As Davina McCall’s latest documentary calls for a ‘contraception revolution’, Dr Janet Barter offers advice on how GPs can help patients choose methods of contraception that best suit their needs
Last month, television presenter Davina McCall’s documentary ‘Davina McCall’s Pill Revolution’ was screened on Channel 4. It focused on the side effects of the oral contraceptive pill, and the challenges women in the UK face when accessing contraception.
As the documentary aired at peak time and received a lot of media coverage, we can expect that many women will have watched it. And as a result, we can expect an increased demand for consultations on contraception, discussions about switching methods of contraception and the pill, and questions about pain relief for intrauterine contraception (IUC) procedures.
Although the programme covered a lot in 60 minutes, it did not cover the full range of contraceptive choices available for women and focused predominantly on the pill. There is, of course, a huge range of alternative choices available, including different brands of pill, long-acting reversible contraception, and non-hormonal options. The best way to offer a patient an individualised, holistic approach to contraception is to encourage continued education on what choices are available and best for them.
It is also vitally important to encourage women to explain their concerns in detail so that they feel heard and respected. While some women experience side effects when taking the combined oral contraceptive pill, as navigated in the documentary, a change in composition of pill may still be the best option for them while others may be better suited to options such as the coil or the implant.
Some of the most popular contraception options available
The implant: The implant is a small flexible plastic rod that is placed under the skin of the arm, which slowly releases progestogen into the blood stream. The implant is effective for three years, does not increase the risk of a blood clot and does not require the woman to remember to take a pill. The implant can also help treat heavy periods, ovulation pain and period pain.
The intrauterine system: The IUS, also known as the hormonal coil, is a small T-shaped plastic device that is inserted into the womb and releases progesterone into the womb. It is one of the most effective forms of contraception, lasts five years, and has been seen to improve symptoms of adenomyosis, menopause and endometriosis.
The intrauterine device: The IUD, also known as the copper coil, is a small T-shaped device that is made of plastic and copper and placed into the womb. As the copper coil does not use hormones, there is no increased blood clot risk or hormonal side effects, but it can cause prolonged or heavier periods.
Patches and rings: Patches and vaginal rings contain synthetic oestrogen and progestogen, similarly as in the combined pill, but the longer duration of use (one week for each patch and three weeks for each ring) may be more convenient. The route of administration may also produce different or fewer side effects.
The diaphragm: The diaphragm, also known as the cap, is a barrier method of contraception. It is a circular dome of plastic which is inserted into the vagina before sex along with spermicide. Using diaphragms, typically 12 in 100 women will get pregnant in one year. There are no hormones, so there is no blood clot risk. Although a barrier method of contraception, the diaphragm does not protect against sexually transmitted infections (STIs).
Condoms: Although condoms can protect from sexually transmitted infections, the effectiveness of the male condom is entirely user dependant. They can be used very successfully, but negotiation of condom use can be difficult in many cases.
Fertility apps: Cycle tracking, natural family planning and fertility apps are very user dependant. Even with perfect use, which involves tracking of periods, sexual activity, and daily temperature measuring, their effectiveness is limited by factors that can affect temperature, the regularity of ovulation, and the extent to which people abstain or use condoms on the predicted fertile days.
How can GPs support women?
The best way you can support women is to help them access the most up-to-date information on contraception, offer them access to the full range of contraception, and listen to their needs, lifestyle and medical history. When assessing for contraceptive needs, it is important to ask them if they have any known issues with hormonal contraception, if they smoke, if they need STI protection and if they can take a pill regularly.
Many women like to do their own research in advance of their appointment, so it’s always helpful to send them links to websites such as Sexwise and Brook. This will enable you to make the most out of the appointment time and to have an informed discussion about available options.
Dr Janet Barter is president of the Faculty of Sexual and Reproductive Healthcare (FSRH)
- UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) The UK MEC helps clinicians decide what contraceptives they can safely recommend based on the medical conditions of patients in their care
- FSRH Guidelines and Statements National clinical guidance produced by the FSRH Clinical Effectiveness Unit (CEU). The CEU is accredited by the National Institute for Health and Care Excellence (NICE)
- FSRH Clinical Standards Service standards produced by the FSRH Clinical Standards Committee
- SRH on Demand If you are looking to refresh your knowledge, our suite of SRH on-demand learning options enable you to train or upskill in key areas, at your own pace, on your own terms, at a time convenient to you
- Read the FSRH statement of IUD fitting and pain relief
- Sexwise Information about STIs, contraception, pregnancy, and pleasure
- Brook Information about each method of contraception based on FSRH recommendations
- Contraception Choices Information to help you choose between different contraception methods
- Brook Find a service tool
- Brook Contraception tool
- The Lowdown Contraception reviews