Getting contraception
right for women in 2012
and beyond
Anne Connolly
The Ridge Medical Practice
Objectives

Practical issues

New products

New recommendations

New(ish) advice
Births per 1000 women age 16–19
Netherlands
Italy
Cyprus
Denmark
Switzerland
France
Sweden
Belgium
Germany
Norway
Greece
Finland
Luxemberg
Spain
Austria
Australia
Portugal
Ireland
New Zealand
UK
USA
0
1.
5
United Nations Population Division 2009
10
15
20
25
30
35
40
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 1,000 women
aged 15–44
Abortion rates in the UK remain high
Number of abortions is highest in the
20-24 age group
60,000
55,481
50,000
40,800
Number of abortions
40,000
34,551
30,000
27,978
27,046
30-34
35+
20,000
10,000
3,718
0
under 16
16-19
20-24
Age
25-29
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
percent
Trussell J. Contraceptive efficacy. In: Hatcher RA, Trussell J et al. Contraceptive Technology, revised edition 19. NY: Ardent Media, 2007
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
1
1
1
1
1
1
Without
lupus anticoagulant
2
2
1
1
1
1
ii) With lupus
anticoagulant
4
2
2
2
1
2
a) Primary
b) Secondary
i)
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
2
1
1
1
1
1
b) BMI ≥ 35
3
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
EURAS results: Impact of age and BMI in VTE
incidence in OC users WITHOUT other known
risk factors1
60
40
26,5
30
18,9
21,1
14,9
15,4
7,7
30+
4,9
0
<25
<25
25-39
Age
1. EURAS study, data on file
20
10
1,7
[25-30[
BMI
19,9
40+
VTE/10,000 WY
50
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