getting contraception right for women in 2012 and beyond anne connolly the ridge medical practice
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Getting contraception right for women in 2012 and beyond
Anne ConnollyThe Ridge Medical Practice
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Objectives
Practical issues
New products
New recommendations
New(ish) advice
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Births per 1000 women age 16–19
0 5 10 15 20 25 30 35 40
USA
UK
New Zealand
Ireland
Portugal
Australia
Austria
Spain
Luxemberg
Finland
Greece
Norway
Germany
Belgium
Sweden
France
Switzerland
Denmark
Cyprus
Italy
Netherlands
1. United Nations Population Division 2009
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Teenage pregnancy matters
>40,000 under-18 conceptions in 2008
20% of under-18 conceptions are repeat pregnancies
Babies of teenage mothers have a 60% higher risk of dying in their first year and have a significantly increased risk of living in poverty, achieving less at school and being unemployed in later life
Teenage pregnancy is both a cause and result of exclusion, poverty and inequality
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Rate
per
1,0
00
wom
en
ag
ed
15
–44
Abortion rates in the UK remain high
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Number of abortions is highest in the 20-24 age group
3,718
34,551
55,481
40,800
27,978 27,046
0
10,000
20,000
30,000
40,000
50,000
60,000
under 16 16-19 20-24 25-29 30-34 35+Age
Nu
mb
er
of
ab
ort
ion
s
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Other influences
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Poor marketing!
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Contraceptive choices
3 000 BC crocodile dung pessaries
2 000 BC women drank mercury
Genesis – withdrawal method
1550BC Ebers Papyrus mixed dates, acacia bark, honey on
wool pessary
200AD Soranus suggested jumping backwards 7 times after
SI
Native Americans drank dried beaver testicles
European women in middle ages wore dried weasel testicles
1640 male barriers from fish bladders
Victorians block wood pessary
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‘Doc I want the pill’
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Accidental pregnancy in first year of use – typical use
Trussell J. Contraceptive efficacy. In: Hatcher RA, Trussell J et al. Contraceptive Technology, revised edition 19. NY: Ardent Media, 2007
percent
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Contraceptive use in the UK
percent
Office for National Statistics, 2010
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‘Doc I want the pill’
23 year old
Raynaud’s disease
Wants ‘the pill’
Can she?
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UKMEC
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UKMEC 2009
Raynauds disease CHC POP DMPA IMP Cu-IUD IUS
a) Primary
b) Secondary
i) Without lupus anti-coagulant
ii) With lupus anti-coagulant
1
2
4
1
2
2
1
1
2
1
1
2
1
1
1
1
1
2
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COCPs
Microgynon 30
Ovysmenn
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COCPs
Femodette Femodene Cilest
Microgynon 30
Ovysmenn
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COCPs
Yasmin
Femodette Femodene Cilest
Microgynon 30
Ovysmenn
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Qlaira
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‘Doc I want the pill’
30 year old
Epileptic on
Lamotrigine
Wants ‘the pill’
Can she?
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Drug interactions
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Guidance on antibiotics and contraceptive pill interaction changed
No need to use
extra precautions
when using
antibiotics and
combined hormonal
contraception
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‘Doc I want the pill’
37 year old
lady wants to
restart her ‘pill’
BMI 44
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UKMEC 2009
Obesity CHC POP DMPA Implant Cu-IUD IUS
a) BMI ≥ 30-34
b) BMI ≥ 35
2
3
1
1
1
1
1
1
1
1
1
1
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Can we use Yasmin?
Epidemiological studies have shown that the risk of
VTE for drospirenone COCs is higher than for
levonorgestrel-containing COCs and may be similar
to the risk for COCs that contain desogestrel or
gestodene . The risk of VTE with Yasmin remains
very small and, like other oral contraceptives, is less
than that associated with pregnancy.
MHRA 2011
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VTE/
10,0
00 W
Y
Age
BMI
EURAS results: Impact of age and BMI in VTE incidence in OC users WITHOUT other known risk factors1
26,5
18,914,9 21,1
15,4
7,7
19,9
4,91,7
0
10
20
30
40
50
60
<25 25-39 40+<25
[25-30[
30+
1. EURAS study, data on file
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Missed pill rules If two or more pills are missed (> 48 hours)
take last forgotten pill (may mean taking 2 pills in 1 day) and the next when it is due
continue with the packet of pills use extra precautions for 7 days
If there are less than 7 pills left in the packet
miss hormone free interval and start new packet immediately
use condoms for 7 days
MHRA 2011