contraindications
  • Health benefits
  • Safety
  • Side effects and treatment
  • Reasons for discontinuation
  • Summary

IUD Overview

  • Types of IUD
  • Efficacy of IUDs and duration of use
  • IUDs and PID risk, screening for STIs prior to insertion
  • Need for antibiotic prophylaxis during insertion
  • Pain management during IUD insertion
  • When to insert (after abortion and pregnancy), switching from another method
  • Risk factors, frequency of expulsion and dislocation, reinsertion after expulsion
  • Post-insertion visit

Copper-IUDs

  • Mechanism of action
  • Efficacy, duration of use
  • Side effects: harmless, harmful, frequency
  • Treatment of side effect
  • Contraindications
  • Misconceptions
  • Counseling
  • Risk of ectopic pregnancy
  • Copper ball and expulsion

LNG-IUS

  • What is the hormone-releasing intrauterine system (IUS) and why was it developed
  • General characteristics of the LNG-IUS
  • Mechanism of action
  • Contraceptive efficacy and duration of use
  • Side effects: harmless and harmful, treatment
  • Reasons for discontinuation
  • Medical indications for LNG-IUS use

IUDs in special situations

  • Adolescents
  • Risk of cervical cancer risk (LSIL and HSIL)
  • Women after STI or at increased risk of STI
  • IUDs and cardiovascular disease
  • Women with HIV
  • Women with immunosuppression

Female and male sterilisation

Female sterilisation

  • Introduction
  • Surgical planning
  • Postpartum sterilisation
  • Interval sterilisation
  • Laparoscopic sterilisation
  • Preoperative counselling
  • Contraceptive failure rates
  • Causes of failed sterilisation
  • Potential post-sterilisation effects
  • Risk of regret
  • Opportunistic bilateral salpingectomy

Male sterilisation

  • Introduction
  • Procedures and techniques
  • Postoperative care
  • Confirmation of sterility
  • Contraceptive failure rates
  • Contraindications
  • Complications
  • Associated morbidity concerns
  • Counselling
  • Vasectomy reversal

MC Mental disorders

  • General considerations
  • Feeding and eating disorders
  • Psychotic disorders
  • Some aspects of contraception in disabled women

MC Obesity, family history and VTE

Obesity

  • Definition of obesity
  • Obesity and VTE risk
  • Which contraceptives are efficient in obese women
  • Contraception after bariatric surgery

Family history and VTE

  • Contraception after VTE
  • Definition of positive family history for VTE
  • Efficient and safe contraception if FH is positive
  • VTE risk in women with positive FH

MC Women with HIV, CHC and Drug interactions

HIV

  • Main characteristics of HIV infection, classification and clinical stages of HIV infection
  • Concerns regarding contraception:
  • Drug interaction
  • Possible impact on progression of HIV infection
  • Impact on HIV transmission and acquisition
  • Potential risks related to HIV infection/aids

Hormonal contraceptives and drug interactions

  • Overview of the metabolism of the contraceptive steroids
  • Pharmacokinetic drug interaction
  • Interactions of CHC and POC with:
    • anti-epileptic drugs
    • psychotropic drugs
    • herbal remedies
    • antimicrobial therapy

MC Migraine and depression

Migraine

  • Sex differences in epidemiology of migraine
  • Prevalence of migraine
  • Background of hormonal triggers for migraine
  • Basics on diagnostic criteria for migraine
  • WHO recommendation for CHC use in migraineurs
  • Association between migraine and stroke
  • When to stop CHCs in migraineurs
  • Contraceptive options for migraineurs

Depression

  • Definition of depression
  • Prevalence in Europe
  • How not to miss depression in taking a history
  • Potential effects of contraceptive methods on the course of depression in women with depression as a pre-existing condition
  • Which contraceptives may cause depressed mood

MC CHC breast and ovarian cancer

  • Effect of CHC on breast cancer risk
  • Effect of CHC on ovarian cancer risk
  • CHC and breast cancer risk in women with hereditary breast cancer
  • CHC and ovarian cancer risk in carriers of BRCA1/BRCA2 mutations
  • CHC and breast cancer risk in carriers of BRCA1/BRCA2 mutations
  • Contraceptive options for women after breast cancer

Contraception after abortion

  • Background : Return of fertility after abortion
  • Background: VTE risk during first and second trimester pregnancy
  • WHO Medical eligibility criteria for contraceptive use after abortion
  • When to initiate contraception after first trimester abortion
  • IUD insertion after medical abortion
  • When to initiate contraception after second trimester medical and surgical abortion