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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 generations and properties
- Mechanism of action
- Contraceptive efficacy and return to fertility
- Safety
- Use in women with medical conditions
- Health benefits
- Contra-indications
- Adverse events: bleeding, breast tenderness, weight, acne, BMD
POC Implant
- General characteristics of the Etonogestrel (ENG)-releasing implant
- Mechanism of action
- Contraceptive efficacy
- Insertion and removal, return of fertility
- Contraindications
- Adverse events
- Bleeding pattern and treatment
- Discontinuation
- Summary
POP
- General characteristics
- Mechanism of action
- Contraceptive efficacy
- Health benefits, migraine
- Adverse events, bleeding
- Emergency contraception
- Breastfeeding
- Summary
DMPA
- General characteristics
- Contraindications
- Safety
- Adverse events (bleeding pattern, weight gain, acne, mood changes, BMD, HIV acquisition)
- 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