Contraception
Contraception is prescribed free of charge on the NHS and there are many different options. Here are some websites with lots of information on the various options. They include videos on the open clinic website showing the longer acting reversible contraceptives (LARCs). These include the copper coil, hormonal coil and implant which are all offered at Marden Medical Practice:
Please book an appointment with the GP or ANP if you would like to start a form of contraception. If this is a pill, we can issue you with 12 months supply.
There is a new way to take the combined pill (oestrogen and progesterone). Here is some information regarding this:
Continuous Pill Taking:
- For many years the standard way of taking the combined oral contraceptive pill (eg Microgynon) has been to take this daily for 21 days then to have a 7 day break (pill free interval) when you would have a “period” or withdrawal bleed.
- If you take the pill in this way and then also by chance miss 1 or 2 further pills in your pack it can make it more likely for your ovaries to release an egg (ovulate) and increase the chance of you getting pregnant.
- New evidence has emerged saying that the pill is much safer as a contraceptive if you take this more flexibly, using 3 or 4 packs continuously and then have a shorter 4 day break (pill free interval).
What is an “off licence” prescription?
- This new way of prescribing the pill is “off licence”, yet it is supported by medical authorities in the UK and by WHO.
- All medicines have a product licence, which informs doctors which conditions the medicines can be prescribed for patients.
- Sometimes guidance can change from the standard advice, and when this happens doctors are then allowed to prescribe “off-licence” if expert medical opinion says that a medicine can now be safely used in different ways or under different conditions.
Advantages of continuous pill taking
- It’s a more effective way of using the contraceptive pill and you are less likely to become pregnant.
- You don’t have to have regular monthly bleeds to know you are not pregnant.
- By having fewer periods or bleeds you will get fewer related problems like period pain, PMT, migraine and other headaches.
- It’s more flexible – You can choose when it’s convenient to take your 4 day break from pill taking, and when you want to continue to take the pill to avoid a bleed e.g. for holidays and special occasions.
How do I take the pill continuously?
- Start your pill on the correct day of the week (as shown on the strip).
- Take one pill at about the same time each day, at a time that is easy for you to remember.
- Take all the pills in that strip, and then start the next strip without a break.
- Keep taking the strips without a break.
How do I start this pill?
- You can start any pill straight away if you are already on a safe method such as the Implant, Injection or the IUD or IUS.
- If you are not using regular contraception, then you can start taking the pill on the 1st day of your next period.
- If you start the pill at other times in the cycle after the 5th day of your last period, then you will also need to use extra precautions (condoms) for 7 days.
How long can I take the pill continuously?
- Indefinitely – until either you choose another method or a clinician at the surgery advises this.
- Alternatively you can take 3 or 4 packs continuously then to have a 4 day break (pill free interval).
Isn’t it better for me to have “periods” every month?
- The “period” on the pill is completely artificial and is just your womb’s response to stopping your pill for a few days. It is called a “hormone withdrawal bleed”.
- Many women prefer to have fewer bleeds, as it is not necessary to have bleeds every month.
What happens if I get bleeding while taking the pill continuously?
- Irregular bleeding and/or ’spotting’ during the first months of continuous pill-taking can occur, but most women find this becomes acceptable as it lessens over time.
- If at any stage the bleeding becomes unacceptable to you and lasts 3-4 days, you can simply have a pill free interval and stop taking the pill for 4 days. This is called flexible extended use.
- Start taking the pill again on the 5th day, even if you’re still bleeding. This can help manage the bleeding. Restart with the pill marked with the correct day of the week and take at least 21 pills before taking your next break.
- There is no need to contact the surgery first.
- You will not need to use other contraceptive precautions (condoms) unless you have for any reason missed pills in the previous week.
- Having this 4-day break usually works to stop or improve the bleeding, but if it carries on and does not resolve, you should seek advice from the surgery in case you need a check up to exclude other causes of bleeding e.g. Chlamydia.
Managing missed or late pills during continuous use
- You can miss up to 7 pills and still be protected against pregnancy, even if you had sex in that week.
- You will not need emergency contraception.
- Restart your strip of pills straight away as soon as you remember and continue with the next strip without any more breaks in pill taking.
What if I’ve missed 7 or more pills?
- Please contact or attend the surgery as you might need to discuss emergency contraception, as you may be at risk of being pregnant.
- You should then restart the pill and use condoms or abstain from sex for seven days.
- You should do a pregnancy test after 3 weeks.
What if I have vomiting and/or severe diarrhoea?
- If you have had vomiting or diarrhoea in the last 7 days, you will need to use extra precautions (condoms) as this might affect your absorbing pills properly. Continue pill-taking.
- Please contact or attend the surgery to discuss if you need emergency contraception.
How often should I come back for follow up?
- Once you are settled on the pill you usually only need an annual check for any changes to your medical history, family history, drug history or allergies.
- You will need to have your blood pressure and your weight and height measured at this check.
Any other questions?
- If at any other time you have any questions, or have a problem or want to switch methods, please make an appointment with a clinician at the practice for review.
