Family Planning
Family planning questions test method choice against the WHO Medical Eligibility Criteria, not memorised brand names.
Effectiveness and counselling
Typical-use failure is highest for fertility awareness and withdrawal, lowest for implants and intrauterine devices. Counsel with a structured sequence: greet, ask, tell, help choose, explain, return. Cover effectiveness, side effects, return to fertility, STI protection and the freedom to switch at any time.
Key rules
- Combined hormonal methods are category 4 with migraine with aura, blood pressure ≥160/100, and smoking 15 or more cigarettes daily at age 35 or older. Breastfeeding under 21 days postpartum is also category 4, and 21 days to six weeks is category 3.
- Progestogen-only implants, injectables and the levonorgestrel IUD suit most women with those conditions.
- Postpartum: an IUD can be inserted immediately after birth or at six weeks; lactational amenorrhoea is reliable only if amenorrhoeic, fully breastfeeding and under six months.
- Enzyme-inducing drugs such as rifampicin and some anticonvulsants reduce hormonal efficacy; recommend an IUD or condoms plus a hormonal method.
Worked example
A 30-year-old, six weeks postpartum and exclusively breastfeeding, has migraine with aura and wants a two-year spacing method. Reasoning: combined pills and the combined ring are category 4 because of the aura. An implant, injectable or levonorgestrel IUD are all suitable; the implant is the most forgettable long-acting option and does not reduce milk supply.
Traps
Forgetting drug interactions; assuming amenorrhoea means infertility; withholding contraception until menses return; and omitting that the copper IUD is also emergency contraception.