Contraception for specific groups of individuals

Young people
Consent, capacity and confidentiality

Any youth in the United Kingdom has the ability to give permission for medical care (including  contraception) provided they are deemed capable. Lawfully speaking, everyone above sixteen  years old are considered capable and competent of providing agreeing. Under 16-year-olds need to prove their proficiency. 

To consent by satisfying the requirements set out by the courts. 

• In Northern Ireland, England, Wales, and Northern Ireland, the young person has to be taken into   having enough maturity and knowledge to understand suggested. 
• Youth in Scotland need to comprehend the nature Probable results of the treatment.

Contraceptive choices

Every form of contraception is given a UKMEC category 1 or 2 based only on age in young people. Among these should be the intrauterine techniques provided to young Every form of contraception is given a UKMEC category 1 or 2 based only on age in young people. This covers the procedures done intrauterine, which young people ought to have access to. One should stress the convenience and effectiveness of the LARC techniques. Worries about the health hazards and adverse effects of contraceptive techniques may arise in young individuals. Taking care of these problems and especially any misconceptions could help people stick to a plan.
Contraception should be started according to the instructions particular to the method. Young people may find quick start contraception to be a helpful alternative. Three months should see follow-up, or at any time if there are queries or worries. group. One should stress the convenience and effectiveness of the LARC techniques. Particular worries about the health hazards and adverse effects of contraceptive techniques may arise in young individuals. Taking care of these problems and especially any misconceptions could help people stick to a plan.
Contraception should be started according to the instructions particular to the method. Young people may find quick start contraception to be a helpful alternative. Three months should see follow-up, or at any time if there are queries or worries. Emergency contraception should be made available, as should STI testing.

Postpartum women

Women who are not nursing

As Day 28 is the earliest date of ovulation, contraception is needed starting on Day 21. By week six, menstruation could start again.
Women who are breastfeeding

Until conditions are no longer met or breastfeeding decreases, LAM can be administered alone in fully nursing mothers.

Effect of contraceptive hormones in breast milk

The very minute levels of contraceptive hormones that are secreted into breast milk raise questions regarding possible negative effects on breastfeeding and the growth or development of the newborn. This is the reason that the application of these techniques to nursing women is subject to certain restrictions. Still, the body of research indicates that hormonal contraceptive methods have little effect on the developmental outcomes of infants.

Progestogen-only contraception

• Volume of breast milk is unaltered. 
• Growth and development of newborns have not been impacted. 

CHC

• Should be steered clear of for the first six weeks following delivery. Women as the safety of usage has not been proven by sufficient data establishing breastfeeding (UKMEC 4). 
• Not advised in women who are exclusively nursing during the first six months. Postpartum unless insufficient other methods are used (UKMEC 3). 

Application of Methods of Contraception 

Do not start CHC due to considering the higher chance of VTE, within 21 days after delivery (UKMEC 3). These medicines can be started on day 21 for non-breastfeeding mothers (UKMEC 1).  Mothers who are breastfeeding could be put in different groups. SPC of techniques might not match the UKMEC classification. Not an intrauterine implant. System or device in the setting of puerperal sepsis (UKMEC 4). Starting early in pregnancy, injectable progestogens may be associated with some ladies have trouble bleeding. 

Extra Concerns for Postpartum Women 

The postpartum phase might bring up sexual problems, such dyspareunia. Any worries women should be able to voice to an HCP with the proper management backing it up. Much as any conversation about contraception, think about the need of getting STI protection.

Later reproductive years of women 

Alternative contraceptive methods 

Though fertility declines with age, especially in the mid-30s, the use of contraceptives must be maintained until next to menopause. Like with younger women, the contraceptive choice age alone should not restrict methods for older women while ladies get older. Medical co-morbidities, for instance, might be present. A hypertension can make it impossible to use some methods of contraception. The UKMEC 2 advises CHC for women over 40. Insertable one example is progestogens. DMPA has been given a UKMEC 2 for ladies 45 years of age and older. All women over 40 are not limited in other operations (UKMEC 1), provided concurrent contraindicating factors do not exist.

