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Prescribing contraception is a core part of primary care practice. Download complete contraception series. This article is the first in a series on prescribing contraceptives in primary care. For further information on specific contraceptive methods, see the accompanying articles in this series:. Patients may find discussing contraception and the prevention of sexually transmitted infections STIs a sensitive or awkward topic, as it touches on issues such as their cme binary options and sexual practices, cme binary options, as well as relationship issues and their future plans for children.
In addition, their views and behaviours can be influenced by social, family, religious or cultural factors. However, cme binary options, there is much to be gained and little to be lost when patients and healthcare providers have open discussions about contraception and prevention of STIs. The goal of counselling patients about contraception is to ensure they are using a safe, effective option which is the most appropriate for their clinical needs and preferences. The most commonly used form of contraception in New Zealand is the oral contraceptive pill.
Depending on co-morbidities, cme binary options, other prescribed medicines or recent pregnancy, some options may be inappropriate due to a high risk of adverse effects Table 1. Patients may base their preference for a contraceptive method on factors such as effectiveness Table 2adverse effects and risks, ease of use, future pregnancy plans, cost, or particular symptoms they wish to manage.
For example, some people may want greater cycle control, relief from menstrual pain or heavy menstrual bleeding, while others may be concerned about age-related adverse effects, such as venous thromboembolism. Patients can cease using contraceptives at age 55 years, as pregnancy is very rare beyond this age even if they continue menstruating, cme binary options.
for two years after the onset of amenorrhoea. Conventionally, IUDs were most commonly used by women who had completed their families and wished to have a long-term form of contraception.
There was some resistance to the idea that an IUD could cme binary options an appropriate contraceptive option for younger women and those who had not yet given birth, due to concerns such as ease of insertion. However, there is no clinical basis for this concern, and an IUD should be considered as an appropriate option for almost anyone.
Some clinicians may be less familiar with this method as they do not have experience in placing the implants, but the procedure can be easily learned. Use of a long-acting reversible contraceptive LARC is associated with a much lower rate of unintended pregnancy, compared to shorter-acting methods such as oral contraceptives or DMPA injections.
The additional appointment time and repeat visits, or visits to another provider, required for initiating a LARC can be a barrier to patients in terms of convenience and cost. by having a clinical staff member trained in insertion and removal techniques, and having a supply of LARC at the practice implants and copper IUDs are available on PSO; levonorgestrel IUDs are not. Some PHOs may also offer funding for sexual health or contraception-related consultations; enquire with your PHO.
Funding for insertions may be available for some women through their local DHB or PHO. Information will be updated as more details emerge or check the Ministry of Health website. Combined oral contraceptive COC pills were first introduced in New Zealand in the s. They were formulated to mimic the natural menstrual cycle, with cme binary options weeks of active hormone tablets followed by one week of placebo tablets at which time a withdrawal bleed usually occurs.
However, there is no medical basis for this withdrawal bleed and COC users can be reassured that skipping the hormone-free interval is safe, and is in fact now recommended. compared with missing pills in the first week of a conventional regimen, thereby extending the cme binary options interval. In addition, bleeding-related adverse effects, such as headache, bloating and abdominal pain, can be avoided, which is likely to improve satisfaction and adherence with this method of contraception.
If contraception is required after childbirth, any of the available options can be given from six weeks post-partum, including COCs; 12 progestogen-only pills, injections or implants can be used prior to six weeks and IUDs can either be inserted immediately post-partum or after four weeks Table 1. It was previously recommended that COCs be avoided for the first six months post-partum cme binary options breastfeeding due to potential suppressive effects of ethinylestradiol on milk supply, cme binary options.
Cme binary options the data on COC use and breastfeeding are limited and conflicting, better quality studies investigating breastfeeding performance, i, cme binary options.
The lactational amenorrhoea method is an effective form of contraception if less than six months post-partum, amenorrhoeic and fully breastfeeding. This method should cme binary options be relied on if the frequency of breastfeeding decreases, e. night feeds stopped, supplemental foods started, cme binary options, if menstruation returns or if the patient is more than six months post-partum.
Tables 1 and 2 can be used to decide, together with the patient, which types of contraception may be the most appropriate cme binary options them; detailed information on each option is available in the accompanying articles in this series:.
Table 1: Recommendations regarding the likely benefits and risks of different contraceptive options. Adapted from the World Health Organization, Centers for Disease Control and Prevention and Faculty of Sexual and Reproductive Healthcare 4, 14, cme binary options, Benefits are likely to outweigh risks Risks may outweigh benefits for some patients, see footnotes for details Not recommended, risks are likely to outweigh benefits.
Table 2: Effectiveness of different contraceptive methods and rates of continuation after one year. Adapted from the Faculty of Sexual and Reproductive Healthcare, cme binary options, United Kingdom 16— Typical use is when contraception is not always used consistently or correctly, e. forgetting to take a dose of medicine, condom applied incorrectly, cme binary options.
