This work belongs to Lulu it is provided purely as a guide to
other student nurses. It should in no way be copied or passed off as belonging to a 3rd party.
It is protected under the UK and international law of copyright.
This work belongs to Lulu it is provided purely as a guide to
other student nurses. It should in no way be copied or passed off as belonging to a 3rd party.
It is protected under the UK and international law of copyright.
Change of Contraception
Reflection
A new patient aged 29, to whom I will give the pseudonym Anna (NMC 2004), attended the Family Planning clinic. She was currently using depo-provera for contraception, but on taking her history it became apparent she wanted to change methods.
A new patient history was completed and during the history taking Anna revealed that she had been on the combined oral contraceptive (COC) Microgynon for about 10 years from age 16. She had been very happy using the COC but had an episode of unilateral facial numbness plus tingling of her left arm followed by a severe headache. Her GP had diagnoses neurological migraine and ceased her COC.
Neurological migraine usually manifests itself with a focal aura, sensory symptoms affecting the limbs and mouth can also occur (MacGregor 2001). It has been associated with an increased risk of ischaemic stroke, added to the increased risk from being on the COC makes its risks outweigh its benefits (MacGregor 2001). This resulted in Anna’s GP discontinuing her COC.
She had then been prescribed a traditional progesterone only pill (POP), which she only tolerated for 2 months due to the limited 3 hour window period and some unpleasant side effects. The risk of ischaemic stroke is not increased with progestogen only methods of contraception (MacGregor 2001).
Anna had then gone on to the Injectable depot medroxyprogesterone acetate (DMPA) trade name Depo-provera, which she liked for its effectiveness but felt that her renewal injections tied her down and did not want to continue on it. She was also planning to start a family within the next few years and at this point I explained to her that the Depo-provera can delay fertility for about 50% of women up to 6 months but 90% should have fertility returned by 2 years (Guillebaud 2004). She felt that changing her method sooner was a good idea to give her fertility time to return but in the meantime use a reliable alternative.
Due to Anna’s neurological migraines all combined oestrogen and progestogen methods were ruled out leaving progesterone only or non-hormonal methods. Anna also wanted a reliable contraceptive that did not interfere with sexual intercourse. I came up with a short list of the implant, copper coil (IUD), Mirena coil (IUS) and the new 3rd generation POP - Cerazette.
However I recalled during our conversation that Anna had mentioned she had really liked taking the COC and ideally would have continued with it, had it not been for the neurological migraine she experienced. I gave her a brief outline of the IUD, IUS and implant but felt that she would find Cerazette the most appealing.
Cerazette contains 75micrograms of desogestrel and works in 2 ways;
• Inhibiting ovulation
• Making cervical mucus impenetrable by sperm
Benefits of using Cerazette
• Suitable for women with diabetes or focal migraines
• Has 12 hour window period to take pill
• Suitable for breast feeding mothers
• No increased risk of VTE
• No increased risk of cardiovascular disease
• No increased risk of hypertension
• Reduction in dysmenorrhoea
• May relieve pre-menstrual symptoms
• Does not interfere with spontaneity of intercourse
• Suitable for smokers over age 35
- Likely to cause irregular cycle or amenorrhoea
- Can cause night sweats
- Can cause acne
- Can cause hair loss.
- Increased risk of ectopic pregnancy
- Uncertain risk of hypo-oestrogenism
o Needs to be taken regularly and consistently
o No protection against STI’s
o Less effective if over 70kg
o Needs extra precautions with certain drugs
For Anna the first 2 benefits were the ones that were most important; she was looking for a reliable contraceptive method preferably like the COC, that was not contraindicated with focal migraine and with a relatively wide window period. The possibility of amenorrhoea was an advantage to Anna and although she was aware of the other risks or side effects she was not unduly concerned about them.
As a new patient she was referred to the doctor to discuss this option further.
New Learning Experience
I found this particular case very encouraging, as I was able to match up Anna’s requirement to what was available and find a suitable method. Using my communication skills I managed to elicit what factors were important and through a shared approach both Anna and I felt that Cerazette would be the best option.
I felt really happy that I was able to practise my skills from taking Anna’s history as a new patient through to achieving a satisfactory outcome and now I feel more confident in my ability.
last updated 05/06/07
Copyright © Lynda Luke 2006 Lulu 2001-2007
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It is almost 99% effective at preventing pregnancy.
Risks of using Cerazette
Drawbacks to using Cerazette