Older women are concerned about the seriousness of specific health risks and use of contraceptives has advantages that should be recognized and talked about.

 Besides

• CHC is more common among women 35 years of age and up who smoke less than 15 cigarettes a day (UKMEC 3).
• CHC is more common in women 35 years of age and older who smoke 15 cigarettes a day or more (UKMEC 4).
• CHC use in women with a history of stroke (including TIA), Cardio vascular disease or current migraine with aura is not advised (UKMEC 4)

Stopping birth control 

Menopause usually occurs when a woman is 51. Menopause diagnosis is usually performed by the end of menstruation, clinically and retrospectively (1 year of Amenorrhoea).

Contraception is necessary until

• If you are under 50, two years after your last menstrual cycle
• If you are over 50, one year after your last menstrual cycle. At age 55, contraception can be discontinued (unless regular menstruation continues)

Menopause can be “masked” by hormonal contraception by encouraging amenorrhoea or variations in bleeding patterns unconnected to ovarian action. This can make it hard to decide when to give up using contraception. Though it is typically not helpful to measure serum gonadotrophic hormones.  In such conditions, during the perimenopause, it can be helpful. 

Additives listed below

• Just ladies 50 years of age and older should get their FSH levels tested. 
• Using strategies of PO. 
• FSH measurement using the CHC methods is unreliable in women. 
• In such situation, serum FSH levels are measurable and interpreted. 

Stopping intrauterine contraception
LNG-IUS

• If implanted after the age of 45, it may be kept in place (off licence) for seven years, or until menopause if the patient is amenorrheic.
• Device should be removed after menopause if implanted after the age of 45 and used just for managing HMB. If installed after that age, it can be kept in place for the length of symptom treatment.
• Cu-IUD
• Women who have had a device implanted at least 40 years of age that contains at least 300 mm² of copper are permitted to keep it in place till menopause.
• After menopause, the device needs to be removed.

HRT and contraception

Other Concerns of Women Over 40 

STIs

It is not uncommon for individuals in their 40s to initiate new relationships.
This is evidenced by an increase in the number of STI diagnoses in this age group. A sexual history should be obtained from women over the age of 40 who are seeking contraceptive advice, and STI screening should be offered when appropriate. It is recommended that guidance be provided regarding the use of condoms to prevent the acquisition and transmission of sexually transmitted infections.

Emergency contraception

Women should be informed of the numerous emergency contraceptive alternatives.
them and how to obtain them in the event that their conventional method of contraception ceases to function or will not be of any benefit.

Contraception and medical conditions
Migraine headache

Context Throughout their lifetime, up to one-third of women are affected by migraine, an episodic headache disorder. There are two primary kinds of migraine: migraine without aura (70% of attacks) and migraine with aura (30% of attacks). Not all patients or attacks involve all four stages of migraine headache

Impact of migraine on contraception

 Migraine is an independent risk factor for ischaemic stroke, particularly in younger women, making a history of migraine relevant to consumers of hormonal contraception. The association seems to be limited to individuals who experience migraines with aura.

CHC

Women with migraine who utilize the COC are at a two-to fourfold increased risk of stroke in comparison to those who do not. Women who are currently experiencing migraines with aura are therefore contraindicated from utilizing CHC procedures.

PO-contraceptives

The risk of ischaemic stroke is not elevated by the use of PO-contraceptive methods. In the same way, women who suffer from migraines can safely utilize nonhormonal methods. The impact of hormonal contraceptives on migraines; headaches are a prevalent symptom in the initial months following the implementation of hormonal contraception. They typically rectify themselves over time. The frequency or severity of migraines may demonstrate no change or ameliorate in women who are taking the COC. The pill-free interval is frequently characterized by migraines and headaches as a result of the decrease in oestrogen levels. Symptom management can be facilitated by extending the regimen and/or reducing the pill-free interval. There is a lack of evidence regarding the impact of progestogen-only methods on migraine; however, anecdotally, migraine is more likely to improve in women who attain amenorrhoea using these methods.

