Getting contraception right for women in 2012 and beyond Anne Connolly The Ridge Medical Practice.

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

FSRH CHC guidance

‘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