Sexual Health and Wellbeing: Learning Experience and Contraception Lecture

Learning Experience on Sexual Health and Wellbeing

Q-1 Describe Your learning or volunteer experience on this module. Some prompt questions to consider:

*Why did you choose this topic? How did it meet your learning needs?

*What was good/bad about the experience? What did you learn from the experience?

*What part of your experience was most challenging or  surprising?

Q-2 Describe why this leaning experience was significant to you as a student nurse. Some prompt questions to consider:

*What about the learning experience made an impact on you? How were you different when you finished this learning experience - have your values, opinions, decisions have been made or changed?

*What broader issues arise from your independent learning - How did the learning experience relate to your other coursework?

*What new skills did you learn - did this learning experience clarify, expand, or create an interest?

Q-3 Describe your next steps – what do you want to do with this new knowledge, where might it take you?. Some prompt questions to consider:

*How will you apply what you learned from your learning experience?

*If you could do the task again, what would you do differently?

*How will your efforts on this task contribute to your career? 

The combined pill contains oestrogen and progestogen and is taken for 21 days after which there is a 7 day break and then the pill is commenced again, during the 7 day break women usually experience a period. You have 24 hours to take your pill, and it is a missed pill if after 24 hours. A woman can miss up to one pill and no extra precautions are needed. If a woman forgets two or more pills then she needs to use extra precautions for 7 days of pills. If there are less than 7 days of pills remaining in the packet she will need to continue with the next packet omitting the Pill free interval and use extra precautions for 7 days. If she has had unprotected sexual intercourse in this time she may need emergency contraception. 

*Reliable and convenient.

*Relieves dysmenorrhoea, premenstrual symptoms.

*Protects against ovarian and endometrial cancer

*Reduces risk of fibroids and ovarian cysts

*Protects against pelvic inflammatory disease

*Needs to be taken carefully according to instructions

*Not suitable for women smoking over the age of 35.

*No protection against HIV and sexually transmitted infections

*Minor side effects such as headaches, breakthrough bleeding

*Slight increased risk of venous thrombosis, high blood pressure, heart disease

*Pregnancy

*Breast-feeding

*Undiagnosed genital tract bleeding

*Past or present severe arterial disease

*Past or present venous thrombosis

*Cardiovascular and ischaemic heart disease

*Severe Lipid disorders

*Focal and Crescendo migraines

*Transient ischaemic attacks

*Present liver disease, liver adenoma or cancer

*Smoker over the age of 35

*Family history of a first-degree relative with arterial or venous disease below age of 45

*Acute Crohn’s disease and ulcerative colitis

*Severe diabetes

*Obesity BMI over 35kg

*Serious medical conditions related to the use of the combined pill or affected by sex steroids e.g. porphyria’s.

*Increased risk of liver cancer, gallstones, cholestatic jaundice

*Increased risk of circulatory disorders, MI, CVA, VTE, hypertension, Hydatidiform mole

*Absolute risk very small of MI, COC does not increase risk if women do not smoke, normal B/P, no family history. Smoking increases risk with COC

-Risk of haemorrhagic stroke very low if under 35, non smoker, normotensive risk not increased by coc. Synergistic effect of COC with increasing age, smoking, hypertension

-Risk of Ischaemic stroke slight increase risk in non smoking, normotensive coc users- Absolute risk 1-3/100 000<35y, 10/100 00 >35y

*Increased by smoking and hypertension, no effect on duration or past use

*Increased risk with women with migraine, and Migraine with aura.

*Independent of risk of ischaemic stroke. Risk associated with migraine with aura greater than migraine without aura. Women on COC with MWA 2 – 4 fold↑ risk of ischaemic stroke compared to woman not on COC without MWA. Avoid COC in migraine without aura if other risk factors for arterial disease (smoking, obesity, diabetes etc).

*Incidence of VTE with 2^ndgeneration preparations = 5 – 7 /10 000 per year

*Incidence of VTE with 3^rdgeneration preparations = 9 - 12/10 000 per year

*Incidence of VTE in non pregnant non COC women = 2/10 000 per year

*Incidence in healthy pregnant women = 60 /100 000 pregnancies

*Risks of VTE are: -Higher dose of oestrogen, obesity, increasing age, immobility, and predisposition – prothrombotic disease

- There is no definitive research on the risk of breast cancer and combined contraception.  Studies in 2002 and 2006 by the United States Centre’s for Disease Control showed no increased COC related risk; however going on worst available case scenario would be the 1996 Collaborative Group study. Collaborative Group 1996.