Epilepsy
Background

Epilepsy is a prevalent neurological condition that impacts approximately 1% of the UK population. The use of any contraceptive methods is not contraindicated by the condition itself; however, the efficacy of contraceptives may be influenced by the medication therapies used to treat epilepsy. Furthermore, hormonal contraceptives may impair seizure control by influencing certain antiepileptic medications (AEDs). These drug interactions have clinical implications, as they may result in contraceptive failure and, in addition, numerous antiepileptic drugs are teratogenic.

Liver enzyme inducing drugs

A number of AEDs induce hepatic cytochrome P450 enzyme activity thus
potentially reducing contraceptive efficacy. Some of these AEDs may be strong enzyme inducers whereas others have a less potent affect. Intrauterine methods, injectable progestogen-only methods and barrier methods are unaffected by AEDs.
If alternative contraceptives are unsuitable or the AED is being used on a short-term basis only, additional precautions, e.g. a barrier method, must be used for the duration of treatment with the enzyme-inducing AED and for 28 days after cessation.

Emergency contraception

The efficacy of POEC (LNG) and UPA may be influenced by enzyme-inducing medications.
The Cu-IUD should be the first-line treatment for women who are currently taking an enzyme-inducing drug or have discontinued it within the past 28 days.
If an oral method is the only acceptable option, a single oral dose of 3 mg of LNG (equivalent to two Levonelle® tablets) should be administered as soon as feasible following UPSI. This is not covered by the product licence. The use of UPA in women who are currently taking or have recently ceased taking an enzyme-inducing drug (within 28 days) is not recommended, as there is no supporting evidence for doubling the dose.

Bone mineral density (BMD)

In at-risk patients, the long-term use of certain AEDs (carbamazepine, phenytoin, primidone, and sodium valproate) is associated with a decrease in bone mineral density. Women who are taking these medications should be apprised of the potential impact on bone mineral density (BMD), undergo a BMD risk assessment, and be provided with strategies to preserve bone health. However, it is unclear whether the concurrent use of DMPA exacerbates this loss.

Inflammatory bowel disease
Background

There are two different types of inflammatory bowel disease (IBD): Crohn’s disease (CD) affects the whole digestive tract, while ulcerative colitis (UC) only affects the large intestine. About 0.1% to 0.2% of people have IBD, and it’s related to SRH because the highest rate of occurrence is in the reproductive years (20–40 years old). IBD is linked to diseases outside of the intestines, like hepatobiliary disease. People with IBD often have osteoporosis. This could be linked to things like using corticosteroids. It is known that IBD and VTE are linked.

Contraceptive issues

When a woman with IBD is in good health, she should plan to get pregnant.
Some drugs for IBD can cause birth defects or aren’t known to affect pregnancy, like methotrexate. This makes it even more important to use effective birth control while taking these medicines and for a while after stopping them. When picking a method, you should think about other risk factors and diseases that are present at the same time.

• Oral birth control: Because EE and progestogens are taken in the small intestine, problems with the small intestine or problems with absorption may make them less effective. Large bowel disease probably won’t change how well oral ways work.
• Another option is progestogen-only injectables and implants. Non-oral CHC methods and intrauterine devices are also good if digestion is a problem.
• Barrier methods don’t work well enough for women who are taking drugs that are known to cause or could cause pregnancy problems. In theory, treatments for IBD that are given recrectally could spread to the genital area and damage barrier systems.
• BMD may be lowered by DMPA. Since osteopenia and osteoporosis are more common in women with IBD, the risks and benefits should be thought through before this substance is used by those with the disease.
• Laparoscopic sterilization has twice as many problems for women who have had abdominal or pelvic surgery before as it does for women who have never had surgery before. If you need to sterilize something during other abdominal surgery, hysteroscopic sterilization is a safe option.
• Cutting back on CHC should begin at least 4 weeks before major surgery is planned to lower the chance of VTE.

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