Contraception – Patient Information Leaflets
IUD and IUS – Patient Information
Continuous Pill Taking – Patient Information
Emergency Contraception
If you have unprotected sex or miss a pill then you can obtain emergency contraception from the GUM clinic, your local pharmacy or Marden Medical Practice. This can be effective up to 5 days from the unprotected episode of intercourse. The emergency contraception can be given in tablet form or as a copper coil. The copper coil is the most effective form of emergency contraception and is over 99% effective. Please call the practice and advise us that you require an emergency coil for contraception, and we will aim to fit it as soon as possible.
Further information on your options are here: Emergency contraception: emergency pills and IUD – Contraception – Sexwise
Unplanned Pregnancy
Sexwise has lots of advice regarding unplanned pregnancy. Their website offers support and advice whatever you decide to do. Further information can be found here:
Abortion clinics, Information, Advice and Treatment | BPAS
Sexually Transmitted Diseases
If you are concerned about STDs then please visit your local GUM clinic. Further information can be found here:
If you would prefer to do a home test, this can be arranged at:
SH.UK — Free STI / STD Testing & Reproductive Health
Menopause and HRT
The menopause is your last menstrual period. However, most women think of the menopause as the time of life leading up to, and after, their last period. In reality, your periods don’t just stop. First they tend to become less frequent. It can take several years for a woman to go through the menopause completely. Women are said to have gone through the menopause (be postmenopausal) when they have not had a period at all for one year.
Symptoms can include hot flushes, sweats, tiredness, irritability, vaginal and vulval dryness, aches and pains in the joints, low mood, anxiety and difficulty sleeping.
Information on non-hormonal management of the menopause can be found here:
Alternatives to HRT for symptoms of the menopause | Patient
There are lots of resources about how what to expect with the menopause and hormone replacement therapy (HRT) options:
Menopause Matters, menopausal symptoms, remedies, advice
Balance – Homepage (balance-menopause.com)
menopausesupport.co.uk – Supporting You Through Change
Menopause and Me|Official Website
If you would like to consider starting HRT please make an appointment with the GP. This can be done by telephone if you have an up to date height, weight and blood pressure for us. If not, please book a face to face appointment.
HRT has lots of benefits, but can carry an increased risk of breast cancer. This leaflet explains those risks:
WHC-UnderstandingRisksofBreastCancer-MARCH2017.pdf (thebms.org.uk)
If you are prescribed HRT it can be delivered in various forms. Here are some videos showing how the oestrogen is delivered. If you still have a womb, you will need progesterone to accompany this, which can be given as oral tablets, vaginal tablets or through a mirena coil:
How to apply oestrogen gel: https://youtu.be/Y6DcKLtQ3tM
How to apply oestrogen/oestrogen and progesterone patch: https://www.youtube.com/watch?v=tXGIYWPqdpI
How to apply oestrogen spray: https://www.youtube.com/watch?v=tXGIYWPqdpI
Smear Tests
Cervical screening is done at the GP practice for women and people with a cervix aged 25 to 64 years and should be invited by letter.
Here is some information and a video about how the test is done: Cervical screening – NHS (www.nhs.uk)
It is the best way to protect yourself from cervical cancer so please attend if you are invited or book a telephone appointment with one of our nurses if you have any questions or concerns regarding smear tests.
Breast Screening
The Shropshire Breast Screening Service is part of the National Breast Screening Programme (NHSBSP) and invites around 25,000 local women for screening each year.
Currently, well women aged between 50 and 70, who are registered with a GP Practice in Shropshire and Telford & Wrekin, are screened every three years. The aim of breast screening is to detect breast cancer at an earlier stage, often before the woman is aware of any problem. Early detection may mean simpler and more successful treatment.
When you are eligible for breast screening you will be sent an invite letter in the post and asked to contact the Breast Screening Office to arrange an appointment. Appointments are offered on multiple sites across Shropshire to make the service as widely accessible as possible. Screening appointments are offered on the mobile units and at each hospital site (Royal Shrewsbury Hospital and Princess Royal Hospital); you will be asked about your mobility to ensure an appropriate appointment is offered.
Please do your best to attend this appointment or phone again if it is no longer suitable.
The contact details for the Breast Screening Office are:
- Phone: 01743 261080
- Email: shropshire.breastscreening@nhs.net
Breast Symptoms
Look at your breasts and feel each breast and armpit, and up to your collarbone. You may find it easiest to do this in the shower or bath, by running a soapy hand over each breast and up under each armpit.
You can also look at your breasts in the mirror. Look with your arms by your side and also with them raised.
Please call reception and book an appointment to see a GP or ANP if you notice any of the following:
- a change in the size, outline or shape of your breast
- a change in the look or feel of the skin on your breast, such as puckering or dimpling, a rash or redness
- a new lump, swelling, thickening or bumpy area in one breast or armpit that was not there before
- a discharge of fluid from either of your nipples
- any change in nipple position, such as your nipple being pulled in or pointing differently
- a rash (like eczema), crusting, scaly or itchy skin or redness on or around your nipple
- any discomfort or pain in one breast, particularly if it’s a new pain and does not go away (although pain is only a symptom of breast cancer in rare cases)
