Getting contraception right for women in 2012 and beyond
Anne ConnollyThe Ridge Medical Practice
Objectives
Practical issues
New products
New recommendations
New(ish) advice
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
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
Rate
per
1,0
00
wom
en
ag
ed
15
–44
Abortion rates in the UK remain high
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
Other influences
Poor marketing!
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
‘Doc I want the pill’
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
Contraceptive use in the UK
percent
Office for National Statistics, 2010
‘Doc I want the pill’
23 year old
Raynaud’s disease
Wants ‘the pill’
Can she?
UKMEC
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
COCPs
Microgynon 30
Ovysmenn
COCPs
Femodette Femodene Cilest
Microgynon 30
Ovysmenn
COCPs
Yasmin
Femodette Femodene Cilest
Microgynon 30
Ovysmenn
Qlaira
‘Doc I want the pill’
30 year old
Epileptic on
Lamotrigine
Wants ‘the pill’
Can she?
Drug interactions
Guidance on antibiotics and contraceptive pill interaction changed
No need to use
extra precautions
when using
antibiotics and
combined hormonal
contraception
‘Doc I want the pill’
37 year old
lady wants to
restart her ‘pill’
BMI 44
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
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
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
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