The endometrium undergoes a series of well-recognised cycles of proliferation, differentiation and tissue breakdown on a monthly basis, in response to exposure to the circulating sex steroids oestrogen and progesterone.
Renewed publicity about the risk of venous thromboembolism (VTE) with combined hormonal contraception (CHC) may encourage busy GPs to prescribe progesterone-only pills to women declining long-acting reversible contraception (LARC). This article aims to put the bad press into context, outline the lifestyle and long-term health benefits of the combined methods, and offer advice about which CHC might suit which client.
The most effective contraceptive is the one that the woman seated opposite you will use. Women are more likely to adhere to contraception when they have been actively involved in choosing the method. This choice is influenced by the patient’s values and beliefs, which are in turn informed by her religious or cultural background. Awareness of these influences helps us to better understand and facilitate patient choice.
Although there is a natural fall in fertility with age, women still need reliable contraception to avoid unintended pregnancies during the perimenopause. No contraceptive method is contraindicated by age alone, but women must be individually assessed, based on the risks and benefits of each method.
Despite a recent decline, the UK still has the highest rate of teenage pregnancy in Western Europe. Young women themselves explain why, although access to contraception is relatively easy in theory, they find it difficult in practice to overcome the many barriers to its successful use.