Posted in Contraception, Physiology, Sexual Health, Uncategorized, Women's Health

Contraception – the basics

This is one of the most common tutorial topics. Why? Because there’s so much to know, it’s a common reason for women consulting, and it’s something that we don’t spend much time thinking about during our hospital jobs – even Obstetrics and Gynaecology posts!

It’s daunting because there are so many options, and so many situations. Who can have what, and when? What are the side effects? How should it be used?

I am not going to talk about all the methods in-depth here. I thought I would start with a quick overview of the options available, and a fact or two about each to get us started. My knowledge is derived from the Faculty of Sexual and Reproductive Healthcare (FSRH) guidance and the online learning modules that comprise the DFSRH.

One thing I like to do when learning is relate clinical knowledge back to anatomy and physiology. I find that by doing this, things just make sense, and tend to stick in my mind better. So you might notice that this post relates back to the physiology of the menstrual cycle!

So what’s available?

Barrier Methods:

  • Male or female condoms
  • Diaphragms
  • Caps

I’m not going to discuss barrier methods any further!

Combined Hormonal Contraception (CHC):

  • Pills
  • Patch
  • Ring

Progesterone only methods:

  • Pills
  • Injection
  • Implant
  • IUS

Non- hormonal:

  • Copper IUD

You can see why it’s so confusing for both the patient, and the doctor! Within these methods – there are so many brands!

But who are the main players, where hormones are concerned, in the reproductive cycle?

Well we need FSH and LH release from the pituitary gland. These hormones are working on the ovaries to ensure maturation of oocytes occurs over the cycle, and to facilitate the release of one each month. As this is occurring there are changes occurring within the uterus to prepare for potential implantation, and subsequent pregnancy.

Feedback cycle

Why is it useful to know this physiology? Because it lets us work out how the different contraceptions might be working to prevent pregnancy, and how they may impact upon the woman’s bleeding patterns.

The cycle - a rough guide!

Thus, progesterone within combined hormonal contraception (CHC) impacts upon the feedback cycle of these hormones to eventually prevent the mid-cycle LH surge, along with it’s affects on cervical mucus. Oestrogen within CHC is acting upon the endometrium, and preventing follicular development.

Progesterone only methods are slightly more complex, because it depends a little on the specific progesterone, and how it’s given, as to how exactly it affects the cycle:

  • The injection suppresses ovulation
  • The progesterone only pill’s (POP) main action is via effects on cervical mucus, but may or may not suppress ovulation (desogestrel, found in brands such as Cerazette and Cerelle, suppresses ovulation in approximately 97% of cycles)
  • The implant often suppresses ovulation but this is not absolute, and certainly not towards the end of the 3 years.
  • Progesterone emergency contraception prevents the LH surge thus arresting follicular development and delaying ovulation
  • The IUS (e.g. Mirena) has it’s greatest effects on the endometrium and thickening of cervical mucus. It inhibits proliferation of the endometrium, thus making it thin and atrophic.

The Copper IUD, as a non-hormonal method, works by producing a foreign body reaction. It can also affect endometrial enzymes, and copper has a direct toxic effect on sperm and ova. It’s primary mechanism of action is the prevention of fertilisation. However, it can be used as an emergency contraception to prevent implantation.

With perfect use, all methods of hormonal contraception are very effective at preventing pregnancy. However, methods that require patient action (pills and the injection) tend to have higher pregnancy rates, and greater discrepancy in typical versus perfect use. The most effective method at preventing pregnancy is the implant. The Mirena IUS and the implant have a greater impact upon pregnancy prevention that female sterilisation.

That was an initial introduction to contraception. It gives you an idea of whats out there, how they work and how they link into the physiology of the menstrual cycle.

There is much more to know, in order to allow women to make informed choices, and help us consider what might be right, and safe, for the woman.

Let me know if you have any thoughts on the above – and through your comments give me an idea of where we should move on to next within the subject of contraception.

Posted in Administration, ARCP, eportfolio, ESR, MRCGP, PDP, Uncategorized

A smart PDP

I attended a joint trainer and trainee meeting, and the focus of the afternoon was how to develop and keep an active PDP during your training and beyond.

I thought I’d share some learning from this because I know that this is not the best part of my appraisal process, and an area that I have spent very little time thinking about previously.

This session really helped change my thinking and knowledge of the process.

What is a PDP?