Diaphragms may be available unsubsidised at some pharmacies, cme binary options. If patients already have a diaphragm they wish to keep using, support is available from Family Planning: www. Female to male transgender or gender diverse patients may require contraception, unless they have undergone surgical procedures which result in infertility.
Gender affirming hormone treatment should not be relied on as a method of contraception as pregnancies can still occur in female to male transgender patients using testosterone; discussion with an endocrinologist involved in cme binary options patients care is recommended. DMPA injections, progestogen implant, or copper or progestogen IUDs may be preferred options as they do not interfere with the process of masculinisation, however, IUD insertion may be more difficult than in other patients due to cme binary options atrophy associated with testosterone treatment.
The use of fertility awareness or withdrawal methods to prevent conception may be preferred by people who wish to avoid other methods of contraception for religious or personal reasons. However, with typical use approximately one-quarter of people relying on these methods become pregnant within one year. Fertility awareness methods rely on monitoring markers of fertility daily, cme binary options, including body temperature, changes in cervical secretions, changes in the cervix and timing of menstruation.
Combining multiple markers is more effective than relying on a single marker. Learning the technique can be difficult and is more complicated if patients have irregular cycles. Further information for patients about using fertility awareness methods is available from: www. Emergency contraception should be considered for patients who have had unprotected sex: Two forms of fully subsidised emergency contraception are available in New Zealand Table 3.
The levonorgestrel tablet is slightly less effective than the copper IUD, however, it does not require an insertion procedure and may be more convenient for patients as it is available at pharmacies without a prescription. The copper IUD should be considered as an option whenever emergency contraception is needed, as it is the most effective method of emergency contraception and effectiveness is not altered by BMI or the use of enzyme-inducing medicines.
The cme binary options IUD can be left in place for ongoing contraception, or removed once pregnancy is excluded, e, cme binary options. at the next menstrual period. After use of levonorgestrel emergency contraception, patients should expect a change in menstruation, typically occurring earlier and heavier than expected.
Some evidence suggests that if levonorgestrel emergency contraception fails there may be a higher risk of ectopic pregnancy, however, this has not been consistently observed in studies and the absolute rate is very low, cme binary options. Discussion about cme binary options should cover issues such as life stage, future plans and relationship stability and ensure that both partners have an opportunity to express any questions or concerns.
Information should be provided on other contraceptive options for the female partner that would offer a similar level of effectiveness, such as an implant or IUD; also consider if the patient has a history of menstrual difficulties cme binary options may reoccur when their current contraceptive is stopped, and menstruation resumes after sterilisation.
Sterilisation options include vasectomy and tubal ligation or occlusion. Tubal ligation or occlusion is carried out by laparoscopy or laparotomy and is typically performed under general cme binary options. Vasectomy is typically performed with a local anaesthetic.
Some patients may be eligible for a sterilisation procedure performed in the public health system, however, most patients will need to seek private treatment. Vasectomies are also performed in some primary care clinics. Some patients may be eligible for assistance from Work and Income WINZ to assist with the cost of a vasectomy see: www.
Sterilisation options are not intended to be reversed. Reversal procedures may be possible, depending on the technique used, cme binary options, but are more complex than the initial sterilisation procedure and may not be successful.
A quiz is available that is related to this article, cme binary options. Do Quiz. Quizzes are endorsed by The Royal New Zealand College of General Practitioners RNZCGP for allocation of Maintenance of Professional Standards MOPS credits, and equate to one hour of Continuing Medical Education CME activity for General Practitioners. Your details are sent to the RNZCGP for allocation of credits after completing a quiz. The MOPS online page is updated periodically, so there will be a delay between completing a quiz and your CME "showing up".
An indicator at the top of the review page will show whether the RNZCGP has been notified. Thank you to Dr Beth MessengerNational Medical Advisor, Family Planning New Zealand for expert review of this article. What's changed? If you would like to know what changes were made when the article was updated please contact us.
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If someone adds cme binary options reply to one of your comments or replies you will recieve an email notifying you of this. You can opt out of or into if currently out all comment notification cme binary options by clicking the cme binary options below. Made with by the bpac nz team. Prescribing Reports. CME Quizzes. Peer Group Discussions. My Bpac cme binary options. Search Mybpac - Login. Latest Articles View Articles.
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/05/06 · CME June 25th Options Begin Trading Stock Options Channel Staff - Thursday, May 6, PM. Investors in CME Group saw new options begin trading today, for the June 25th expiration. At Stock Options Channel, our YieldBoost formula has looked up and down the CME options chain for the new June 25th contracts and identified one put and one call contract of particular interest CME Group is the world's leading and most diverse derivatives marketplace. The company is comprised of four Designated Contract Markets (DCMs). Further information on each exchange's rules and product listings can be found by clicking on the links to CME, CBOT, NYMEX and COMEX In finance, an option is a contract which conveys its owner, the holder, the right, but not the obligation, to buy or sell an underlying asset or instrument at a specified strike price prior to or on a specified date, depending on the form of the blogger.coms are typically acquired by purchase, as a form of compensation, or as part of a complex financial transaction
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