Family Planning and Contraception
Core concepts
Contraception questions test your knowledge of efficacy, mechanism, side effects, contraindications, and counselling. Know the WHO Medical Eligibility Criteria categories, the difference between typical and perfect use, and the long-acting reversible contraceptives (implants, intrauterine devices) as first-line for many women.
Understand combined hormonal contraception (oestrogen plus progestogen), progestogen-only methods, barrier methods, and emergency contraception. Know the absolute contraindications to combined hormonal contraception (migraine with aura, venous thromboembolism, breast cancer, severe hypertension, smoking over 35). Understand the timing of initiation, the management of missed pills, and the role of emergency contraception (levonorgestrel, ulipristal, copper IUD).
Traps
- Prescribing combined hormonal contraception to a woman with migraine with aura.
- Forgetting that the copper IUD is the most effective emergency contraception.
- Missing that progestogen-only methods require different missed-pill rules.
- Overlooking drug interactions, particularly enzyme inducers.
Worked rule of thumb
For any contraception question, ask: what is the patient's medical eligibility, what is her preference, and what is the typical-use efficacy? The most effective reversible methods are the implant and the IUD; the combined pill is effective with perfect use but less so with typical use. When a woman has a contraindication to oestrogen, choose a progestogen-only or non-hormonal method. The common error is choosing a method by efficacy alone without considering eligibility and preference.
Exam technique
State the method, the eligibility category, and the counselling points. Examiners reward shared decision-making.