Hawkins D M, Booth R
J R Nav Med Serv. 2014;100(3):321-7.
The right to make an informed choice about contraception should be afforded to every individual serving within the United Kingdom (UK) Armed Forces. This article looks at the responsibilities and approach that healthcare professionals should take within a Primary Care setting, summarises the common contraceptive options available, discusses the associated advantages and disadvantages of each technique, and considers operational factors in a military environment that combine to influence the final contraceptive choice an individual makes. Case Study. A 19-year old Able Rate joined the Royal Navy (RN) and at her joining medical it was noted that she had been on Microgynon™ combined oral contraceptive pill for approximately three years. During this time, her menstrual periods remained light; she never experienced adverse effects, demonstrated good compliance, and was happy to remain on this contraceptive regimen. Over the course of the next eighteen months, she was reviewed by a number of Medical Officers and Civilian Medical Practitioners on a quarterly basis, with Microgynon™ re-prescribed on each occasion. The appropriate Defence Medical Information Capability Programme (DMICP) template was used, with weight, smoking status, compliance and any issues or comments documented accordingly. In December 2010, a discussion regarding long-acting reversible contraception (LARC) was documented for the first time. The patient agreed to give LARC some thought and a review appointment was made for one month. She was subsequently started on the progestogen-only pill Cerazette™. It was noted by the consulting doctor that both the patient's mother and grandmother had a positive history of cerebrovascular events and the combined oral contraceptive pill was discontinued. Upon review at two months, the patient reported that she was content on Cerazette™ and wished to continue with this medication. She was amenorrhoeic, highly compliant, had given up smoking and her weight and blood pressure were stable. However, due to supply issues, it was explained that Cerazette™ was no longer a viable option for her. She had no plans to start a family, and was keen to investigate other contraceptive options. Furthermore, she expressed a particular desire to remain amenorrhoeic, as she was due to deploy overseas in the coming months, and not only wanted to avoid the inconvenience of having her period, but also felt it preferable not to have to take a daily pill when considering the constantly changing time zones. She subsequently had the etonogestrel-releasing subdermal implant Nexplanon™ fitted without complication. She has remained amenorrhoeic throughout and this form of long-acting reversible contraception has particularly suited her busy working role and active lifestyle.
英国武装部队中的每一个人都应享有就避孕措施做出明智选择的权利。本文探讨了医疗保健专业人员在初级保健环境中应承担的责任和采取的方法，总结了现有的常见避孕选择，讨论了每种技术的相关优缺点，并考虑了军事环境中综合影响个人最终避孕选择的操作因素。案例研究。一名19岁的一等水兵加入了皇家海军，在入伍体检时发现她服用复方短效口服避孕药妈富隆™约三年。在此期间，她的月经量一直很少；从未出现过不良反应，服药依从性良好，并且乐于继续采用这种避孕方案。在接下来的18个月里，多名军医和民间医生每季度对她进行复查，每次都重新开妈富隆™的药方。使用了适当的国防医疗信息能力计划（DMICP）模板，记录了体重、吸烟状况、服药依从性以及任何问题或意见。2010年12月，首次记录了关于长效可逆避孕法（LARC）的讨论。患者同意考虑长效可逆避孕法，并预约了一个月后的复查。随后她开始服用仅含孕激素的避孕药思悦™。咨询医生注意到患者的母亲和祖母都有脑血管事件的阳性病史，因此停用了复方口服避孕药。两个月后复查时，患者报告说她对思悦™很满意，并希望继续服用这种药物。她闭经，服药依从性高，已戒烟，体重和血压稳定。然而，由于供应问题，被告知思悦™对她来说不再是可行的选择。她没有生育计划，并且热衷于研究其他避孕选择。此外，她特别希望保持闭经状态，因为她将在未来几个月部署到海外，不仅想避免月经带来的不便，而且考虑到时区不断变化，觉得不必每天服药会更好。她随后植入了释放依托孕烯皮下埋植剂依伴侬™，没有出现并发症。她一直保持闭经状态，这种长效可逆避孕方法特别适合她繁忙的工作和积极的生活方式。