It’s a personal development plan. It’s a way of showing your supervisor that you are considering your learning needs and how you plan to meet these needs. This is by setting an action plan that details what you will do to address this learning need, how you will evidence that this has been completed, and a timeframe for this learning.

Why is it important I hear you ask……

……because we are learning all the time. A good PDP will focus your learning, and allow you to prioritise your time and learning needs. There is large amount to cover during GP training, and it’s going to seem daunting at times. So setting some aims and making plans might just make it a little easier.

Also, being MRCGP focussed, apparently some ARCPs have flagged up a poor PDP, or with nothing ‘active’ within it. This has held up some trainees’ progress to certification. In addition, the PDP you have at the end of GP training will form your PDP for your on-going appraisal process. Having an active PDP is mandatory for appraisals, and completed appraisals, are mandatory for revalidation.

How do I get started?

Firstly, how many entries should we have on our PDP? The golden number is three, however you may more or less! You need enough to show you’re addressing your learning needs, but not so many that you cannot keep up with the learning. Some might be more straightforward than others, and some more complex. Some may have a relatively short time frame, and some longer.

What shall I include?

This is where it gets difficult. It’s a ‘personal’ development plan. So you are the only person that can answer this. You need to look at your learning needs (lets talk about learning needs assessment/analysis another time). Perhaps they will relate to the current job you’re undertaking. They may relate to where in your training you are. For example, if you are preparing for AKT they may be related to knowledge development, or preparing for the CSA they’ll perhaps be more specific to consultation skills. They might be related to developing an interest you have, or managing your work life balance. If you can justify the reason for including it at this time, then go for it.

Creating the perfect PDP item

It needs to be ‘SMART’

S – specific

M – measurable

A – attainable

R – realistic and relevant

T – timescale

I’m going to use an example from my current appraisal, which I have now refined to reflect the above learning! I think if I use an example to talk through it, it will make more sense.

Specific – ‘To become accredited as a full trainer’. This is a specific aim, as opposed to something along the lines of ‘develop my training skills further’. The latter could include anything, and doesn’t necessarily have an end point, whereas the former has a defined end point.

Measurable – I can evidence that this has been completed via being approved as a full trainer. I can link to areas in my learning log that show the things I have done to support and facilitate my application.

Attainable – Can I get this done? Well I know there is a trainer panel in February time. I have been attending the right meetings, and undertaking the appropriate work in anticipation of this, so it is definitely possible!

Realistic and relevant – The work I need to complete to achieve this is already part of my workload, so I am not adding more work to my plate. I do need to factor in some time to complete the paperwork though. It is relevant, because we have an ST3 currently, and without being a full trainer I cannot be a named supervisor for an ST3, which I would really like in order to further my position within the practice where training is concerned.

Timescale – Well I shall aim for the end of March, as this gives me time to complete the application, attend the panel and hopefully receive confirmation that this has been achieved!

By laying out the objective like this I have focussed my learning, I know what I need to do, and I am telling whoever’s reading it what I’m going to do and how.

I have added a link to a good RCGP document on completing a PDP, with some good examples of real PDP entries, and what makes them work well or not so well. Follow this link and then click on the PDP pdf.

Why don’t you sit and write a PDP entry now and see if it’s a bit easier. Feel free to share some ideas or ask questions in the comment sections below!

Posted in Administration, MRCGP, Uncategorized


This is a blog I have set up to share information about GP training with trainees. It might be or interest to trainers and fellow GP colleagues also.

I have been a trainee. Sometimes you just don’t find the answer you’re looking for about how to get things done. Sometimes you just need a snippet of information rather than a whole essay. Sometimes you’re just thinking ‘how do I explain this to a patient’.

I’m going to try and help! This is new for me, and I’m going to figure out what to add in as I go along. That’s where I need my readers’ help and interaction – If you give me ideas, based on what will help you I will shape this to meet your needs!

I’m an associate trainer, and I do weekly tutorials with my trainees’. I will take some inspiration from what they suggest as topics, and share some of these with you too.

I also hope it’s a place for support – if you work with me and use the comments section to share ideas, tips and thoughts, it develops a network of trainees beyond your local area potentially.

The only thing I wont be doing, and I really don’t want you to do, is put anything that is patient specific on here. Any ‘cases’ I use for learning will be ones that are made up. They will be those patients that make the ‘perfect’ CSA case, or ones that allow us to consider and practice our communication skills. They are often the brainchild of active imagination that I bring to role-plays – I do have an A* in GCSE drama don’t you know!!